ABSTRACT
This study described the antibiotic dispensing practices of community pharmacists and factors associated with such dispensing practices in Port Harcourt, Nigeria. The study used a cross-sectional descriptive design. Simple random sampling was used to select a sample of 84 community pharmacies out of a total of approximately 107 community pharmacies in Port Harcourt, and one community pharmacist from each community pharmacy. A research assistant was trained to administer the questionnaire along with the researcher and collect information on community pharmacists’ demographics, antibiotic dispensing practices, and the factors associated with those dispensing practices. The socio-demographic data was analysed via descriptive analytical tools such as simple percentages and crosstabulations. These tools were used to generate a descriptive picture of the data, patterns and associations using SPSS version 25. Quantitative content analysis was done on responses to scenario-based questions, and recommendations made as to how the dispensing of antibiotics could be improved. The majority of the community pharmacists (87%) indicated that patients could purchase antibiotics without prescription from their pharmacies, and most pharmacists (98%) asked for reasons why antibiotics were demanded for without prescriptions. While 58% indicated that patients could purchase partial quantities of prescribed antibiotics at their pharmacies, 96% investigated the reasons for partial requests, and 94% counselled on the right dosage and frequency of the prescribed antibiotics. Sixty-seven percent of the pharmacists indicated that one of the major reasons for dispensing antibiotics without prescription was self-medication by patients, while most (87%) indicated that financial constraint was a major reason why patients requested for partial quantities of prescribed antibiotics. The dispensing of non-prescribed and part-prescribed antibioticsis a common practice amongst community pharmacists in Port Harcourt, Nigeria. Enhancing the financial status of Nigerians, as well as ensuring stricter regulatory measures on antibiotic use, would help promote rational use of antibiotics and reduce rising antimicrobial resistance rates.
CHAPTER ONE
INTRODUCTION
1.1 Background
Rational medicine use, according to the World Health Organisation (WHO) (1985), requires that the right medicine gets to the right patient, at the right dose, for the appropriate clinical indication, and in the right quantity that the patient and community can afford. Irrational medicine use, therefore, implies that medicines are being used in a way that does not conform to the rational medicine use principles described above. Achieving rational medicine use is a global public health challenge, and the World Health Organization (2002) reported that globally more than 50% of medicines are either prescribed or dispensed irrationally and about 50% of patients take their medicines incorrectly. This report has also been cited by other authors (Bilal et al., 2016; Dakhale et al., 2016). According to Adebayo and Hussain (2010), the WHO reported that irrational use of medicines is very common in developing countries. A key aspect of irrational medicine use is the irrational use of antibiotics. This is partly underpinned by poor dispensing practices of health professionals, a contributory factor of the rise in antimicrobial resistance globally (Homedes and Ugalde, 2012; Nakwatumbah et al., 2017). To tackle the challenge of irrational medicine use, it is imperative to ascertain its extent and predisposing factors. This will inform the necessary and appropriate interventions that could be deployed to both address it and promote rational medicine use (World Health Organization, 2002). Some of the factors contributing to irrational medicine use have been highlighted by Atif et al. (2016) as polypharmacy, self-medication, overuse of injections, overuse or underuse of antibiotics, and non-adherence to standard treatment guidelines. These could be influenced by the knowledge, attitudes, and practices of healthcare workers (including pharmacists),
