OBJECTIVES: In resource-deprived healthcare systems, the drugstores are a prime point-of-care for less-informed people in the community and, likewise, the role of community pharmacists as frontline health worker has become critical in Covid-19. Therefore, the practices at the drugstores were evaluated to determine the level and type of antibiotics dispensed in mild Covid-19 scenario.

METHODS: Using a simulated client method, the mild symptoms of Covid-19 for a 10-years old child and a 27-years old adult were presented at both categories of drugstores (pharmacies and medical stores) in two cities of northern Punjab, Pakistan (Lahore and Rawalpindi). An equal number of pharmacies and medical stores were chosen by random sampling method from the list provided by the Primary & Secondary Healthcare Department Punjab (P&SHD). Chi-square test was applied to evaluate the differences in the level of antibiotics dispensed between age groups.

RESULTS: The simulated clients visited 362 drugstores out of which the antibiotics were dispensed in 250 (69.1%) cases. The excessive dispensing was observed in both cities, however, antibiotics were obtainable more often when the symptoms for a child were presented at the drugstores (p value=0.004) indicating higher rates of dispensing for children. Co-Amoxiclav and cefixime were the most commonly dispensed antibiotics; 28.4% and 24.0% respectively. Ciprofloxacin (13.6%) and amoxicillin (11.6%) were also dispensed in many visits. Less commonly dispensed antibiotics were levofloxacin (9.6%), azithromycin (7.2%), clarithromycin (4.8%) and moxifloxacin (0.8%).

CONCLUSIONS: The study revealed extensive availability of antibiotics at the drugstores for mild cases of Covid-19; more frequently in children. Therefore, strategic priority of the National Action Plan on AMR to mitigate use of antibiotics and to restrict their availability by prescription should be implemented as a moral and legal obligation to eradicate growing levels of resistant microbes in the community.