Non-prescription supply of antibiotics for symptoms of upper respiratory tract infections in community pharmacies: a systematic review and meta-analysis

Background and objectives: Community pharmacies have been identified as important sources of non-prescription antibiotics. We aimed to estimate the proportion of consultations for symptoms of upper respiratory tract infections that resulted in non-prescription supply of antibiotics in community pharmacies globally. Design and methodology: We systematically searched the EMBASE, Medline and CINAHL databases for studies published from January 2000 to September 2017 reporting the frequency of non-prescription sale and supply of antibiotics for symptoms of upper respiratory tract infections in community pharmacies across the world. Additional articles were identified through checking of reference list and a Google Scholar search. A random effects meta-analysis was conducted to calculate pooled estimates of non-prescription supply of antibiotics. Results: Of the 3302 articles identified, 23 studies met the inclusion criteria and were included in the review. The overall pooled proportion of non-prescription supply of antibiotics was 67% (95% CI 55 - 79). Regional estimates of non-prescription supply of antibiotics for upper respiratory tract infections varied widely from as low as 47% (95% CI 17-77) in Southern and Eastern Europe to as high as 71% (95% CI 61-82) in Asia. Penicillins (37%, 95% CI 28-45) was the commonly supplied class of antibiotics. Pooled analysis by individual type of antibiotics supplied revealed that amoxicillin 53% (95% CI 34-71), amoxicillin-clavulanic acid (co-amoxiclav) 39% (95% CI 23-54) and azithromycin 19% (95% CI 11-27) were commonly supplied for upper respiratory tract infections. Conclusion: Antibiotics are frequently supplied without prescription to treat symptoms of upper respiratory tract infections. This overuse of antibiotics likely facilitates the development and spread of antibiotic resistance.