title: Pathways for inappropriate dispensing of antibiotics for rhinosinusitis: a randomized trial.
abstract: We evaluated the extent of and factors that determine the inappropriate use of antibiotics that are obtained without a physician's prescription. Ninety-eight Greek pharmacists were visited by actress-researchers who played clients requesting antibiotics without a physician's prescription. Pharmacists were randomly challenged in a scenario that involved simulated cases of acute uncomplicated rhinosinusitis with either low fever (38.5 degrees C) or high fever (40 degrees C). Antibiotics were offered by 34 (69%) of 49 pharmacists who were presented with the high-fever scenario and by 42 (86%) of 49 pharmacists who were presented with the low-fever scenario (risk difference, 16.3%; P = .05). Thirty-two (65%) and 35 (71%) pharmacists in the high- and low-fever study arms, respectively, agreed to sell the actress-researchers broad-spectrum antibiotics. Only 28 (57%) and 17 (35%) pharmacists, respectively, recommended that the patient visit a physician (P = .03). Inappropriate recommendations regarding antibiotic use were very common in the studied setting. Antibiotics were more likely to be offered to persons who did not have a prescription when they were less likely to be clinically indicated.
authors.affiliation: Clinical Trials and Evidence-Based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
authors.forename: D G
authors.initials: DG
authors.lastname: Contopoulos-Ioannidis
authors.forename: I D
authors.initials: ID
authors.lastname: Koliofoti
authors.forename: I C
authors.initials: IC
authors.lastname: Koutroumpa
authors.forename: I A
authors.initials: IA
authors.lastname: Giannakakis
authors.forename: J P
authors.initials: JP
authors.lastname: Ioannidis
mesh_terms: D000900:Anti-Bacterial Agents / Q000600:supply & distribution* / Q000627:therapeutic use*; D011307:Drug Prescriptions; D005260:Female; D005334:Fever; D006115:Greece; D006801:Humans; D008508:Medication Errors; D016544:Patient Simulation; D010595:Pharmacists; D010604:Pharmacy; D012220:Rhinitis / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents