Selling antibiotics without prescriptions among community pharmacies and drug outlets : a simulated client study from Ghana

Background Selling antibiotics without prescriptions is mostly illegal, including in Ghana, and promotes antimicrobial resistance. We evaluated the prevalence and practice of selling antibiotics without prescriptions among community pharmacies (CPs) and drug outlets, for the first time, in Ghana to quantify and characterise this issue to inform future interventions. Research design/methods Two scenarios utilising the Simulated Client Methodology were enacted: an upper respiratory tract infection of viral origin (scenario one); and paediatric diarrhoea (scenario two). CPs/Outlets were selected by stratified proportional random sampling from four metropolitan cities (~14% of the total Ghanaian population). Selling of antibiotics was assessed at three demand levels and its overall prevalence was estimated, then stratified by the study variables. Results Out of the 265 sampled CPs/outlets, the prevalence of selling antibiotic without prescription was 88.3% (n=234/265), with variations not only across the four regions [92.5% (n=123/133) in Kumasi, 87.5% (n=14/16) in Cape Coast, 84.1% (n=69/82) in Accra, and 82.4% (n=28/34) in Tamale] but also across CPs [90% (n=121/134)] and drug outlets [86% (n=113/131)]. Conclusions A very high prevalence/sub-optimal practice of selling antibiotics without prescriptions was found. This highlights the need to increase compliance with antibiotic dispensing legislation through evidence-based interventions including education of key stakeholders