Prevalence and determinants of inappropriate antibiotic dispensing at private drug retail outlets in urban and rural areas of Indonesia: a mixed methods study

Introduction The aim of this mixed-method study was to determine the extent and determinants inappropriate dispensing antibiotics by licensed private drug retail outlets in Indonesia. Methods Standardised patients (SPs) made a total 495 visits 166 (community pharmacies stores) between July August 2019. SPs presented three clinical cases outlet staff: parent child at home with diarrhoea; an adult presumptive tuberculosis (TB); upper respiratory tract infection (URTI). primary outcome antibiotic without prescription, or client requesting it. We used multivariable random effects logistic regression assess factors associated conducted 31 interviews staff explore these greater depth. Results Antibiotic prescription occurred 69% SP visits. Dispensing more likely standalone attached clinics compared stores, OR 5.9 (95% CI 3.2 10.8) 2.2 1.2 3.9); for TB URTI SP-performed diarrhoea cases, 5.7 3.1 5.2 2.7 9.8). Interviews revealed that driven strong patient demand antibiotics, unqualified sellers medicines, competition different types outlets, owners pushing their sell weak enforcement regulations. Conclusion This shows is widespread. Interventions will need address not only role sellers, but also among clients push from compete other outlets.