Abstract
BACKGROUND: Antimicrobial resistance (AMR) is a major global threat, projected to cause 10 million deaths annually by 2050, mostly in sub-Saharan Africa. Indiscriminate dispensing and policy non-adherence worsen AMR, yet non-prescription antimicrobial use persists. This study examines over-the-counter (OTC) antimicrobial dispensing by pharmacy personnel in Lusaka Province, Zambia. OBJECTIVE: To describe OTC antimicrobial dispensing by retail pharmacy personnel in Lusaka Province and its implications for AMR. METHODS: We conducted a cross-sectional survey using simulated clients at 142 retail pharmacies to assess OTC antimicrobial dispensing practices. RESULTS: Of the 142 retail pharmacies in Lusaka visited by simulation clients seeking antimicrobials without prescriptions, 90.1% complied with the requests. While 28.9% mentioned that a prescription was needed, only 25.4% advised clients to obtain one. Additionally, 83.3% recommended buying antimicrobials instead of visiting a hospital, with in-pharmacy treatment rates of 86.7% for Upper Respiratory Tract Infection symptoms, 90.5% for cough and 91.7% for sore throat. CONCLUSIONS: We observed a high level of OTC antimicrobial dispensing among retail pharmacy personnel in Lusaka Province, which may hinder efforts to combat AMR in Zambia. Although the study lacked qualitative data to explore the reasons behind this practice, such research is urgently needed. Nonetheless, our findings highlight the need for the ZMRA to enhance monitoring of retail pharmacies to ensure adherence to international antimicrobial dispensing standards and help reduce AMR.