Comparison of Methods of Measuring Pharmacy Sales of Antibiotics without Prescriptions in Pratumthani, Thailand

Abstract

Mock-patient presentations and structured interviews of drugstore personnel were conducted to evaluate the sales of antibiotics without prescription in pharmacies at Pratumthami, Thailand. Data for mock-patient presentation were collected from 280 (89%), out of 315 drugstores identified, by interns who acted as patients having a friend with 1 of 5 common syndromic illnesses (acute viral pharyngitis, influenza, acute viral sinusitis, acute viral gastroenteritis, and noninfected skin abrasion) not needing antibiotic treatment. Structured interview was subsequently performed on pharmacists who prescribed antibiotics in the previous method. Appropriate dispensing of antibiotics for the 5 indications occurred at 56/280 (20%) of the drugstores during mock-patient presentations. Structured interview revealed that 26 (9%) pharmacies would sell antibiotics for any of the indications. In the mock presentations however, antibiotic treatment was dispensed by 207(74%) drugstores for acute viral pharyngitis, 182 (65%) for influenza, 224 (80%) for acute viral sinusitis, 213 (76%) for acute viral gastroenteritis, and 179 (64%) for noninfected skin abrasion. The median durations of prescribed therapy in the mock-patient were 7 days for acute viral pharyngitis, 7 days for influenza, 10 for acute viral sinusitis, 5 for acute viral gastroenteritis, and 6 days for noninfected skin abrasion. For the structured interview, the median durations reported were 3 days for acute viral pharyngitis, 3 days for influenza, 7 days for acute viral sinusitis, 3 days for acute viral gastroenteritis, and 2 days for noninfected skin abrasion. The reasons for inappropriate antibiotic dispensing in mock-presentation were fear of an untoward clinical outcome (139 pharmacies), inadequate knowledge (54 pharmacies), and inadequate and/or limited antibiotic supply (31 pharmacies). High patient demand was the reason of the interviewed pharmacists (26 pharmacies). Results indicate that the pharmacist interview method may overestimate appropriate antibiotic use and shorter duration of antibiotic therapy compared with the mock-patient presentation method.