Objectives: The present study was conducted to describe and analyze antibiotic demands via prescription and non-prescription media received in private pharmacies in Lomé. Methods: A cross - sectional study was conducted in 26 private pharmacies in Lomé (Togo) from August to October 2013. The study was based on a survey conducted with a standardized questionnaire to collect data representing the daily activity of the pharmacies. Data on prescription documents, non-prescription media, patients’ and prescribers’ identification, and antibiotics requested were collected and analyzed. Key findings: During the study period, 596 antibiotic prescriptions were collected. Various prescription and non-prescription media permit ted available antibiotic access in private pharmacies. Seventy-nine percent (79%) of the received orders contained one antibiotic. All categories of health care professionals were found among antibiotic prescribers. Prescribers were not identifiable in 40.2% of all prescription tools received for antibiotics demand. Forty-four percent (44%) of antibiotic orders were supported by a prescription. The study found that many people ordering antibiotic (61%) were not the direct users. Some elements of prescription compliance were mentioned at the rate of 82%, 44.7% and 59% (date, prescribers’ identity and qualification), 3/4 of the prescription material (patients’ identity and sex), more than 87% (accuracy of the dosage), 79.7% (oral route of administration) and less than 1/3 (duration of treatment). The results also indicate d that Beta-lactams (41%), quinolones (17%), and 5-nitroimidazoles (15%) were the most prescribed classes of antibiotics. Conclusions: The study revealed that more than half of the antibiotics orders, received in pharmacies were non-compliant. This calls for an awareness of healthcare workers and populations on the rational use of antibiotics. Access to antibiotics should be further controlled (prescription dispensing), community should ban other media of obtaining antibiotics without a prescription and avoid particularly antimicrobial self-medication.
Medicines are the weapons to fight against disease but may also cause serious harm when used improperly [
A survey was carried out in private pharmacies in Lomé from August to October 2013. The choice of Lomé for this study is justified by the fact that it is the largest city and at the same time the capital of Togo. It is a cosmopolitan city characterized by a high concentration of care facilities (public, private and confessional), drug distribution structure, private pharmacies, health personnel of all categories (teachers, doctors, surgeons, medical-assistants, nurses, midwives...) and a better organized and more efficient health system. As a result, health needs are much more pronounced, with the attendant need for access to medicines, particularly antibiotics with or without prescriptions, which is the current problem because of the potential risk of resistance.
It was a cross-sectional study designated to provide a descriptive analysis of ATBs’ orders (or demands) received in private pharmacies.
Inclusion Criteria
All the prescriptions’ media containing at least one ATB were collected.
Exclusion Criteria
The prescriptions’ tools containing antibiotics for which the carriers refused to take part in our study.
We used the 2013 second semester duty program to select data collection sites. The area of Lomé was divided into 7 parts rated from 1 to 7. The collections’ sites (private pharmacies) were selected randomly in each part. The pharmacies eligible for data collection are shown in
We designed a questionnaire to collect the following information:
・ description of the prescription bearer: user or issuer;
・ description of the prescription document: prescription sheet, health record book, piece of paper, text message, drug packaging, oral request, and other media;
・ information on prescribed molecules: International Common Denomination (ICD), brand name, dosage, duration of treatment, route of administration;
・ qualification of the prescriber: physician (general practitioner, specialist), resident medical student, physician-assistant, nurse, mid-wife, and other prescribers (responsible, technical health officer, nursing aid, health scientist);
・ prescription issuing facility: university hospital, intermediate health care center (regional and district hospitals), health center, denominational facility, private facility, or unknown issuing facility;
・ patient information: identity, age, weight, and gender.
All drug prescription documents containing at least one ATB received at the research sites at the time of the survey were included in the study. The regulatory compliance of prescription documents was checked according to the standards of the World Health Organisation (WHO) [
596 antibiotic demand materials were received across 26 private eligible pharmacies during the period of the study.
