Determinants of antibiotic dispensing without a medical prescription: a cross-sectional study in the north of Spain

J Antimicrob Chemother. 2014 Nov;69(11):3156-60. doi: 10.1093/jac/dku229. Epub 2014 Jun 24.


Objectives: Antibiotic resistance is a major public health concern and is greatly exacerbated by inappropriate antibiotic use at a community level. The aim of this study was to ascertain which attitudes of community pharmacists were related to inappropriate antibiotic dispensing.

Methods: We conducted a cross-sectional study of community pharmacists in a region situated in northern Spain (n = 393). Personal interviews were conducted using a self-administered questionnaire. The degree of agreement with each item of knowledge and attitude was measured using an unnumbered, horizontal visual analogue scale, with replies being scored from 0 (total disagreement) to 10 (total agreement). The data were analysed using logistic regression.

Results: Of the total of 286 pharmacists (72.8%) who completed the questionnaire, 185 (64.7%) acknowledged having undertaken dispensing of antibiotics without a medical prescription (DAwMP). Attitudes such as patient complacency, external responsibility, indifference and insufficient knowledge were shown to be related to DAwMP. In contrast, no association was found with any of the pharmacists' personal or professional traits.

Conclusions: This study confirms that, albeit unlawful, DAwMP is a common practice in Spanish pharmacies. DAwMP was seen to be usually associated with some of the attitudes evaluated.

Keywords: antibiotic usage; antimicrobial resistance; pharmacists.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Community Pharmacy Services / trends*
  • Cross-Sectional Studies
  • Drug Prescriptions*
  • Drug Resistance, Bacterial / drug effects*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Pharmacists / trends*
  • Spain / epidemiology
  • Surveys and Questionnaires


  • Anti-Bacterial Agents