Current knowledge and attitudes toward antibiotic use among community pharmacy personnel in a rural province in South Africa and the implications

Tiyani Milta Maluleke^1,2Morgan Tiyiselani Maluleke²Ana Golić Jelić³Stephen M Campbell^1,4Vanda Marković-Peković³Natalie Schellack⁵Nishana Ramdas¹Brian Godman^1,6,7*Johanna Catharina Meyer¹

• ¹Sefako Makgatho Health Sciences University, Pretoria, South Africa
• ²Saselamani Pharmacy, Saselamani, South Africa
• ³Univerzitet u Banjoj Luci, Banja Luka, Bosnia and Herzegovina
• ⁴The University of Manchester, Manchester, United Kingdom
• ⁵University of Pretoria, Pretoria, South Africa
• ⁶Laboratory Medicine Clinical Pharmacology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Faculty of Science, University of Strathclyde, Glasgow, United Kingdom
• ⁷St George's University of London, London, United Kingdom

Background: Antimicrobial resistance (AMR) is an appreciable threat to public health especially among low- and middle-income countries (LMICs), exacerbated by high levels of inappropriate prescribing and dispensing of antibiotics in these countries. There have been variable levels of dispensing of antibiotics without a prescription among community pharmacies in South Africa. Given the importance of community pharmacies, especially in rural South Africa, there is a need to assess their knowledge and attitudes towards antibiotics, AMR and antibiotic stewardship. This was the aim of this study. Methods: Administer a previously piloted questionnaire to all currently operating community pharmacists in a rural province in South Africa where dispensing of antibiotics without a prescription is likely to be greatest. The questionnaire included key knowledge questions regarding antibiotics and AMR as well as ways to reduce AMR. Community pharmacies were divided into three: Independent, Chain and Franchise. Results: 128 pharmacies participated (75.7%), with independent pharmacies representing the majority (60.9%). 313 completed questionnaires were returned (78.3% response rate) including from 106 pharmacists (33.9%) and 207 pharmacist assistants (66.1%). Overall, there was very good knowledge among both community pharmacists and pharmacist assistants concerning antibiotics and AMR. However, a significant misconception regarding the potential role of antibiotics to relieve pain. Encouragingly, attitudes regarding the risks associated with obtaining antibiotics without a prescription among both community pharmacists and pharmacist assistants were high. There was also strong agreement among both community pharmacist and pharmacist assistants for potential solutions to AMR. Conclusion: Overall, the findings showed that the vast majority of pharmacists and pharmacist assistants in this rural province demonstrated a strong understanding of the effectiveness of antibiotics in bacterial infections and their lack of effectiveness for viral infections. They also demonstrated considerable knowledge regarding the risks associated with inappropriate dispensing of antibiotics without a prescription as well as ways to address rising AMR rates.