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International Journal of Clinical Pharmacy

, Volume 39, Issue 5, pp 1110–1118 | Cite as

Perspectives of pharmacy staff on dispensing subtherapeutic doses of antibiotics: a theory informed qualitative study

  • Mohamed Ezzat Khamis AminEmail author
  • Amira Amine
  • Mohammad Shoukry Newegy
Research Article
First Online:
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Abstract

Background Injudicious dispensing of antibiotics in subtherapeutic doses is common in many developing countries. In Egypt, as in many developing countries, a few pills of common cold products are offered under the name cold group (CG). A cold group may contain one or more pills of antibiotics. A pharmacy client may obtain subtherapeutic doses of antibiotics upon direct request or as part of a CG. Objective To examine factors associated with the unwarranted dispensing of subtherapeutic doses of antibiotics in community pharmacies as part of a CG or upon direct request from patients among community pharmacy staff. Setting Community pharmacy staff in Alexandria, Egypt. Methods Semi-structured interviews were conducted with a purposeful sample of community pharmacy staff. An interview guide was developed based on the theory of planned behavior. Constructs related to attitudes, subjective norm, perceived behavioral control and perceived moral obligation were explored. Directed content analysis was conducted using interview data which were recorded and transcribed verbatim. Main outcome measures Community pharmacy staff’s views on factors associated with the unwarranted dispensing of subtherapeutic doses of antibiotics. Results Nine Pharmacists and six pharmacy assistants were purposively sampled to assure variance in age, gender, time in practice and socioeconomic status of patients served by their corresponding pharmacies. Factors contributing to dispensing antibiotics injudiciously included incorrect beliefs about potential benefit of antibiotics, profit, client pressure, ease of obtaining antibiotics from other pharmacies, inadequate enforcement of the law, pharmacist absenteeism, and assuming that the ‘nonmalfeasance’ principle is not violated. Reasons for lying to clients about the actual content of CGs included protecting the patient from harm resulting from antibiotic resistance and avoiding a possible argument. Conclusions Examining constructs related to pharmacy staff’s attitude, subjective norm, perceived behavioral control as well as perceived moral obligation provided insight into community pharmacy staff’s behavior related to dispensing subtherapeutic doses of antibiotics. Multi-tiered interventions are urgently needed to tackle different factors contributing to this dangerous practice.

Keywords

Antibiotics Antimicrobial resistance Drug dispensing Egypt OTC Pharmacy assistant Pharmacist Theory of planned behavior 
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Notes

Acknowledgements

The authors are thankful for pharmacists and pharmacy assistants who participated in this study.

Funding

This research received no financial support.

Conflicts of interest

The author declares no conflict of interest.

