title: Antibiotics Dispensing for URTIs by Community Pharmacists (CPs) and General Medical Practitioners in Penang, Malaysia: A Comparative Study using Simulated Patients (SPs).
abstract: BACKGROUND
  In Malaysia, doctors in private clinics (often called dispensing doctors) are permitted to dispense medicines. This potentially may compromise rational dispensing of medicines in general and antibiotics in particular.
  
  
  OBJECTIVE
  This study explored, assessed and compared dispensing of antibiotics between Community Pharmacist (CP) and General Practitioners (GPs) regarding symptomatic diagnosis, antibiotic categories, adherence to therapeutic doses and promotion of generic antibiotics.
  
  
  METHODS
  The study used trained Simulated Patients (SPs), who used a scenario of common cold symptoms at GP private clinics and community pharmacies to observe and explore the practice of antibiotics dispensing. The study was conducted within the period of May to September 2011 in Penang, Malaysia. The data was analysed using descriptive statistics, Chi-square and Fisher's Exact Tests at alpha level of 0.05.
  
  
  RESULTS
  GPs dispensed more antibiotics than CPs (p= 0.001) for common cold symptoms. They dispensed more Amoxicillin (n = 14, 35%) than CPs (n = 11, 11%) (p < 0.001) and more Tetracycline (n = 3, 7.5%) while no CP dispensed this category (p = 0.022). On the other hand, CPs (n = 11, 11%) suggested brand antibiotics where as GPs dispensed only generic antibiotics (p < 0.001). Generally GPs comply better with the symptomatic diagnosis standard e.g. when asking SPs about the symptoms they had, all GPs (n = 40, 100%) complied better with this standard. Despite that, they dispensed more antibiotics (n = 26, 65%) than CPs (n = 29, 29%) (p = 0.001). GPs (n = 22, 55%) also are better than CPs (n = 16, 16%) in adherence to therapeutic doses (p< 0.001).
  
  
  CONCLUSIONS
  Findings showed poor adherence to rational dispensing of antibiotics by both providers. Although, GPs adhere better to symptomatic diagnosis and therapeutic dosing of antibiotics than CPs, they unnecessarily prescribe and dispense more antibiotics for Upper respiratory tract infection (URTI) symptoms. Establishing prescription guidance and regulatory actions, especially for URTIs treatment, and separating of medication dispensing are seemed to be crucial steps for the reform.
authors.affiliation: PhD Candidate, Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia Penang, Malaysia .
authors.forename: Alamin Hassan M A
authors.initials: AH
authors.lastname: Alabid
authors.affiliation: Professor of Social & Administrative Pharmacy, Associate Dean of Research & Graduate Studies Affairs, College of Pharmacy , P.O. Box 2713, Qatar University, Doha, Qatar .
authors.forename: Mohamed Izham Mohamed
authors.initials: MI
authors.lastname: Ibrahim
authors.affiliation: Professor of Social & Administrative Pharmacy, Associate Dean of Research & Graduate Studies Affairs, College of Pharmacy , P.O. Box 2713, Qatar University, Doha, Qatar .
authors.forename: Mohamed Azmi
authors.initials: MA
authors.lastname: Hassali
keywords: Community pharmacists; Dispensing doctors; Dispensing separation; General practitioners; Simulated patients ligament