Antibiotic Dispensing Practice among Medicine Retailers of Butwal and Bhairahawa Cities: An Interventional Study

Background::
Dispensing practice is the fundamental component of the rational use of drugs. Inappropriate dispensing of drugs can lead to Adverse drug reaction
(ADR), Drug interaction (DI), therapeutic failure, and increased cost of treatment. In case of antibiotic misuse, it can lead to developing an extra
burden of antibiotic resistance.


Objective::
The objective of this study is to determine the antibiotic dispensing practice and the impact of intervention among medicine retailers of Butwal and
Bhairahawa cities of Nepal.


Methods::
An interventional simulated patients survey study was conducted in two cities of Nepal from 2016-2018. A scenario of fictitious cases of common
cold and running nose was simulated by two trained pharmacists in two different sites. Prior to the survey, the researcher visited selected retailers
to obtain consent and demography details. About two weeks after obtaining consent, simulated patients visited the retailers. The information given
by the community pharmacist was memorized and recorded in data collection form after leaving the community pharmacy. The intervention study
was carried out 30 days after the simulated study survey. The educational intervention was given to the test group i.e. the community medicine
retailer of Butwal. The researchers also provided a booklet to the test groups. Post-intervention simulated patient survey was conducted after 3 days
of the training period. Data were entered into Microsoft Excel and SPSS for analysis.


Results::
All together 64 community pharmacies were included in this study involving 32 medicine retailers from each city of Butwal and Bhairahawa. The
total drugs dispensed by medicine retailers were 146 and 127 drugs in Butwal and Bhairahawa, respectively in the before-intervention studies.
Similarly, about 122 and 152 drugs were dispensed by medicine retailers in Butwal and Bhairahawa after intervention studies. The average number
of medicines dispensed by medicine retailers was 4.56±1.66 and 3.96±1.92 before intervention in the Butwal and Bhairahawa study sites. The
average numbers of medicines dispensed by medicine retailers were 3.78±1.06 and 4.78±1.73 after intervention in the study sites of Butwal and
Bhairahawa. None of the medicine retailers talked about either the brand or generic name and strength of antibiotic medicine to the simulated
patient before and after intervention in both study sites. Similarly, medicine retailers informed about the frequency of dosage of antibiotic medicine
to simulated patients before and after interventions in Butwal and Bhairahawa cities. However, there was no statistical significance (P=0.388)
observed in Butwal City, whereas in Bhairahawa City, statistical significance (P=0.006) was observed.


Conclusion::
Antibiotic dispensing without a prescription is routine. Insufficient medicine information was given to the simulated patient by the medicine
retailer. Hence, we suggest meaningful implementation of policy and regular inspection to improve the situation.