Non-prescription antibiotic dispensing in community pharmacies in jordan: a simulated patient study

Inappropriate antibiotic use in community settings is a major contributor to antimicrobial resistance, particularly in low- and middle-income countries where regulatory enforcement may be inconsistent. Community pharmacies are a critical interface between health systems and the public; however, real-world dispensing practices remain insufficiently characterized in many settings. This study evaluated the prevalence, behavioral drivers, and clinical quality of non-prescription antibiotic dispensing in Jordanian community pharmacies using a simulated patient methodology.A cross-sectional simulated patient study was conducted across 200 community pharmacies in Jordan. A standardized encounter involving a three-stage progressive escalation protocol assessed dispensing behavior under increasing patient demand. The primary outcome was antibiotic supply without a valid prescription. Secondary outcomes included clinical assessment, counseling, referral behavior, and antibiotic class supplied. Multivariable logistic regression was used to identify predictors of non-prescription dispensing and adequate clinical assessment.Antibiotics were dispensed without prescription in 162 encounters (81.0%; 95% CI, 75.6-86.4). During the initial symptom-based presentation, 110 pharmacies (55.0%) supplied antibiotics. Among pharmacies that initially declined, a direct antibiotic request resulted in additional dispensing in 44.4% of cases, while subsequent patient insistence led to further supply in 24.0%, producing a cumulative prevalence of 81.0%. Independent pharmacies (adjusted odds ratio [AOR], 2.48; 95% CI, 1.23-5.02) and rural locations (AOR, 2.02; 95% CI, 1.01-4.03) were associated with higher dispensing odds. History-taking occurred in 49.4% of dispensing encounters, allergy screening in 14.2%, and no counseling was provided in 29.0%. Broad-spectrum agents represented 73.5% of dispensed antibiotics.Non-prescription antibiotic dispensing remains widespread in Jordan and is influenced by patient pressure and practice characteristics. Strengthened regulatory enforcement, professional training, and public awareness interventions are urgently needed.