Dispensing Practices of Antibiotics among Community Pharmacies of Bharatpur, Nepal: A Simulated Patient Cross-Sectional Study

Background: The practice of community pharmacies dispensing antibiotics without a prescription is widespread, and improper use of these medications is associated with the emergence of resistance. Hence, this study aimed to evaluate the dispensing practices of antimicrobials in community pharmacies of Bharatpur city, Nepal. Materials and Methods: A cross-sectional study involving 101 community pharmacies of Bharatpur Metropolitan city was conducted for a duration of six months starting from 1st January 2022 till 30th June 2022. A simulated patient method was used to determine the antimicrobials dispensing practices using a case scenario of acute diarrhea. Using a simple random method, the community pharmacy was chosen as the study site from among the community pharmacies that were registered with the Department of Drug Administration (DDA). A trained pharmacists posing as a simulated patient gathered data, and the data was then analyzed using chi-square test to find out the association. Results: Ninety-three percent of the 101 community pharmacies dispensed antimicrobials without prescription. Among the most frequently dispensed medications were antimicrobials (53.5%), gastrointestinal agents (44.4%) and mineral supplements (2%). Moreover, the trend of dispensing antimicrobials was significantly higher among non-pharmacy professionals (p=0.014), including Health Assistants (64%), Community Medical Assistance (55.6%) and those with orientation training (42.9%). Conclusion: The study findings indicate that there is unquestionably irrational dispensing of antimicrobials in cases of acute diarrhea. To reduce this, it is necessary to prioritize awareness campaigns about the responsible use of antimicrobials, and to ensure that relevant policies, rules and regulations are implemented promptly.