Non-prescription antibiotics dispensing for common infections using simulated patients

Non-prescription antibiotic dispensing at community drugstores is a widespread public health concern, particularly in low and middle-income countries. This practice promotes irrational antibiotic use that can hasten the emergence and spread of antibiotic resistance.

This simulated patient study aimed to assess the rate and dispensing patterns of non-prescription antibiotics for common infections, and concurrently document the types and classes of antibiotics dispensed.

A cross-sectional study using the simulated patient method was conducted in Bahawalpur, Pakistan, for a period of one month starting from May 28 to June 29, 2025, and was reported in accordance with the CRiSPHe Statement (checklist for reporting research using a simulated patient methodology in Health). Four common simulated scenarios, flu, diarrhea, sore throat, and urinary tract infections (UTIs) were presented. Descriptive statistics were used to determine frequencies and percentages, while the association between non-prescription antibiotic dispensing and independent variables was determined by using inferential statistics. P-values<0.05 were considered significant.

Of the total 175 drugstores visited, 96.5% of them dispensed antibiotics without a prescription. The most commonly dispensed antibiotics were ciprofloxacin (31.7%), levofloxacin (15.6%), and metronidazole (10.8%). Most of the antibiotics (79%) were dispensed at the first level of demand, with 89.5% dispensed single antibiotic, while 10.2% dispensed two antibiotics in a single visit. Qualified personnel were present at only 9 (5.2%) drugstores. Drugstores located in front of the hospitals were 10.1 times less likely to dispense antibiotics without a prescription than those located in the community settings (95%CI:0.016-0.619, AOR:0.099).

Non-prescription antibiotic dispensing is a common practice, fueling antibiotic resistance. Strengthening regulations, enforcing prescription-only policies, and increasing public awareness are essential to ensure safe and rational antibiotic use.