title: Antibiotic dispensation by Lebanese pharmacists: a comparison of higher and lower socio-economic levels.
abstract: BACKGROUND
  Indiscriminate use of antibiotics contributes to a global spread of antimicrobial resistance. Previous studies showed an excessive consumption of antibiotics purchased without medical prescription from community pharmacies, mainly in developing countries. There is a shortage of studies revealing the role of community pharmacists in the overuse of antibiotics. Our objective is to study the dispensing policy of non-medical prescription antibiotics in community pharmacies, assessing the possible influence of the socio-economic level of the area over this practice.
  
  
  METHODS
  A cross-sectional study was conducted between February and May 2011 among 100 pharmacists working in Beirut's pharmacies and its suburbs. Pharmacies were divided into 2 groups according to the socio-economic level of the population living in the pharmacy area. A self-administered questionnaire was filled by pharmacists.
  
  
  RESULTS
  Over-the-counter antibiotic availability existed in both higher and lower socio-economic areas: on the whole, 32% of antibiotics were dispensed without medical prescription, with higher frequency in lower socio-economic areas (p=0.003). Dispensing injectable antibiotics without medical prescription was significantly higher in lower socio-economic areas (p=0.021), as well as dispensing an association of 2 antibiotics without medical prescription (p=0.001). Pharmacists working in lower socio-economic areas recommended more frequent antibiotics to children and the elderly (p<0.001 and p=0.004, respectively).
  
  
  CONCLUSIONS
  Dispensing antibiotics without medical prescription in Beirut community pharmacies is a common practice, particularly in lower socioeconomic areas. This public health problem should be addressed at the social, educational, and legislative levels.
authors.affiliation: Faculty of Public Health, Section II, Lebanese University, Beirut, Lebanon. Electronic address: ritajfarah@hotmail.com.
authors.forename: Rita
authors.initials: R
authors.lastname: Farah
authors.affiliation: Doctoral School of Sciences and Technology, Lebanese University, Beirut, Lebanon. Electronic address: nathalie.lahoud@hotmail.com.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lahoud
authors.affiliation: Faculty of Public Health, Section II, Lebanese University, Beirut, Lebanon; Doctoral School of Sciences and Technology, Lebanese University, Beirut, Lebanon; Faculty of Pharmacy, Lebanese University, Beirut, Lebanon. Electronic address: pascalesalameh1@hotmail.com.
authors.forename: Pascale
authors.initials: P
authors.lastname: Salameh
authors.affiliation: Faculty of Public Health, Section II, Lebanese University, Beirut, Lebanon; Doctoral School of Sciences and Technology, Lebanese University, Beirut, Lebanon. Electronic address: nadeensh@gmail.com.
authors.forename: Nadine
authors.initials: N
authors.lastname: Saleh
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003157:Community Pharmacy Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data*; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics / Q000706:statistics & numerical data*; D007861:Lebanon; D008297:Male; D004366:Nonprescription Drugs / Q000600:supply & distribution; D010595:Pharmacists; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents; D004366:Nonprescription Drugs
keywords: Community pharmacist; Dispensing antibiotics; Lebanon; Medical prescription; Socio-economic level