ArticleThe Libyan journal of medicine2026
Non-prescription antibiotic dispensing in community pharmacies in jordan: a simulated patient study.
Article in The Libyan journal of medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Inappropriate antibiotic use in community settings is a major contributor to antimicrobial resistance, particularly in low- and middle-income countries where regulatory enforcement may be inconsistent. Community pharmacies are a critical interface between health systems and the public; however, real-world dispensing practices remain insufficiently characterized in many settings. This study evaluated the prevalence, behavioral drivers, and clinical quality of non-prescription antibiotic dispensing in Jordanian community pharmacies using a simulated patient methodology.A cross-sectional simulated patient study was conducted across 200 community pharmacies in Jordan. A standardized encounter involving a three-stage progressive escalation protocol assessed dispensing behavior under increasing patient demand. The primary outcome was antibiotic supply without a valid prescription. Secondary outcomes included clinical assessment, counseling, referral behavior, and antibiotic class supplied. Multivariable logistic regression was used to identify predictors of non-prescription dispensing and adequate clinical assessment.Antibiotics were dispensed without prescription in 162 encounters (81.0%; 95% CI, 75.6-86.4). During the initial symptom-based presentation, 110 pharmacies (55.0%) supplied antibiotics. Among pharmacies that initially declined, a direct antibiotic request resulted in additional dispensing in 44.4% of cases, while subsequent patient insistence led to further supply in 24.0%, producing a cumulative prevalence of 81.0%. Independent pharmacies (adjusted odds ratio [AOR], 2.48; 95% CI, 1.23-5.02) and rural locations (AOR, 2.02; 95% CI, 1.01-4.03) were associated with higher dispensing odds. History-taking occurred in 49.4% of dispensing encounters, allergy screening in 14.2%, and no counseling was provided in 29.0%. Broad-spectrum agents represented 73.5% of dispensed antibiotics.Non-prescription antibiotic dispensing remains widespread in Jordan and is influenced by patient pressure and practice characteristics. Strengthened regulatory enforcement, professional training, and public awareness interventions are urgently needed.
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