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. 2021 Aug 23;10(8):1025.
doi: 10.3390/antibiotics10081025.

Dispensing Antibiotics without Prescription at Community Pharmacies and Accredited Drug Dispensing Outlets in Tanzania: A Cross-Sectional Study

Pendo M Ndaki  1 , Martha F Mushi  2 , Joseph R Mwanga  1 , Eveline T Konje  1 , Nyanda E Ntinginya  3 , Blandina T Mmbaga  4 , Katherine Keenan  5 , Wilber Sabiiti  6 , Mike Kesby  5 , Fernando Benitez-Paez  5 , Alison Sandeman  6 , Matthew T G Holden  6 , Stephen E Mshana  2 , Hatua Consortium
Affiliations

Dispensing Antibiotics without Prescription at Community Pharmacies and Accredited Drug Dispensing Outlets in Tanzania: A Cross-Sectional Study

Pendo M Ndaki et al. Antibiotics (Basel). .

Abstract

Worldwide, antimicrobial resistance is increasing rapidly and is associated with misuse of antimicrobials. The HATUA study (a broader 3-country study) investigated the antibiotic dispensing practices of pharmaceutical providers to clients, particularly the propensity to dispense without prescription. A cross-sectional study using a 'mystery client' method was conducted in 1148 community pharmacies and accredited drugs dispensing outlets (ADDO) in Mwanza (n = 612), Mbeya (n = 304) and Kilimanjaro (n = 232) in Tanzania. Mystery clients asked directly for amoxicillin, had no prescription to present, did not discuss symptoms unless asked [when asked reported UTI-like symptoms] and attempted to buy a half course. Dispensing of amoxicillin without prescription was common [88.2, 95%CI 86.3-89.9%], across all three regions. Furthermore, the majority of outlets sold a half course of amoxicillin without prescription: Mwanza (98%), Mbeya (99%) and Kilimanjaro (98%). Generally, most providers in all three regions dispensed amoxicillin on demand, without asking the client any questions, with significant variations among regions [p-value = 0.003]. In Mbeya and Kilimanjaro, providers in ADDOs were more likely to do this than those in pharmacies but no difference was observed in Mwanza. While the Tanzanian government has laws, regulations and guidelines that prohibit antibiotic dispensing without prescription, our study suggests non-compliance by drug providers. Enforcement, surveillance, and the provision of continuing education on dispensing practices is recommended, particularly for ADDO providers.

Keywords: antibiotic; antibiotic resistance; dispensing practice; prescription.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Location of our three study areas within Tanzania.
Figure 2
Figure 2
Geographical distribution of ADDOs, pharmacies and other drug providers mapped in the three study areas. ADDOs and pharmacies were surveyed in the mystery client study.
Figure 3
Figure 3
Proportion of sellers dispensing without prescription, according to types of outlets across three regions.
Figure 4
Figure 4
Location of outlets dispensing amoxicillin without prescription in three regions.
See this image and copyright information in PMC

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