References

  1. 1.
    Dua V, Kunin CM, White LV. The use of antimicrobial drugs in Nagpur, India. A window on medical care in a developing country. Soc Sci Med. 1994;38(5):717–24.CrossRefPubMedGoogle Scholar
  2. 2.
    Kagashe GA, Minzi O, Matowe L. An assessment of dispensing practices in private pharmacies in Dar-es-Salaam, Tanzania. Int J Pharm Pract. 2011;19(1):30–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Nyazema N, Viberg N, Khoza S, Vyas S, Kumaranayake L, Tomson G, et al. Low sale of antibiotics without prescription: a cross-sectional study in Zimbabwean private pharmacies. J Antimicrob Chemother. 2007;59(4):718–26.CrossRefPubMedGoogle Scholar
  4. 4.
    Volpato DE, de Souza BV, Dalla Rosa LG, Melo LH, Daudt CA, Deboni L. Use of antibiotics without medical prescription. Braz J Infect Dis. 2005;9(4):288–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Wolffers I. Drug information and sale practices in some pharmacies of Colombo, Sri Lanka. Soc Sci Med. 1987;25(3):319–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Grigoryan L, Haaijer-Ruskamp FM, Burgerhof JG, Mechtler R, Deschepper R, Tambic-Andrasevic A, et al. Self-medication with antimicrobial drugs in Europe. Emerg Infect Dis. 2006;12(3):452–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Igun UA. Reported and actual prescription of oral rehydration therapy for childhood diarrhoeas by retail pharmacists in Nigeria. Soc Sci Med. 1994;39(6):797–806.CrossRefPubMedGoogle Scholar
  8. 8.
    Zapata-Cachafeiro M, González-González C, Váquez-Lago JM, López-Vázquez P, López-Durán A, Smyth E, et al. Determinants of antibiotic dispensing without a medical prescription: a cross-sectional study in the north of Spain. J Antimicrob Chemother. 2014;69(11):3156–60.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Calva J, Bojalil R. Antibiotic use in a periurban community in Mexico: a household and drugstore survey. Soc Sci Med. 1996;42(8):1121–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Hadi U, van den Broek P, Kolopaking EP, Zairina N, Gardjito W, Gyssens IC. Cross-sectional study of availability and pharmaceutical quality of antibiotics requested with or without prescription (Over The Counter) in Surabaya, Indonesia. BMC Infect Dis. 2010;10:203.Google Scholar
  11. 11.
    Indalo A. Antibiotic sale behaviour in Nairobi: a contributing factor to antimicrobial drug resistance. East Afr Med J. 1997;74(3):171–3.PubMedGoogle Scholar
  12. 12.
    Amin ME, Amine A, Newegy MS. Injudicious provision of subtherapeutic doses of antibiotics in community pharmacies. Inov Pharm. 2017;8(1): Article 18.Google Scholar
  13. 13.
    Amin ME, Chewning BA. Pharmacies without pharmacists: absenteeism plagues pharmacies in developing countries. Res Social Adm Pharm. 2017;13(2):400–1.CrossRefGoogle Scholar
  14. 14.
    Taher A, Stuart EW, Hegazy I. The pharmacist’s role in the Egyptian pharmaceutical market. Int J Pharm Healthc Mark. 2012;6(2):140–55.CrossRefGoogle Scholar
  15. 15.
    Sabry NA, Farid SF, Dawoud DM. Antibiotic dispensing in Egyptian community pharmacies: an observational study. Res Soc Adm Pharm. 2014;10(1):168–84.CrossRefGoogle Scholar
  16. 16.
    Kotwani A, Wattal C, Joshi PC, Holloway K. Irrational use of antibiotics and role of the pharmacist: an insight from a qualitative study in New Delhi, India. J Clin Pharm Ther. 2012;37(3):308–12.CrossRefPubMedGoogle Scholar
  17. 17.
    Roque F, Soares S, Breitenfeld L, López-Durán A, Figueiras A, Herdeiro MT. Attitudes of community pharmacists to antibiotic dispensing and microbial resistance: a qualitative study in Portugal. Int J Clin Pharm. 2013;35(3):417–24.CrossRefPubMedGoogle Scholar
  18. 18.
    Salim AM, Elgizoli B. Exploring the reasons why pharmacists dispense antibiotics without prescriptions in Khartoum state, Sudan. Int J Pharm Pract. 2017;25(1):59–65.CrossRefPubMedGoogle Scholar
  19. 19.
    Dameh M, Norris P, Green J. New Zealand pharmacists’ experiences, practices and views regarding antibiotic use without prescription. J Prim Health Care. 2012;4(2):131–40.PubMedGoogle Scholar
