Self-assessment of pharmacists regarding the practice of dispensing antibiotics in public pharmacies
Authors: Živanović Slađana 
Published: July 2024

Introduction: Approximately at the end of one century after the discovery of penicillin, the world is facing the development of bacterial resistance to antibiotics. The focus of our work is the pharmacist, as one of the key actors in the chain of antibiotic dispensing. Through research, we aimed to determine the level of knowledge among employees in pharmacies in the city and municipality of Šabac in the Republic of Serbia about antibiotics, antimicrobial resistance, the legal framework regulating the area of antibiotic dispensing, as important factors for self-assessment in the practice of antibiotic dispensing in public pharmacies. Objectives: (1) to examine the knowledge of pharmacy employees about antibiotics, antimicrobial resistance (AMR), and the legal framework regulating the area of antibiotic dispensing; (2) to investigate the practice of antibiotic dispensing in public pharmacies; (3) to assess differences in the practice of antibiotic dispensing based on gender of the respondents, pharmacy location, and level of education. Methodology: A cross-sectional study was conducted using a purposefully created questionnaire consisting of 33 questions, through which respondents self-assessed their knowledge related to antibiotics and the practice of antibiotic dispensing in the last six months. Health workers of all levels of pharmacy education employed in almost all pharmacies in the territory of the city of Šabac (including city and rural pharmacies) participated in the study. Data were collected from March to August 2022. Results: The total number of respondents in the study was 229, with the majority being female. Regarding formal education, the majority of respondents were graduate pharmacists (59%), followed by higher pharmacy technicians (3.5%) and pharmacy technicians (37.6%). When it comes to viral infections, 95.2% of respondents knew that antibiotics are ineffective in such cases; while 72.6% of respondents believe that acute sore throat should not be treated with antibiotics. As much as 99.6% of respondents confirmed the statement that inappropriate use of antibiotics contributes to the increase in antibiotic resistance. Also, 96.5% of respondents confirmed that dispensing antibiotics without a prescription leads to the development of antibiotic resistance. A total of 90.8% of respondents are aware that pharmacists can be penalized in accordance with existing legal regulations if they dispense antibiotics without a prescription. In practice, dispensing antibiotics without a prescription is still present in certain situations. Although this phenomenon is not common based on survey responses ("I always prescribe without a prescription at the patient's request") for the surveyed locations of infections, it occurs in a small number of cases, from 1.4% to 4.0%. However, based on the response "I sometimes prescribe without a prescription at the patient's request," it occurs more frequently in certain clinical conditions and complaints: most commonly urinary tract infections in 52% of cases, infected wounds -42.4%, acute sore throats in 29.8%, and diarrhea -15.7%, and least commonly for common colds and coughs in 9.2%. At the patient's request, the majority of respondents -79.9% never dispense antibiotics without a prescription, but still globally 20.1% of respondents sometimes dispense antibiotics without a prescription or doctor's report. Conclusion: Based on the results of the sample of 229 pharmacist and pharmacy technician respondents, it is concluded that dispensing antibiotics without a prescription is still present in practice in certain situations. Although this phenomenon is not common from responses: "I always prescribe without a prescription at the patient's request" for surveyed locations of infections (1.4% to 4.0%), and sometimes for certain conditions and complaints, most commonly for common colds and coughs at 9.2% and most commonly for urinary tract infections -52%, At the patient's request, 79.9% of respondents never dispense antibiotics without a prescription, but still globally 20.1% of respondents sometimes dispense antibiotics without a prescription or doctor's report. Antimicrobial resistance is a systemic issue that undoubtedly requires teamwork of all stakeholders in society where the role of pharmacists and pharmacy technicians is one of the most significant.