Economic and social drivers of antibiotic dispensing practices among community pharmacies in Nepal

OBJECTIVE To assess economic and social drivers of dispensing antibiotics without prescription by community pharmacies in Nepal.

METHOD A survey was conducted among 111 pharmacy owners and managers in five districts. Information on demographic and economic characteristics of the pharmacies (e.g., revenue and profits from antibiotics), and their inclination to sell antibiotics without a physician’s prescription under various scenarios (e.g., diarrhea in a child), was collected. Univariate analysis was conducted to assess the demographic and economic characteristics. Bivariate analysis was conducted to examine the relationship between dispensing antibiotics without prescription and economic and social factors.

RESULTS Azithromycin and amoxicillin were the most commonly dispensed antibiotics. The proportions of pharmacies reporting that they would ‘most likely’ or ‘likely’ dispense antibiotics without prescription to adult patients ranged between 36.9% (sore throat) to 67.6% (cough). The proportions for pediatric patients ranged between 62.2% (sore throat) to 80.2% (cough or diarrhea). There was no consistent relationship between the likelihood of dispensing antibiotics and revenues, profits, or the number of patients. Instead, dispensing behavior was influenced by the pressure from the patient; the respondents were more likely to dispense antibiotics when the patient specifically asked for “an antibiotic” rather than for “a medicine”, and 68.5% respondents ranked ‘customer satisfaction’ as the most important factor motivating their work.

CONCLUSIONS In Nepal, inappropriate sale of antibiotics by community pharmacists is high, particularly for pediatric patients. Additional research is needed to establish key drivers of this behavior and to help design effective approaches to reducing AMR.

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Work Title Economic and social drivers of antibiotic dispensing practices among community pharmacies in Nepal
Open Access
  1. Yubraj Acharya
  2. Prajwol Nepal
  3. Di Yang
  4. Kshitij Karki
  5. Deepak Bajracharya
  6. Tyler Prentis
  7. Susan L. Davis
  8. Linda Kaljee
License In Copyright (Rights Reserved)
Work Type Article
  1. Tropical Medicine and International Health
Publication Date May 1, 2021
Publisher Identifier (DOI)
Deposited August 19, 2021




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Work History

Version 1

  • Created
  • Added Revised_Manuscript_Abx_Nepal_12172020.docx
  • Added Creator Yubraj Acharya
  • Added Creator Prajwol Nepal
  • Added Creator Di Yang
  • Added Creator Kshitij Karki
  • Added Creator Deepak Bajracharya
  • Added Creator Tyler Prentis
  • Added Creator Susan L. Davis
  • Added Creator Linda Kaljee
  • Published
  • Updated
  • Updated
  • Updated