Pharmacy Distribution of Advice, Symptomatic Treatment and Antimicrobial Drugs to Patients with Cough

It is an accepted fact that, in many countries, pharmacies are the predominant source of medical advice over-the-counter drugs, and supplies of "prescription-only" drugs for sale without a prescription. To assess the activities conducted by pharmacists or pharmacy counter assistants in response to a common health problem, a cross-sectional study was done at 114 pharmacies in Porto Alegre, Brazil. A fictitious case-history of cough was used by trained personnel entering the pharmacy and the subsequent activities by the pharmacist or pharmacy counter assistant were analyzed. Some kind of medication was provided in 101 (88.5%) of the pharmacies. Pharmacists gave medication in 80% of pharmacies, and pharmacy assistants in 95.5% (p<0.03). The class of medication most frequently dispensed was the expectorants (97 times, 92.4%), however, systemic antibiotics were provided in 11 pharmacies (10.5%). Of note, the pharmacists provided antibiotics more frequently than did pharmacy assistants (p=0.016). We conclude that pharmacy advice and symptomatic medical care (expectorants) are very common and that pharmacy assistants are more likely than pharmacists to provide medication. Of concern, when pharmacists were the drug dispensers of antibiotics which should be provided by prescription only, drugs were provided without proper diagnosis, and often in incorrect dosages. This reflects a potentially dangerous practice in need of careful evaluation, education and supervision.