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Non-prescription antibiotic dispensing and counseling practices in Iraqi community pharmacies: implications for antimicrobial stewardship and resistance containment.

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Τίτλος: Non-prescription antibiotic dispensing and counseling practices in Iraqi community pharmacies: implications for antimicrobial stewardship and resistance containment.
Συγγραφείς: Darweesh O; College of Pharmacy, Al-Kitab University, Kirkuk, Iraq., Godman B; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.; Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.; Antibiotic Policy Group, Institute for Infection and Immunity, City St. George's, University of London, London, United Kingdom., Kurdi A; College of Pharmacy, Al-Kitab University, Kirkuk, Iraq.; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.; Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.; College of Pharmacy, Hawler Medical University, Erbil, Iraq.
Πηγή: Expert review of anti-infective therapy [Expert Rev Anti Infect Ther] 2026 Apr; Vol. 24 (4), pp. 435-448. Date of Electronic Publication: 2026 Apr 21.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Taylor & Francis Country of Publication: England NLM ID: 101181284 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1744-8336 (Electronic) Linking ISSN: 14787210 NLM ISO Abbreviation: Expert Rev Anti Infect Ther Subsets: MEDLINE
Imprint Name(s): Publication: 2015- : Abingdon, Oxford : Taylor & Francis
Original Publication: London : Future Drugs Ltd.
Ιατρικοί όροι (MeSH): Anti-Bacterial Agents*/administration & dosage , Counseling*/statistics & numerical data , Counseling*/methods , Nonprescription Drugs*/administration & dosage , Practice Patterns, Pharmacists'*/statistics & numerical data , Community Pharmacy Services*/statistics & numerical data , Community Pharmacy Services*/organization & administration , Antimicrobial Stewardship*, Respiratory Tract Infections/drug therapy ; Pharmacists/organization & administration ; Pharmacists/statistics & numerical data ; Pharmacies/statistics & numerical data ; Humans ; Iraq ; Cross-Sectional Studies ; Female ; Male ; Adult ; Logistic Models
Περίληψη: Background: To assess the prevalence, characteristics, dispensing practices, and counseling behavior of non-prescription antibiotic dispensing among Iraqi community pharmacies to inform antimicrobial stewardship (AMS) policy.
Research Design and Methods: A cross-sectional simulated client study was conducted among 696 pharmacies across five Iraqi provinces. Standardized scenarios of upper respiratory tract infection were used to evaluate dispensing behavior, counseling quality (defined as whether staff provided key counseling components including enquiry about symptoms, allergy status, dosage instructions, and treatment duration), and antibiotic class distribution according to the WHO-AWaRe framework. Data were analyzed using descriptive and multivariable logistic regression.
Results: Antibiotics were dispensed without prescription in 80.6% (95%CI:77.6-83.5%) of the visits. Access antibiotics accounted for 60.8% (95%CI:56.9-65.0%) and Watch agents for 39.2% (95%CI:34.9-43.1%), with amoxicillin-(26.4%), amoxicillin-clavulanate-(30.7%), and azithromycin-(25.5%) most common. Counseling was poor; only 15% (95%CI:12.3-18.3%) of the providers asked any clinical question and only 7.7% (95%CI:5.5-9.9%) enquired about allergy history. Non-pharmacist staff (nurses) were significantly more likely to dispense antibiotics without prescription compared with pharmacists (OR = 5.7; 95%CI:3.2-10.1).
Conclusions: Non-prescription antibiotic dispensing and minimal counseling remain widespread in Iraqi pharmacies. Effective AMS in Iraq will require phased, system-level approaches, including strengthened regulatory enforcement, workforce support addressing all pharmacy personnel, and integration of community pharmacies into national AMR strategies.
