Inappropriate dispensation of antimicrobials in pharmacies in Santa Cruz de la Sierra, Bolivia

Background: Although, since 1996, all medications must have been prescribed by a health professional (doctors or dentists) and their dispensation supervised by a pharmacist (Law 1737), recently in February 2017, the State Agency for Medicines and Health Technology (AGEMED) delivered the statement 00781, “CONTAINMENT OF ANTIMICROBIAL RESISTANCE”, establishing the obligation to comply with and apply Law 1737. However, the compliance to this provision has been irregular. The aim of this study was to determine the frequency of inappropriate dispensation of antimicrobials in pharmacies in Santa Cruz de la Sierra, Bolivia when clinical simulated situations where used (hidden client) Methods & Materials: A point-prevalence survey, was carried out between April and June 2017, in pharmacies in Santa Cruz de la Sierra, Bolivia. Through a simulation technique the antimicrobial dispensation was evaluated against two clinical situations: a) upper acute respiratory infection (URI); b) acute diarrhea (AD). Students of the last year of Pharmacy career were trained as patients to simulate the situations described above. Spontaneous and induced antimicrobial dispensation was evaluated. In all cases, the simulation was carried out without medical prescription. The antimicrobial delivery rate was evaluated as a percentage of the total contacts. The antimicrobials were grouped by family and by clinical situation. Results: Ninety-two pharmacies (86%) out of a total of 107 establishments were evaluated. Eighty (86%) of the pharmacies were tested by URI simulation and the rest (14%) by AD clinical situation. Antimicrobials were dispensed in 56 (61%) of the total simulations (54% spontaneous and 46% induced). In the rest of contacts (39%) the antimicrobials were not dispensed, even after the induction. While in the URI, the antimicrobials dispensed were: aminopenicillins (51%); macrolides (38%); Fluoroquinolones (8%) and cotrimoxazole (2%), in AD, the antimicrobials were: cotrimoxazole (86%) and nifuroxazide (14%). Dosing errors were also detected. Of total antimicrobials, 82% were dispensed by pharmacy assistants and 18% by pharmacists. Conclusion: Although in our country there is a norm that requires the dispensation of antimicrobials exclusively on prescription, it was not fulfilled in most of cases, allowing patients to access these agents without any control, increasing the risk of adverse events, drug interactions and development of resistance.