System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Epublish 2 citations

PubMed: 42433647 DOI: 10.1080/20523211.2026.2691452

A point prevalence survey on antibiotic dispensing practices identifies targets for quality improvement of antimicrobial stewardship in community pharmacies in Dar es Salaam, Tanzania.

J Pharm Policy Pract 19(1):2691452

Authors: Mary Migiro, Mtebe Majigo, Agricola Joachim, Doreen Kamori, Salim Masoud, Upendo Kibwana, Bjørn Blomberg, Joel Manyahi

Affiliations

  • Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
  • Department of Clinical Science, University of Bergen, Bergen, Norway.
  • Department of Medicine, National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway.

Abstract

BACKGROUND

Inappropriate antibiotic use is a major driver of antimicrobial resistance (AMR), especially in low- and middle-income countries (LMICs), where over-the-counter antibiotics are readily available without a prescription. This study assessed antibiotic dispensing practices in community pharmacies in Dar es Salaam, Tanzania.

METHODOLOGY

From February to March 2025, a point prevalence survey was conducted in 100 community pharmacies in Dar es Salaam. Researchers approached existing customers, obtained consent, and conducted confidential interviews. Five participants were enrolled per pharmacy, for a total of 500 participants.

RESULTS

Overall, 64% (320/500) of community pharmacy attendees were dispensed antibiotics, of whom 71% (227/320) received them without a prescription. Access-group antibiotics were most frequently dispensed (56%, 201/356), followed by Watch (32%, 115/356) and Reserve groups (3%, 10/356), with metronidazole (15%, 53/356) and azithromycin (12%, 44/356) being the most commonly dispensed antibiotics. Urinary tract infection (UTI) was the leading indication (37%, 119/320), mainly treated with azithromycin (25%, 35/138), ciprofloxacin (12%, 16/138), and nitrofurantoin (7%, 9/138). Among antibiotic recipients, 44% (140/320) received antibiotics based on dispensers' recommendations. Ceftriaxone was commonly dispensed with prescriptions, while all Reserve antibiotics were dispensed without prescriptions. Participants with technical/vocational education (adjusted prevalence ratio [aPR], 1.38, 95% CI: 1.13-1.68, p = 0.001) were more likely to be dispensed antibiotics than those with no formal education or primary and secondary education, and a borderline association was found for college/university education (aPR, 1.22, 95% CI: 0.99 - 1.48, p = 0.05). The presence of an underlying medical condition was an independent protective factor against antibiotic dispensing (aPR, 0.70; 95% CI: 0.49-0.88; p = 0.005).

CONCLUSION

Most clients attending community pharmacies in Dar es Salaam receive antibiotics without prescriptions, often based on dispensers' recommendations. The widespread use of Watch and Reserve antibiotics without oversight highlights major regulatory gaps and the urgent need for stronger policy enforcement and antimicrobial stewardship.

MeSH

Pharmacies, Pharmacy, Prescriptions, Antimicrobial Stewardship, Prevalence, Azithromycin, Education, Quality Improvement