Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance

Sono TM 1 , Yeika E 2 , Cook A 3 , Kalungia A 4 , Opanga SA 5 , Acolatse JEE 6 Show all authors , Sefah IA 7 , Jelić AG 8 , Campbell S 1 , Lorenzetti G 3 , Ul Mustafa Z 9 , Marković-Peković V 8 , Kurdi A 1 , Anand Paramadhas BD 10 , Rwegerera GM 11 , Amu AA 12 , Alabi ME 13 , Wesangula E 14 , Oluka M 5 , Khuluza F 15 , Chikowe I 15 , Fadare JO 16 , Ogunleye OO 17 , Kibuule D 18 , Hango E 19 , Schellack N 20 , Ramdas N 1 , Massele A 21 , Mudenda S 4 , Hoxha I 22 , Moore CE 3 , Godman B 1 , Meyer JC 1

Affiliations 

  • 1 Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
  • 2 Programs coordinator/Technical supervisor for HIV/Malaria, Delegation of Public Health, Cameroon
  • 3 Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
  • 4 Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
  • 5 Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
  • 6 Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
  • 7 Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho, Ghana
  • 8 Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
  • 9 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
  • 10 Department of Health Services Management, Central Medical Stores, Ministry of Health, Gaborone, Botswana
  • 11 Faculty of Medicine, Department of Internal Medicine, University of Botswana, Gaborone, Botswana
  • 12 Pharmacy Department, Eswatini Medical Christian University, Mbabane, Kingdom of Eswatini
  • 13 School of Pharmaceutical Sciences, College of Health Sciences,University of Kwazulu-natal (UKZN), Durban, South Africa
  • 14 East Central and Southern Africa Health Community, Arusha, Tanzania
  • 15 Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
  • 16 Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
  • 17 Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
  • 18 Department of Pharmacology & Therapeutics, Busitema University, Mbale, Uganda
  • 19 Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
  • 20 Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, SouthAfrica
  • 21 Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
  • 22 Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
Expert Rev Anti Infect Ther, 2023;21(10):1025-1055.
PMID: 37740561 DOI: 10.1080/14787210.2023.2259106

Abstract

INTRODUCTION: Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription.

AREAS COVERED: A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing antibiotics without a prescription). However, considerable variation was seen with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients.

EXPERT OPINION: ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications