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Influence of Antibiotic Dispensing Practices on Antibiotic Use among Community Residents in Nigeria

Abstract

Antibiotics are essential medicines for the treatment of bacterial infections, but inappropriate antibiotic use is an important public health concern because it can contribute to antimicrobial resistance, treatment failure, adverse drug reactions, and unnecessary healthcare expenditure. Community pharmacies and medicine outlets play an important role in determining how antibiotics are supplied and used within communities. Antibiotic dispensing practices refer to the procedures and professional behaviours involved in the supply of antibiotics to patients or consumers, including assessment of symptoms, verification of prescriptions, provision of dosage and administration instructions, counselling on treatment duration, advice on adherence, information on adverse effects, and guidance on appropriate antibiotic use. Antibiotic use refers to the manner in which community residents obtain and consume antibiotics, including the indication for use, source of the medicine, adherence to recommended dosage and duration, use without professional advice, sharing of antibiotics, use of leftover medicines, and discontinuation of treatment when symptoms improve. In Nigeria, antibiotics may be obtained from different sources, including community pharmacies and medicine outlets, and inappropriate dispensing practices may contribute to self-medication, non-prescription antibiotic use, incorrect dosing, incomplete treatment courses, and other forms of inappropriate antibiotic use. Effective and responsible antibiotic dispensing may therefore contribute to safer antibiotic-use practices among community residents. Against this background, this study investigates the influence of antibiotic dispensing practices on antibiotic use among community residents in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and the Knowledge-Attitude-Practice framework. The Health Belief Model provides a framework for understanding antibiotic-use behaviour through perceived susceptibility to infection, perceived severity of illness, perceived benefits of appropriate antibiotic use, perceived barriers, and cues to action. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, observational learning, social influences, and environmental factors in shaping medicine-use behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how dispensing practices and related medication counselling may influence residents' knowledge and attitudes and translate these into appropriate antibiotic-use practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how antibiotic dispensing practices may influence antibiotic use among community residents in Nigeria. The study will adopt a quantitative cross-sectional research design. Primary data will be collected from community residents and antibiotic-dispensing outlets in selected Nigerian communities using structured questionnaires, antibiotic-use assessment tools, and standardized antibiotic dispensing-practice checklists. A multistage sampling technique will be employed to select states, local government areas, communities, community pharmacies or medicine outlets, and eligible adult residents. Antibiotic dispensing practices will be assessed using indicators such as prescription verification, assessment of the reason for antibiotic use, provision of dosage instructions, explanation of treatment duration, adherence counselling, information on possible adverse effects, advice against sharing antibiotics, guidance on appropriate storage, and recommendations to seek medical attention when necessary. Where feasible, simulated-client or mystery-client assessments may be used alongside direct observation and dispenser questionnaires to objectively assess actual dispensing practices. Antibiotic use among community residents will be assessed using indicators such as source of antibiotics, prescription versus non-prescription use, self-medication, adherence to prescribed dosage and duration, use of leftover antibiotics, sharing of antibiotics, discontinuation when symptoms improve, and use of antibiotics for conditions that may not require antibiotic treatment. Descriptive statistics will be used to summarize residents' sociodemographic characteristics, antibiotic-use patterns, and dispensing practices. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the influence of antibiotic dispensing practices on antibiotic use. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, multicollinearity, and robustness of the findings. The study is expected to find that appropriate antibiotic dispensing practices have a significant positive influence on responsible antibiotic use among community residents in Nigeria. Residents who obtain antibiotics from outlets where appropriate dispensing and counselling practices are consistently observed are expected to demonstrate better adherence to recommended dosage and treatment duration, greater understanding of antibiotic use, and reduced reliance on inappropriate self-medication. Effective counselling is expected to improve residents' awareness of the importance of completing prescribed treatment, avoiding unnecessary antibiotic use, not sharing medicines, and seeking professional healthcare advice when symptoms persist or worsen. Conversely, dispensing practices that allow antibiotics to be supplied without appropriate assessment or prescription verification may be associated with inappropriate self-medication, incorrect dosing, incomplete treatment, and unnecessary antibiotic consumption. However, dispensing practices alone may not fully determine antibiotic use because residents' behaviour may also be influenced by medicine costs, previous experiences, health beliefs, accessibility of healthcare facilities, availability of antibiotics, peer influence, and health information obtained from other sources. Consequently, responsible dispensing should be supported by antimicrobial-stewardship education, effective regulation, accessible healthcare services, and community-level awareness programmes. The study is expected to contribute to the literature on antibiotic dispensing practices, antibiotic use, antimicrobial stewardship, community pharmacy practice, pharmaceutical care, self-medication, medication safety, health education, and public health in Nigeria by providing empirical evidence on the influence of dispensing practices on antibiotic-use behaviour among community residents. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Pharmacists Council of Nigeria, regulatory authorities, community pharmacies, medicine outlets, pharmacists, pharmacy technicians, physicians, public health practitioners, health educators, antimicrobial-stewardship programmes, development partners, and policymakers regarding strategies for promoting responsible antibiotic use. The study will also provide evidence-based recommendations for strengthening prescription verification, improving antibiotic counselling, enhancing antimicrobial-stewardship training for medicine dispensers, strengthening monitoring and regulation of antibiotic dispensing, improving community awareness of antibiotic risks, and promoting appropriate antibiotic use among community residents in Nigeria.

Keywords: Antibiotic dispensing practices, antibiotic use, community residents, Nigeria, antimicrobial stewardship, community pharmacy, antibiotic misuse, self-medication, medication safety, pharmaceutical care, antibiotic resistance, health education, responsible medicine use, public health.