title: Community pharmacists' knowledge, attitude, and practices towards dispensing antibiotics without prescription (DAwP): a cross-sectional survey in Makkah Province, Saudi Arabia.
abstract: OBJECTIVE
  To evaluate knowledge, attitude, and practices of community pharmacists towards dispensing antibiotics without prescription (DAwP) in Makkah Province, Saudi Arabia.
  
  
  METHODS
  A cross-sectional survey was conducted between January and February 2016 using a structured, validated, and pilot-tested questionnaire. A four-step systematic approach was used to recruit community pharmacists who completed a 28-item questionnaire either in English or Arabic language based on their personal preference.
  
  
  RESULTS
  Of the 200 community pharmacists approached, 189 completed the questionnaire. More than two-thirds (70.5%) of the pharmacists were not aware that DAwP is illegal practice. Lack of patient willingness to consult a physician for a non-serious infection (69.9%) and an inability to afford a consultation with a physician (65.3%) were the most common reasons cited for DAwP. A statistically significant association was found between the number of antibiotics dispensed and educating patients about the importance of adherence and completion of the full course of antibiotics (p=0.007).
  
  
  CONCLUSIONS
  In general, community pharmacists have a poor understanding of the regulations prohibiting the over-the-counter sale of antibiotics in Saudi Arabia, explaining the high rate of DAwP in the country. A multifaceted approach consisting of educational interventions and improving the access to and affordability of healthcare facilities for the general public is required to effectively reduce DAwP and its negative consequences on public health.
authors.affiliation: Department of Clinical Pharmacy, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia; School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK. Electronic address: m.a.hadi@leeds.ac.uk.
authors.forename: Muhammad Abdul
authors.initials: MA
authors.lastname: Hadi
authors.affiliation: Department of Clinical Pharmacy, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Nedaa Ali
authors.initials: NA
authors.lastname: Karami
authors.affiliation: Department of Clinical Pharmacy, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Anhar S
authors.initials: AS
authors.lastname: Al-Muwalid
authors.affiliation: Department of Clinical Pharmacy, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Areej
authors.initials: A
authors.lastname: Al-Otabi
authors.affiliation: Department of Clinical Pharmacy, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Eshtyaq
authors.initials: E
authors.lastname: Al-Subahi
authors.affiliation: Department of Clinical Pharmacy, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Asmaa
authors.initials: A
authors.lastname: Bamomen
authors.affiliation: Department of Clinical Pharmacy, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia; Pharmaceutical Research Centre, Deanship of Scientific Affairs, Umm-Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Mahmoud M A
authors.initials: MM
authors.lastname: Mohamed
authors.affiliation: Department of Clinical Pharmacy, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia; Pharmaceutical Research Centre, Deanship of Scientific Affairs, Umm-Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Mahmoud E
authors.initials: ME
authors.lastname: Elrggal
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010594:Pharmacies; D010595:Pharmacists; D055553:Prescription Drugs; D012529:Saudi Arabia; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents; D055553:Prescription Drugs
keywords: Antimicrobial resistance; Community pharmacists; Over-the-counter; Pilgrims; Prescription; Quality use of antibiotics