Antibiotic Dispensing Practices in Community Pharmacies: Implications for Antimicrobial Stewardship in Resource-Constrained Settings and Role of Pharmacist in Controlling Anti-Microbial Resistance (AMR) in Lahore, Pakistan
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Abstract
Background: Antimicrobial resistance is a growing public health threat in low- and middle-income countries, where community pharmacies frequently serve as the first point of care and may contribute to non-prescription antibiotic use. Objective: This study assessed antimicrobial resistance knowledge and simulated antibiotic dispensing practices among community pharmacy personnel in urban and rural areas of Lahore, Pakistan. Methods: A cross-sectional observational study was conducted among 148 community pharmacy personnel using a structured questionnaire and two simulated scenarios representing upper respiratory tract infection and acute gastrointestinal infection. Knowledge responses, referral behavior, non-antibiotic management, antibiotic recommendation, WHO AWaRe category, and deviation from standard treatment guidance were analyzed using descriptive statistics and chi-square tests. Results: Most participants recognized antimicrobial resistance as a community problem (93.9%), but inappropriate antibiotic recommendation remained frequent. Antibiotics were recommended by 62.2% of participants in the upper respiratory tract infection scenario and 63.5% in the gastrointestinal scenario. Poor knowledge was associated with higher odds of antibiotic recommendation for both upper respiratory tract infection (83.3% vs. 56.5%; OR 3.86, 95% CI 1.25–11.95) and gastrointestinal infection (87.5% vs. 58.9%; OR 4.89, 95% CI 1.39–17.27). Watch-category antibiotics comprised 56.5% of upper respiratory tract infection antibiotic recommendations, and 17.6% of gastrointestinal encounters involved dual-antibiotic combinations. Conclusion: Community pharmacy antibiotic dispensing in Lahore showed a marked knowledge–practice gap, requiring scenario-based training, AWaRe-guided decision support, public awareness, and stronger prescription-only enforcement
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