Multifaceted interventions needed to reduce the use of antibiotics without a prescription: Integrating patient education, pharmacist training and regulation in rural South Africa
1
Public health pharmacy and management, school of pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
2
Pharmacy, Saselamani pharmacy, Saselamani, South Africa
3
Pharmacology, University of Pretoria, Pretoria, South Africa
4
Pharmacoepidemiology, Strathclyde institude of pharmacy and biomedical sciences, University of Strathclyde, UK, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A3284
ABSTRACT
INTRODUCTION:
Antimicrobial resistance (AMR) poses a critical threat to global health, especially in low- and middle-income countries (LMICs) where inappropriate antibiotic use in primary healthcare (PHC) is common. Community pharmacists are key frontline stewards of antibiotic use, yet dispensing antibiotics without a prescription undermines efforts to combat AMR, particularly in rural settings with limited healthcare access.
METHODS:
This mixed-methods study conducted in a rural province, included 313 self-administered surveys among pharmacists and pharmacist assistants from 128 community pharmacies, and 465 patient exit interviews. Data on antibiotic knowledge, attitudes and practices, including purchasing antibiotics without a prescription, was collected, summarised using jamovi 2.6.2. and triangulated with a review of the regulatory and policy framework.
RESULTS:
Overall, 56.9% (178/313) of pharmacists and assistants reported having dispensed antibiotics without prescriptions previously. Among patients, 54.4% (253/465) received at least one antibiotic, including 78.7% (199/253) dispensed without a prescription, mainly for sexually transmitted infections and mostly from independent pharmacies (74.4%; 148/199). Patient demand was driven by prior antibiotic use (56.8%; 113/199) and long clinic wait times (15.6%; 31/199). Knowledge was variable with only 21.5% (100/465) correctly understanding that resistance occurs in bacteria, though 76.3% (355/465) recognised overuse leads to resistance. Among pharmacists, attitudes towards stewardship were positive (81.4%; 206/253), and 94.8% (441/465) of patients supported pharmacist-led education. While dispensing antibiotics without a prescription is prohibited, regulatory and policy review revealed gaps and opportunities for pharmacist-led antimicrobial stewardship.
CONCLUSIONS:
Non-prescription antibiotic dispensing is widespread and fuelled by patient demand linked to prior use. A disconnect exists between awareness, practice and legislation. Multifaceted strategies to expand the services of community pharmacists, educate patients and strengthen regulation offer sustainable means to reduce inappropriate antibiotic use. These approaches promote equitable stewardship and provide a scalable model for LMICs, essential for advancing AMR containment and preserving antibiotic efficacy.
Antimicrobial resistance (AMR) poses a critical threat to global health, especially in low- and middle-income countries (LMICs) where inappropriate antibiotic use in primary healthcare (PHC) is common. Community pharmacists are key frontline stewards of antibiotic use, yet dispensing antibiotics without a prescription undermines efforts to combat AMR, particularly in rural settings with limited healthcare access.
METHODS:
This mixed-methods study conducted in a rural province, included 313 self-administered surveys among pharmacists and pharmacist assistants from 128 community pharmacies, and 465 patient exit interviews. Data on antibiotic knowledge, attitudes and practices, including purchasing antibiotics without a prescription, was collected, summarised using jamovi 2.6.2. and triangulated with a review of the regulatory and policy framework.
RESULTS:
Overall, 56.9% (178/313) of pharmacists and assistants reported having dispensed antibiotics without prescriptions previously. Among patients, 54.4% (253/465) received at least one antibiotic, including 78.7% (199/253) dispensed without a prescription, mainly for sexually transmitted infections and mostly from independent pharmacies (74.4%; 148/199). Patient demand was driven by prior antibiotic use (56.8%; 113/199) and long clinic wait times (15.6%; 31/199). Knowledge was variable with only 21.5% (100/465) correctly understanding that resistance occurs in bacteria, though 76.3% (355/465) recognised overuse leads to resistance. Among pharmacists, attitudes towards stewardship were positive (81.4%; 206/253), and 94.8% (441/465) of patients supported pharmacist-led education. While dispensing antibiotics without a prescription is prohibited, regulatory and policy review revealed gaps and opportunities for pharmacist-led antimicrobial stewardship.
CONCLUSIONS:
Non-prescription antibiotic dispensing is widespread and fuelled by patient demand linked to prior use. A disconnect exists between awareness, practice and legislation. Multifaceted strategies to expand the services of community pharmacists, educate patients and strengthen regulation offer sustainable means to reduce inappropriate antibiotic use. These approaches promote equitable stewardship and provide a scalable model for LMICs, essential for advancing AMR containment and preserving antibiotic efficacy.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