  20. 20.
    Nørgaard LS, Morgall JM, Bissell P. Arguments for theory-based Pharmacy Practice research. Int J Pharm Pract. 2000;8(2):77–81.CrossRefGoogle Scholar
  21. 21.
    Ajzen I. The theory of planned behavior. In: Van Lange PAM, Kruglanski AW, Higgins ET, editors. Handbook of theories of social psychology, vol. 1. Thousand Oaks: Sage Publications Ltd; 2012 (Chapter 21).Google Scholar
  22. 22.
    Ajzen I. The theory of planned behavior. Organ Behav Hum Dec. 1991;50(2):179–211.CrossRefGoogle Scholar
  23. 23.
    Fleming ML, Barner JC, Brown CM, Shepherd MD, Strassels S, Novak S. Using the theory of planned behavior to examine pharmacists’ intention to utilize a prescription drug monitoring program database. Res Social Adm Pharm. 2014;10(2):285–96.CrossRefPubMedGoogle Scholar
  24. 24.
    Gavaza P, Fleming M, Barner JC. Examination of psychosocial predictors of Virginia pharmacists’ intention to utilize a prescription drug monitoring program using the theory of planned behavior. Res Soc Adm Pharm. 2014;10(2):448–58.CrossRefGoogle Scholar
  25. 25.
    Salgado TM, Moles R, Benrimoj SI, Fernandez-Llimos F. Exploring the role of renal pharmacists in outpatient dialysis centres: a qualitative study. Int J Clin Pharm. 2012;34(4):569–78.CrossRefPubMedGoogle Scholar
  26. 26.
    Amin ME, Chewning BA. Predicting pharmacists’ adjustment of medication regimens in Ramadan using the Theory of Planned Behavior. Res Soc Adm Pharm. 2015;11(1):e1–15.CrossRefGoogle Scholar
  27. 27.
    Amin ME, Chewning BA. Pharmacists’ counseling on oral contraceptives: a theory informed analysis. Res Soc Adm Pharm. 2016;12(5):669–81.CrossRefGoogle Scholar
  28. 28.
    Bowen GA. Naturalistic inquiry and the saturation concept: a research note. Qual Res. 2008;8(1):137–52.CrossRefGoogle Scholar
  29. 29.
    Saengcharoen W, Chongsuvivatwong V, Lerkiatbundit S, Wongpoowarak P. Factors influencing dispensing of antibiotics for upper respiratory infections among Southern Thai community pharmacists. J Clin Pharm Ther. 2008;33(2):123–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMedGoogle Scholar
  31. 31.
    Goel P, Ross-Degnan D, Berman P, Soumerai S. Retail pharmacies in developing countries: a behavior and intervention framework. Soc Sci Med. 1996;42(8):1155–61.CrossRefPubMedGoogle Scholar
  32. 32.
    Al-Mohamadi A, Badr A, Bin Mahfouz L, Samargandi D, Al Ahdal A. Dispensing medications without prescription at Saudi community pharmacy: extent and perception. Saudi Pharm J. 2013;21(1):13–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Radyowijati A, Haak H. Improving antibiotic use in low-income countries: an overview of evidence on determinants. Soc Sci Med. 2003;57(4):733–44.CrossRefPubMedGoogle Scholar
  34. 34.
    Ghiga I, Stalsby Lundborg C. ‘Struggling to be a defender of health’—a qualitative study on the pharmacists’ perceptions of their role in antibiotic consumption and antibiotic resistance in Romania. J Pharm Policy Pract. 2016;9:10.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Sokol DK. Can deceiving patients be morally acceptable? BMJ. 2007;334(7601):984–6.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Huttner B, Goossens H, Verheij T, Harbarth S. Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. Lancet Infect Dis. 2010;10(1):17–31.CrossRefPubMedGoogle Scholar
  37. 37.
    Chuc NT, Larsson M, Do NT, Diwan VK, Tomson GB, Falkenberg T. Improving private pharmacy practice: a multi-intervention experiment in Hanoi, Vietnam. J Clin Epidemiol. 2002;55(11):1148–55.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Mohamed Ezzat Khamis Amin
    • 1
    Email author
  • Amira Amine
    • 2
  • Mohammad Shoukry Newegy
    • 3
  1. 1.College of Pharmacy, Natural and Health SciencesManchester UniversityFort WayneUSA
  2. 2.High Institute of Public HealthAlexandria UniversityAlexandriaEgypt
  3. 3.Directorate of Health AffairsMinistry of HealthMatrouhEgypt

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