Contributed Indexing: Keywords: Antimicrobial resistance; antimicrobial stewardship; community pharmacy; non-prescription antibiotic dispensing; simulated client methodology
Local Abstract: [plain-language-summary] Antimicrobial resistance (AMR) happens when bacteria stop responding to antibiotics, making infections harder to treat. In many countries, including Iraq, people can still buy antibiotics from community pharmacies without a prescription, which increases the risk of resistance. This study looked at how often and how responsibly antibiotics were sold in 696 pharmacies across five Iraqi cities. Researchers found that in over 80% of visits, antibiotics were given without a prescription. Nearly 40% were drugs that the World Health Organization classifies as higher-risk ‘Watch’ antibiotics. Most pharmacy staff did not ask important clinical questions or check for allergies before dispensing. These results show the urgent need for better antibiotic control and community pharmacy personnel training. Trained pharmacists could play an important role in improving antibiotic use in Iraq; however, our findings also show that other staff, including nurses, are often involved in dispensing antibiotics in community pharmacies. Ensuring safe and appropriate antibiotic use will therefore require clear regulations, proper oversight, and monitoring systems that address the practices of all personnel involved in medicine supply.
Substance Nomenclature: 0 (Anti-Bacterial Agents)
0 (Nonprescription Drugs)
Entry Date(s): Date Created: 20260418 Date Completed: 20260715 Latest Revision: 20260715
Update Code: 20260715
DOI: 10.1080/14787210.2026.2663104
PMID: 41999609
Βάση Δεδομένων: MEDLINE
FullText Text:
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  Data: Non-prescription antibiotic dispensing and counseling practices in Iraqi community pharmacies: implications for antimicrobial stewardship and resistance containment.
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  Data: <searchLink fieldCode="AU" term="%22Darweesh+O%22">Darweesh O</searchLink>; College of Pharmacy, Al-Kitab University, Kirkuk, Iraq.<br /><searchLink fieldCode="AU" term="%22Godman+B%22">Godman B</searchLink>; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.; Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.; Antibiotic Policy Group, Institute for Infection and Immunity, City St. George's, University of London, London, United Kingdom.<br /><searchLink fieldCode="AU" term="%22Kurdi+A%22">Kurdi A</searchLink>; College of Pharmacy, Al-Kitab University, Kirkuk, Iraq.; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.; Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.; College of Pharmacy, Hawler Medical University, Erbil, Iraq.
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  Data: <searchLink fieldCode="JN" term="%22101181284%22">Expert review of anti-infective therapy</searchLink> [Expert Rev Anti Infect Ther] 2026 Apr; Vol. 24 (4), pp. 435-448. <i>Date of Electronic Publication: </i>2026 Apr 21.
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Taylor+%26+Francis%22">Taylor & Francis </searchLink><i>Country of Publication: </i>England <i>NLM ID: </i>101181284 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1744-8336 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2214787210%22">14787210 </searchLink><i>NLM ISO Abbreviation: </i>Expert Rev Anti Infect Ther <i>Subsets: </i>MEDLINE
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  Data: <i>Publication</i>: 2015- : Abingdon, Oxford : Taylor & Francis<br /><i>Original Publication</i>: London : Future Drugs Ltd.
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  Data: <searchLink fieldCode="MM" term="%22Anti-Bacterial+Agents%22">Anti-Bacterial Agents*</searchLink>/<searchLink fieldCode="MM" term="%22Anti-Bacterial+Agents+administration+%26+dosage%22">administration & dosage</searchLink> <br /><searchLink fieldCode="MM" term="%22Counseling%22">Counseling*</searchLink>/<searchLink fieldCode="MM" term="%22Counseling+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> <br /><searchLink fieldCode="MM" term="%22Counseling%22">Counseling*</searchLink>/<searchLink fieldCode="MM" term="%22Counseling+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Nonprescription+Drugs%22">Nonprescription Drugs*</searchLink>/<searchLink fieldCode="MM" term="%22Nonprescription+Drugs+administration+%26+dosage%22">administration & dosage</searchLink> <br /><searchLink fieldCode="MM" term="%22Practice+Patterns%2C+Pharmacists'%22">Practice Patterns, Pharmacists'*</searchLink>/<searchLink fieldCode="MM" term="%22Practice+Patterns%2C+Pharmacists'+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> <br /><searchLink fieldCode="MM" term="%22Community+Pharmacy+Services%22">Community Pharmacy Services*</searchLink>/<searchLink fieldCode="MM" term="%22Community+Pharmacy+Services+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> <br /><searchLink fieldCode="MM" term="%22Community+Pharmacy+Services%22">Community