Dispensing of Antibiotics Without Prescription in the Metropolitan Area of Athens, Greece, in 2021-Can New Legislation Change Old Habits?

Overview

Journal Antimicrob Steward Healthc Epidemiol

Publisher Cambridge University Press

Specialty Infectious Diseases

Date 2023 Mar 24

PMID 36960086

Authors

Ioannis Kopsidas

Lydia Kokkinidou

Dioni Pinelopi Petsiou

Eleni Kourkouni

Christos Triantafyllou

Grammatiki-Christina Tsopela

Theoklis Zaoutis

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the effect of new legislation on the dispensing of antimicrobials without prescription from pharmacies in Greece.

Design: In-person survey.

Setting: The study included 110 pharmacies in the greater Athens Metropolitan area.

Methods: Volunteer collaborators visited 110 pharmacies in the greater Athens Metropolitan area in December 2021 and January 2022. They asked for either ciprofloxacin or amoxicillin-clavulanate acid (6:5 ratio) without providing a prescription, without simulating symptoms, and without offering justification or insisting. Fluoroquinolones have additional dispensing restrictions in Greece. Results were compared to a 2008 study. In 2020, legislation allowed the dispensing of antibiotics from pharmacies only with an electronic prescription, overriding the 1973 forbidding the dispensing of all medications without prescriptions.

Results: All pharmacists refused to dispense ciprofloxacin without a prescription. Only 1 pharmacy dispensed amoxicillin-clavulanate without a prescription. Compared to the 2008 study, dispensing of amoxicillin-clavulanate without a prescription dropped from 100% in 2008 to 1% in 2021 and dispensing ciprofloxacin without a prescription dropped from 53% in 2008 to 0% in 2021.

Conclusions: A new and enforced law that requires electronic prescribing led to a dramatic reduction of antibiotic dispensing without prescription compared to 12 years ago. Similar initiatives could help solve the problem of antibiotic consumption and resistance in Greece and elsewhere.

Citing Articles

Knowledge and Attitudes of Healthcare Workers towards Antibiotic Use and Antimicrobial Resistance in Two Major Tertiary Hospitals in Western Greece.

Lagadinou M, Tsami E, Deligakis A, Paraskevas T, Michailides C, Velissaris D Antibiotics (Basel). 2023; 12(11).

PMID: 37998785 PMC: 10668655. DOI: 10.3390/antibiotics12111583.

Clinical and Economic Value of Reducing Antimicrobial Resistance in the Management of Hospital-Acquired Infections with Limited Treatment Options in Greece.

Barmpouni M, Gordon J, Miller R, Dennis J, Grammelis V, Rousakis A Infect Dis Ther. 2023; 12(7):1891-1905.

PMID: 37410343 PMC: 10390381. DOI: 10.1007/s40121-023-00837-7.

References

Auta A, Hadi M, Oga E, Adewuyi E, Abdu-Aguye S, Adeloye D . Global access to antibiotics without prescription in community pharmacies: A systematic review and meta-analysis. J Infect. 2018; 78(1):8-18. DOI: 10.1016/j.jinf.2018.07.001. View

Mitsi G, Jelastopulu E, Basiaris H, Skoutelis A, Gogos C . Patterns of antibiotic use among adults and parents in the community: a questionnaire-based survey in a Greek urban population. Int J Antimicrob Agents. 2005; 25(5):439-43. DOI: 10.1016/j.ijantimicag.2005.02.009. View

Saleem Z, Hassali M, Godman B, Fatima M, Ahmad Z, Sajid A . Sale of WHO AWaRe groups antibiotics without a prescription in Pakistan: a simulated client study. J Pharm Policy Pract. 2020; 13:26. PMC: 7397594. DOI: 10.1186/s40545-020-00233-3. View

Llor C, Cots J . The sale of antibiotics without prescription in pharmacies in Catalonia, Spain. Clin Infect Dis. 2009; 48(10):1345-9. DOI: 10.1086/598183. View

Batista A, A Rodrigues D, Figueiras A, Zapata-Cachafeiro M, Roque F, Herdeiro M . Antibiotic Dispensation without a Prescription Worldwide: A Systematic Review. Antibiotics (Basel). 2020; 9(11). PMC: 7694985. DOI: 10.3390/antibiotics9110786. View

