Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance

Sono, Tiyani Milta and Yeika, Eugene and Cook, Aislinn and Kalungia, Aubrey and Opanga, Sylvia A. and Acolatse, ,Joseph Elikem Efui and Sefah, Israel Abebrese and Jelić, Ana Golić and Campbell, Stephen and Lorenzetti, Giulia and Mustafa, Zia Ul and Marković-Peković, Vanda and Kurdi, Amanj and Paramadhas, Bene D Anand and Rwegerera, Godfrey Mutashambara and Amu, Adefolarin A and Alabi, Mobolaji Eniola and Wesangula, Evelyn and Oluka, Margaret and Khuluza, Felix and Chikowe, Ibrahim and Fadare, Joseph O. and Ogunleye, Olayinka O. and Kibuule, Dan and Hango, Ester and Schellack, Natalie and Ramdas, Nishana and Massele, Amos and Mudenda, Steward and Hoxha, Iris and Moore, Catrin E. and Godman, Brian and Meyer, Johanna C. (2023) Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance. Expert Review of Anti-infective Therapy, 21 (10). pp. 1025-1055. ISSN 1744-8336 (https://doi.org/10.1080/14787210.2023.2259106)

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Abstract

Introduction: Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. Areas covered: A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing without a prescription). However, considerable variation with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centring on educating pharmacists and patients. Expert Opinion: ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists’ activities to reduce inappropriate dispensing. Such activities, alongside educating patients and HCPs, should enhance appropriate dispensing of antibiotics and reduce AMR.

ORCID iDs

Sono, Tiyani Milta, Yeika, Eugene, Cook, Aislinn, Kalungia, Aubrey, Opanga, Sylvia A., Acolatse, ,Joseph Elikem Efui, Sefah, Israel Abebrese, Jelić, Ana Golić, Campbell, Stephen, Lorenzetti, Giulia, Mustafa, Zia Ul, Marković-Peković, Vanda, Kurdi, Amanj ORCID logoORCID: https://orcid.org/0000-0001-5036-1988, Paramadhas, Bene D Anand, Rwegerera, Godfrey Mutashambara, Amu, Adefolarin A, Alabi, Mobolaji Eniola, Wesangula, Evelyn, Oluka, Margaret, Khuluza, Felix, Chikowe, Ibrahim, Fadare, Joseph O., Ogunleye, Olayinka O., Kibuule, Dan, Hango, Ester, Schellack, Natalie, Ramdas, Nishana, Massele, Amos, Mudenda, Steward, Hoxha, Iris, Moore, Catrin E., Godman, Brian and Meyer, Johanna C.;
CORE (COnnecting REpositories)