About 61.0% (n = 366) of people who requested ATBs were not the direct beneficiaries. Patient’s verbal requests (23.3%) dominated among the demands without prescription followed by other media (8.9%) and external packaging (3.7%). The different kinds of antibiotic demand received are summarized in
Forty-four percent (44%) of ATB’s requests were made by submitting a formal prescription (prescription sheet (32.4%) and health record book (11.6%), n = 262) (
Eighty-two (82%, n = 310) percent of paper prescription media (prescription sheet, health record book, piece of paper, n = 378) were dated. Prescribers’ qualifications were mentioned in 59% of the orders registered. Three out of four paper prescription media mentioned patients’ identity and sex. The age of children is reported on 27% of prescription media and children’s weight on 23.1% (
Fifty one out of 193 antibiotic prescribers (40.2%) were not identified. The prescribers’ profile is summarized in
Type of access | Type of document | n | Frequency (%) |
---|---|---|---|
With prescription | Prescription sheet | 193 | 32.4 |
Health record book | 069 | 11.6 | |
Piece of paper | 116 | 19.5 | |
Without prescription | Patient's verbal request | 139 | 23.3 |
External packaging | 022 | 03.7 | |
Short message system | 004 | 00.7 | |
Other media | 053 | 08.9 | |
Total | 596 | 100.0 |
Prescription sheet | Health record book | Piece of paper | Total | (%) | |
---|---|---|---|---|---|
Physicians | 63 | 03 | 05 | 71 | 18.8 |
Physician assistants | 19 | 14 | 08 | 41 | 10.9 |
Midwives | 02 | 06 | 00 | 08 | 02.1 |
Nurses | 26 | 10 | 07 | 43 | 11.4 |
Other prescribers | 32 | 13 | 18 | 63 | 16.7 |
Unidentified prescribers | 51 | 23 | 78 | 152 | 40.2 |
(10.9) and midwives (2.1%).
The oral route (79.7%) was the most frequent administration way reported on antibiotic demand media (n = 596). The accuracy of the dosage (strength) was documented by the different types of healthcare facilities as shown in
More than 87% of prescribers mentioned the dosage on prescription documents as shown in
The duration of the treatment was not specified in more than 3/4 of the prescriptions issued from each type of facility (
The most prescribed or requested classes of ATBs were beta-lactams (40.9%),
quinolones (16.7%), 5-nitro-imidazoles (15.3%), aminosides (7.7%) and macrolides (5.7%) as shown in
The present work did not collect data for clinical use of antibiotic requested and patient recovery; hence the treatment outcome could not be determined. Moreover, we did not consider self-medication and its determinants.
As reported by some authors in their studies, information on antibiotic consumption is needed to control the development and spread of resistant bacteria
[
About 61.0% (n = 366) of the people who requested ATBs were not the direct users. To the best of our knowledge, there is little literature related to this topic. In our context, it is common that the applicant for medicines in general and ATB in particular who visits private pharmacies is not the direct beneficiary but rather a friend or a parent or even a child. This further increases the risk of antibiotic therapy since in case of advice for an adequate use of ATB, it is not sure that these pieces of advice will be faithfully transmitted to the real beneficiary of the treatment. This situation could cause misunderstanding and non-compliance with the treatment by the patient, which is a source of antimicrobial resistance.
Patient’s verbal requests (23.3%) dominated among antibiotic demands without prescription. They were followed by other media (8.9%) and external packaging (3.7%). There is not much literature concerning the media through which clients access antibiotics in private pharmacies. However, in Northern Ireland, more than 25% and 55% respectively of all systemic and topical antimicrobials were initiated following telephone consultations [
Forty-four percent (44%) out of 596 ATBs’ demand documents collected during the study period were supported by a formal prescription (prescription sheet, 32.4% and health record book, 11.6%). Chem et al. reported an overall percentage prescription with antibiotics of 36.7% in primary health care facilities in Cameroon [
Seventy-nine percent (79%) of the received documents in private pharmacies contained one ATB prescribed compared to the majority of prescriptions (87.42%) with one antibiotic in primary health care setting in Cameroon [
Our findings are compared with literature data as part of the prescriptions in general practice since antibiotic-specific prescription data are rare.