Pharmacy Services*</searchLink>/<searchLink fieldCode="MM" term="%22Community+Pharmacy+Services+organization+%26+administration%22">organization & administration</searchLink> <br /><searchLink fieldCode="MM" term="%22Antimicrobial+Stewardship%22">Antimicrobial Stewardship*</searchLink><br /><searchLink fieldCode="MH" term="%22Respiratory+Tract+Infections%22">Respiratory Tract Infections</searchLink>/<searchLink fieldCode="MH" term="%22Respiratory+Tract+Infections+drug+therapy%22">drug therapy</searchLink> ; <searchLink fieldCode="MH" term="%22Pharmacists%22">Pharmacists</searchLink>/<searchLink fieldCode="MH" term="%22Pharmacists+organization+%26+administration%22">organization & administration</searchLink> ; <searchLink fieldCode="MH" term="%22Pharmacists%22">Pharmacists</searchLink>/<searchLink fieldCode="MH" term="%22Pharmacists+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> ; <searchLink fieldCode="MH" term="%22Pharmacies%22">Pharmacies</searchLink>/<searchLink fieldCode="MH" term="%22Pharmacies+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Iraq%22">Iraq</searchLink> ; <searchLink fieldCode="MH" term="%22Cross-Sectional+Studies%22">Cross-Sectional Studies</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Logistic+Models%22">Logistic Models</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: To assess the prevalence, characteristics, dispensing practices, and counseling behavior of non-prescription antibiotic dispensing among Iraqi community pharmacies to inform antimicrobial stewardship (AMS) policy.<br />Research Design and Methods: A cross-sectional simulated client study was conducted among 696 pharmacies across five Iraqi provinces. Standardized scenarios of upper respiratory tract infection were used to evaluate dispensing behavior, counseling quality (defined as whether staff provided key counseling components including enquiry about symptoms, allergy status, dosage instructions, and treatment duration), and antibiotic class distribution according to the WHO-AWaRe framework. Data were analyzed using descriptive and multivariable logistic regression.<br />Results: Antibiotics were dispensed without prescription in 80.6% (95%CI:77.6-83.5%) of the visits. Access antibiotics accounted for 60.8% (95%CI:56.9-65.0%) and Watch agents for 39.2% (95%CI:34.9-43.1%), with amoxicillin-(26.4%), amoxicillin-clavulanate-(30.7%), and azithromycin-(25.5%) most common. Counseling was poor; only 15% (95%CI:12.3-18.3%) of the providers asked any clinical question and only 7.7% (95%CI:5.5-9.9%) enquired about allergy history. Non-pharmacist staff (nurses) were significantly more likely to dispense antibiotics without prescription compared with pharmacists (OR = 5.7; 95%CI:3.2-10.1).<br />Conclusions: Non-prescription antibiotic dispensing and minimal counseling remain widespread in Iraqi pharmacies. Effective AMS in Iraq will require phased, system-level approaches, including strengthened regulatory enforcement, workforce support addressing all pharmacy personnel, and integration of community pharmacies into national AMR strategies.
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  Label: Contributed Indexing
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  Data: <i>Keywords: </i>Antimicrobial resistance; antimicrobial stewardship; community pharmacy; non-prescription antibiotic dispensing; simulated client methodology<br /><i>Local Abstract: </i>[plain-language-summary] Antimicrobial resistance (AMR) happens when bacteria stop responding to antibiotics, making infections harder to treat. In many countries, including Iraq, people can still buy antibiotics from community pharmacies without a prescription, which increases the risk of resistance. This study looked at how often and how responsibly antibiotics were sold in 696 pharmacies across five Iraqi cities. Researchers found that in over 80% of visits, antibiotics were given without a prescription. Nearly 40% were drugs that the World Health Organization classifies as higher-risk ‘Watch’ antibiotics. Most pharmacy staff did not ask important clinical questions or check for allergies before dispensing. These results show the urgent need for better antibiotic control and community pharmacy personnel training. Trained pharmacists could play an important role in improving antibiotic use in Iraq; however, our findings also show that other staff, including nurses, are often involved in dispensing antibiotics in community pharmacies. Ensuring safe and appropriate antibiotic use will therefore require clear regulations, proper oversight, and monitoring systems that address the practices of all personnel involved in medicine supply.
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        Text: English
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      – SubjectFull: Respiratory Tract Infections drug therapy
        Type: general
      – SubjectFull: Pharmacists organization & administration
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