Klein E, Van Boeckel T, Martinez E, Pant S, Gandra S, Levin S . Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A. 2018; 115(15):E3463-E3470. PMC: 5899442. DOI: 10.1073/pnas.1717295115. View

Chang J, Xu S, Zhu S, Li Z, Yu J, Zhang Y . Assessment of non-prescription antibiotic dispensing at community pharmacies in China with simulated clients: a mixed cross-sectional and longitudinal study. Lancet Infect Dis. 2019; 19(12):1345-1354. DOI: 10.1016/S1473-3099(19)30324-X. View

Chang J, Ye D, Lv B, Jiang M, Zhu S, Yan K . Sale of antibiotics without a prescription at community pharmacies in urban China: a multicentre cross-sectional survey. J Antimicrob Chemother. 2017; 72(4):1235-1242. DOI: 10.1093/jac/dkw519. View

Belachew S, Hall L, Selvey L . Non-prescription dispensing of antibiotic agents among community drug retail outlets in Sub-Saharan African countries: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2021; 10(1):13. PMC: 7807893. DOI: 10.1186/s13756-020-00880-w. View

10.

Santa-Ana-Tellez Y, Mantel-Teeuwisse A, Dreser A, Leufkens H, Wirtz V . Impact of over-the-counter restrictions on antibiotic consumption in Brazil and Mexico. PLoS One. 2013; 8(10):e75550. PMC: 3797702. DOI: 10.1371/journal.pone.0075550. View

11.

Alrasheedy A, Alsalloum M, Almuqbil F, Almuzaini M, Aba Alkhayl B, Albishri A . The impact of law enforcement on dispensing antibiotics without prescription: a multi-methods study from Saudi Arabia. Expert Rev Anti Infect Ther. 2019; 18(1):87-97. DOI: 10.1080/14787210.2020.1705156. View

12.

Hall J, Bouchard J, Bookstaver P, Haldeman M, Kishimbo P, Mbwanji G . The Mbeya Antimicrobial Stewardship Team: Implementing Antimicrobial Stewardship at a Zonal-Level Hospital in Southern Tanzania. Pharmacy (Basel). 2020; 8(2). PMC: 7356184. DOI: 10.3390/pharmacy8020107. View

13.

Plachouras D, Kavatha D, Antoniadou A, Giannitsioti E, Poulakou G, Kanellakopoulou K . Dispensing of antibiotics without prescription in Greece, 2008: another link in the antibiotic resistance chain. Euro Surveill. 2010; 15(7). View

14.

Vazquez-Lago J, Gonzalez-Gonzalez C, Zapata-Cachafeiro M, Lopez-Vazquez P, Taracido M, Lopez A . Knowledge, attitudes, perceptions and habits towards antibiotics dispensed without medical prescription: a qualitative study of Spanish pharmacists. BMJ Open. 2017; 7(10):e015674. PMC: 5640063. DOI: 10.1136/bmjopen-2016-015674. View

15.

Al-Halawa D, Abu Seir R, Qasrawi R . Antibiotic Resistance Knowledge, Attitudes, and Practices among Pharmacists: A Cross-Sectional Study in West Bank, Palestine. J Environ Public Health. 2023; 2023:2294048. PMC: 9902159. DOI: 10.1155/2023/2294048. View

16.

Bavestrello L, Cabello A, Casanova D . [Impact of regulatory measures in the trends of community consumption of antibiotics in Chile]. Rev Med Chil. 2003; 130(11):1265-72. View

17.

Grigoryan L, Haaijer-Ruskamp F, Burgerhof J, Mechtler R, Deschepper R, Tambic-Andrasevic A . Self-medication with antimicrobial drugs in Europe. Emerg Infect Dis. 2006; 12(3):452-9. PMC: 3291450. DOI: 10.3201/eid1203.050992. View

18.

Al-Tannir M, Altannir Y, Altannir M, AlFayyad I . Community pharmacy sales of non-prescribed antibiotics in Riyadh, Saudi Arabia: a simulated patient study. Int J Clin Pharm. 2020; 42(2):341-346. DOI: 10.1007/s11096-020-01033-0. View