Study of the Drivers of Inappropriate Use of Antibiotics in Community Pharmacy: Request for Antibiotics Without a Prescription, Degree of Adherence to Treatment and Correct Recycling of Leftover Treatment.

Introduction: The WHO considered antibiotic resistance as 1 of the 10 greatest threats to global health in 2019. The inappropriate and indiscriminate use of antibiotics, together with the lack of new therapeutic alternatives, may eradicate their effectiveness in the closest future.

Objective: The general objective is to analyze the different causes attributable to patients, providers and pharmacists that could be drivers of irrational use of antibiotics, and responsible for the appearance of bacterial resistance, in community pharmacies. To this end, the different processes or indicators were studied: patients' requests of antibiotics at the pharmacy, their degree of adherence, satisfaction with the prescribed treatment and antibiotics' surplus recycling.

Methods: This study was observational, descriptive, and cross-sectional, carried out in 2 pharmacy offices, including 333 participants. At the time of dispensing, first phase, surveys to collect patients', providers' and pharmacists' data were carried out over the counter. The second phase, with the aim of checking adherence, degree of satisfaction and recycling.

Results: There were 333 requests for antibiotic regardless prescription availability, 17% of the patients requested an antibiotic without having one. 38% of patients did not have full adherence to antibiotics. Exploring non-adherence reasons, 24% forgot to take the treatment, 2% experienced adverse effects; 8% improved infection symptoms and 21% had problems to follow schedule. Regarding the recycling habits, 57% of patients had leftover treatments at home, but only 11% recycled it. 10% of medical prescriptions were forced by the patient, and significant gender differences were observed in adherence and knowledge of treatment.

Conclusion: The results of this study suggested that there may be a significant level of antibiotic inappropriate use locally, potentially related to patients' sex, finding significant deficiencies in prescription by doctors, in the dispensing act carried out in community pharmacies, and finally in patient compliance with treatment.