Self-Medication and Over-The-Counter Dispensing of Antibiotics in Egypt_ Prevalence, Reasons and Outcomes. A systematic review

Background: The excessive and unwarranted consumption of antibiotics is the leading factor in promoting the spread of antimicrobial resistant (AMR), which is considered to be a potential major threat to global public health and economic growth. Several systematic reviews have been published exploring the pattern of antibiotic use in the Middle East and low-and middle-income countries without including studies from Egypt. Because of the strategic importance of Egypt as the most populated country in the Middle East and the largest producer of health workers in the area, a systematic review focusing on the situation in Egypt is timely and useful. Objective: Investigating the problem of self-medication and non-prescription dispensing of antibiotics in Egypt and suggesting interventions that could fit in the Egyptian context. Methods: A thorough search was done across databases (Medline, ProQuest and Scopus) using MeSH terms and regular keywords generated from the research question. The Inclusion and Exclusion criteria were applied, and the included studies were critically appraised using NOS. Results: The review included 10 studies after screening processes. The aggregate rate was 46% for self-medication with antibiotics and 76% for dispensing of antibiotics without prescription. Financial issues, time-consuming doctor visits and the lack of strict regulations were the leading reasons for such high rates. β-lactam antibiotics were the most used antibiotic class. Discussion: The prevalence of over-the-counter use and dispensing of antibiotics is quite high in Egypt, with serious consequences nationally and globally, which call for taking corrective actions. Awareness campaigns for public and health personnel and the enforcement of strict regulations are straightforward and effective interventions. Conclusion: Intense international efforts are essential to control the inappropriate antibiotic-use in order to limit the spread of AMR and keep our disease-fighting tools effective