Eighty-two (82%, n = 310) percent of paper prescription media (prescription sheet, health record book, piece of paper, n = 378) were dated. In a study conducted in private and public pharmacies among random clients, Potchoo et al. reported that 73.04% of prescription media specified the date [
The identity and qualification of the prescribers were mentioned respectively in 44.7% and 59% of the orders received. Potchoo et al. reported that prescribers did not mention their name or their qualification in 47.75% and 33.04% of cases respectively [
Three out of four paper prescription media mentioned patients’ identity and sex. This rate is higher than that observed in the study carried out in 2009 by Potchoo et al. in which the orders did not mention patient’s name in 41.18% of prescription [
About 40.2% of ATB prescribers (51/193) were not identified against 33% as reported by Potchoo et al. in their study [
The accuracy of the dosage was documented by the different types of health care facilities and different category of prescribers but we did not find the data for comparison in literature. More than 87% of prescribers mentioned the dosage on prescription documents. This rate seems to be improved by sensitizations since Potchoo et al. (2009) report 54.51% of no dosage mention in their study [
The oral route (79.7%) was the most frequent administration way reported on antibiotic demand media (n = 596) compared to 54.51% of non-mention of the route of administration in the study published by Potchoo et al. [
The duration of treatment was not specified in more than 3/4 of prescriptions issued from all type of facility. The frequency of reporting the duration of treatment was less than 50% (33.8% for physicians, 17.1% for physician-assistants and 14% for nurses) compared with the study of Potchoo et al. in which the rate of mention of this parameter was 38.13% for physicians, 31.38% for physician-assistants, 27.06% for midwifes and 22% for nurses [
Beta-lactams (40.9%), quinolones (16.7%), 5-nitro-imidazoles (15.3%), aminosides (7.7%) and macrolides (5.7%) were the most purchased classes of ATBs. Musey et al. in a study finds 57.7% of beta-lactams, 14.9% of quinolones and 5.9% of 5-nitro-imidazoles [
In our context, various media with prescription or without prescription permitted antibiotic requestors to access antibiotic available in private pharmacies. The antibiotic requestor is either the direct beneficiary or a relative beneficiary including the children. The regulation in force in prescription matter is not fully respected with regard to the mention of information concerning the prescriber, the patient and those related to medicine (dosage, route and rhythm of administration, and duration of treatment) whatever the health care facility and the category of health professional. Almost all ATBs’ classes are prescribed in Lomé with a high frequency of beta-lactams, quinolones and 5-nitro-imidazoles. They are prescribed in all kinds of health care centers in which all categories of professionals prescribe them in any available media. Moreover, it is not rare to see a patient in a drugstore asking for ATBs because they feel the need of taking them. All those habits contribute to maintain and increase AMR cases. Access to antibiotics should be further controlled (prescription dispensing). Community should ban other media of obtaining antibiotics without a prescription and avoid particularly antimicrobial self-medication.
We would like to thank the pharmacy staff that took part in this study. We are also grateful to Professor Essowe K. Essizewa for reviewing the language quality of this work.
The authors declare no conflicts of interest regarding the publication of this paper.
Potchoo, Y., Mounerou, S., Soukouratou, R., Sika, D., Ekouevi, K.D., Mouhoudine, Y., Mireille, P.-D. and Dagnra, A.Y. (2019) Access to Antibiotics through Prescription and Non-Prescription Media in Private Pharmacies in Lomé, Togo. Pharmacology & Pharmacy, 10, 31-47. https://doi.org/10.4236/pp.2019.101004