Assessing community antibiotic usage and adherence as per standard treatment guidelines: A potential area to enhance awareness at community pharmacy settings.

Background: Antibiotic nonadherence significantly contributes to poor treatment outcomes and antimicrobial resistance. In Southeast Asia, including Bangladesh, community pharmacies are crucial in primary healthcare, and are key sources of over-the-counter antibiotics. However, understanding of adherence to the full course of community-dispensed antibiotics is limited. This study measured antibiotic adherence to Bangladesh government and WHO Standard Treatment Guidelines (STGs) among patients at community pharmacies and identifies associated factors.

Methods: A cross-sectional survey was conducted via phone among 358 respondents from four urban and rural areas of Bangladesh who participated in a previous antibiotic purchasing behavior survey. Descriptive analysis identified antibiotic use patterns, and adherence to the full course of antibiotics was assessed against STGs recommendations. Poisson regression model was used to explore correlations between patients' demographic characteristics, knowledge of antibiotic dosage, dosage regimen, and type of health-symptoms and adherence to the full course of antibiotics.

Results: Adherence to antibiotic dosage per STGs was 40.5 %. Patients consulting a registered medical practitioner were significantly more likely to adhere (Adj-PR: 3.81, 95 % CI: 2.82-5.14) compared to those who did not. Males were 32.0 % less likely to adhere than females (Adj-PR: 0.68, 95 % CI: 0.54-0.86). Rural residents demonstrated 37.0 % lower adherence compared to urban (Adj- PR: 0.63, 95 % CI: 0.45-0.87). Respondents who recalled the antibiotic dosage had a higher likelihood of adherence (Adj-PR: 2.04, 95 % CI: 1.06-3.93). Patients on 12-hourly regimens had higher adherence (Adj-PR: 1.55, 95 % CI: 1.03-2.33) than 6-hourly regimens. Patients with uncomplicated skin-infections had higher adherence (Adj-PR: 1.72, 95 % CI: 1.22-2.47), while other symptoms showed no significant association.

Conclusion: Targeted interventions in diverse healthcare settings are essential, including user-centric research and enhancing patient knowledge and involvement. Strengthening patient-physician relationships and involving community pharmacies in antimicrobial stewardship programs can improve antibiotic dispensing and counselling practices among drug-sellers.