Practices, knowledge, and attitude toward dispensing antibiotics without a prescription in Iraqi pharmacies

Dispensing antibiotics without a prescription (DAWRx) is a potential threat to global public health and can lead to antimicrobial abuse and resistance development. Further research is required to examine the characteristics of DAWRx practice in Iraq. This study aimed to investigate the practices of DAWRx in Iraqi community pharmacies. A semi-structured, validated, pilot-tested online questionnaire was used to conduct a descriptive cross-sectional study in March 2020 among the members of the Iraqi Pharmacist Syndicate. The questionnaire contained five sections: demographics, antibiotic dispensing knowledge, and the prevalence, sources, and characteristic features of DAWRx practices. The results are presented using descriptive statistics and significant associations were reported. A total of 403 respondents completed the questionnaire and, of them, 363 were analyzed. Despite having a satisfactory knowledge of dispensing (64.7%), the practice of DAWRx was prevalent (98.3%). DAWRx was reported based on the pharmacies’ recommendation (30.58%) and patients’ request for antibiotics. Adults and pediatric patients received antibiotics from pharmacies for various conditions. Injectable antibiotics were also dispensed without a prescription (mainly ceftriaxone, n = 51/72). Moreover, the prevalence and the daily number of antibiotics dispensed were significantly associated with sex, pharmacy attitude toward DAWRx, and DAWRx upon patients’ request. A significant association was noted between the knowledge of dispensing inquiries and the prevalence of and attitude toward DAWRx (p < 0.05). Impactful intervention strategies based on patterns identified in this study should be developed to improve antibiotic dispensing in community pharmacies and safeguard public health from the adverse effects of antimicrobial resistance.