Nationwide Survey of Antimicrobial Dispensation and Training in Pharmacies and Nonpharmacy Stores in the Dominican Republic

Abstract

Background: Antimicrobial use in low- and middle-income countries (LMICs) can play a major role in the development of antimicrobial resistance (AMR). In many LMICs, antimicrobials can be dispensed without prescriptions; they often available in pharmacies and nonpharmacy stores alike. We conducted a nationwide survey to describe the availability and antimicrobial dispensation practices in pharmacies and nonpharmacy stores in the Dominican Republic. Methods: A survey was administered to staff responsible for dispensing antimicrobials at pharmacies and nonpharmacy stores in the Dominican Republic. Stores were randomly selected from March through November 2019 in 7 cities representing all geographic regions of the Dominican Republic. Data on availability of antimicrobials and staff education on antimicrobial use were obtained. Case scenarios with commons symptoms were used to survey staff on antimicrobial use recommendations. Symptoms included dysuria, throat pain, diarrhea, fever, and cough. The availability of antimicrobials ordering by phone and via online delivery was assessed for each store. Results: Staff from 125 stores were invited to participate; 34 pharmacies and 48 nonpharmacy stores participated and 43 refused to participate. Overall, 200 antimicrobial use recommendations were given in pharmacies and 43 in nonpharmacy stores. The most common type of antimicrobial use recommendations were aminopenicillins (Fig. 1). Staff received prior training or education on antimicrobials in 61% of pharmacies and 0% of nonpharmacy stores. Antimicrobial recommendations by case scenario in pharmacies and nonpharmacy stores are shown in Figs. 2 and 3. Antimicrobials are available for phone order in 80% of pharmacies and 90% of nonpharmacy stores. No antimicrobials were available via online delivery apps. Conclusions: Antimicrobials are widely available in the Dominican Republic and can be obtained without a prescription, in person or via delivery. Staff at pharmacy stores recommended different antimicrobials by symptom, whereas staff at nonpharmacy stores commonly recommended aminopenicillins for all symptoms. Training or education on antimicrobial use was common for staff at pharmacy stores but nonexistent for staff at nonpharmacy stores. In LMICs with easy access to antimicrobials, frontline staff in pharmacies and nonpharmacy stores are gatekeepers for antimicrobial use and may represent an important target for outpatient antimicrobial stewardship initiatives.

Funding: None

Disclosures: None