title: Sale of antibiotics without a prescription at community pharmacies in urban China: a multicentre cross-sectional survey.
abstract: To quantify sales of antibiotics without a medical prescription and to assess the quality of pharmacy services in relation to the antibiotics sold in community pharmacies in urban China.
  
  
  
  A multicentre cross-sectional survey of community pharmacies was undertaken in 2015 using the simulated client method. Two clinical case scenarios (paediatric diarrhoea and adult acute upper respiratory infection) were presented at systematically sampled community pharmacies in Eastern (Nanjing), Central (Changsha) and Western China (Xi'an).
  
  
  
  Of 256 pharmacies, antibiotics were obtained without a prescription from 55.9% (95% CI: 49.5%-62.0%) when paediatric diarrhoea was simulated and from 77.7% (95% CI: 72.1%-82.7%) when adult respiratory infection was simulated. Of the pharmacies where antibiotics were dispensed, 83.9% and 66.3% dispensed after the simulated clients requested or insisted in the case of paediatric diarrhoea and adult respiratory infection, respectively. Significant differences ( P  < 0.001, χ 2 test) in inappropriate antibiotic dispensing were found among cities, with 57.7%, 37.3% and 73.7% in the case of paediatric diarrhoea and 60.8%, 80.7% and 96.1% in adult respiratory infection in Nanjing, Changsha and Xi'an, respectively. Pharmacists were available in only 14.8% (95% CI: 10.7%-19.8%) of the pharmacies. The performance of pharmacy staff regarding the provision of information and advice was unsatisfactory.
  
  
  
  Antibiotics were easily obtained without a prescription in community pharmacies in urban China. Measures to enhance the enforcement of prescription-only regulations and training programmes for pharmacy staff to promote the appropriate use of antibiotics are warranted.
authors.affiliation: Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.|Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chang
authors.affiliation: Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.|Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Ye
authors.affiliation: Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.|Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Lv
authors.affiliation: School of Pharmacy, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Minghuan
authors.initials: M
authors.lastname: Jiang
authors.affiliation: Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.|Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Shan
authors.initials: S
authors.lastname: Zhu
authors.affiliation: Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.|Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Kangkang
authors.initials: K
authors.lastname: Yan
authors.affiliation: Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.|Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.|Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Fang
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002681:China; D003132:Commerce; D003198:Computer Simulation; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000188:drug therapy; D011307:Drug Prescriptions; D006801:Humans; D010594:Pharmacies / Q000592:standards*; D012141:Respiratory Tract Infections / Q000188:drug therapy; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents