Pathways for inappropriate dispensing of antibiotics for rhinosinusitis: a randomized trial

Clin Infect Dis. 2001 Jul 1;33(1):76-82. doi: 10.1086/320888. Epub 2001 Jun 5.


We evaluated the extent of and factors that determine the inappropriate use of antibiotics that are obtained without a physician's prescription. Ninety-eight Greek pharmacists were visited by actress-researchers who played clients requesting antibiotics without a physician's prescription. Pharmacists were randomly challenged in a scenario that involved simulated cases of acute uncomplicated rhinosinusitis with either low fever (38.5 degrees C) or high fever (40 degrees C). Antibiotics were offered by 34 (69%) of 49 pharmacists who were presented with the high-fever scenario and by 42 (86%) of 49 pharmacists who were presented with the low-fever scenario (risk difference, 16.3%; P = .05). Thirty-two (65%) and 35 (71%) pharmacists in the high- and low-fever study arms, respectively, agreed to sell the actress-researchers broad-spectrum antibiotics. Only 28 (57%) and 17 (35%) pharmacists, respectively, recommended that the patient visit a physician (P = .03). Inappropriate recommendations regarding antibiotic use were very common in the studied setting. Antibiotics were more likely to be offered to persons who did not have a prescription when they were less likely to be clinically indicated.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Anti-Bacterial Agents / supply & distribution*
  • Anti-Bacterial Agents / therapeutic use*
  • Drug Prescriptions
  • Female
  • Fever
  • Greece
  • Humans
  • Medication Errors*
  • Patient Simulation
  • Pharmacists*
  • Pharmacy
  • Rhinitis / drug therapy*
  • Sinusitis / drug therapy*


  • Anti-Bacterial Agents