Dispensing of antibiotics without prescription in the metropolitan area of Athens, Greece, in 2021-Can new legislation change old habits?

Ioannis Kopsidas; Lydia Kokkinidou; Dioni Pinelopi Petsiou; Eleni Kourkouni; Christos Triantafyllou; Grammatiki-Christina Tsopela; Theoklis Zaoutis

doi:10.1017/ash.2022.357

Dispensing of antibiotics without prescription in the metropolitan area of Athens, Greece, in 2021-Can new legislation change old habits?

Antimicrob Steward Healthc Epidemiol. 2023 Mar 2;3(1):e40. doi: 10.1017/ash.2022.357. eCollection 2023.

Authors

Ioannis Kopsidas^{1

2}, Lydia Kokkinidou², Dioni Pinelopi Petsiou², Eleni Kourkouni², Christos Triantafyllou², Grammatiki-Christina Tsopela², Theoklis Zaoutis^{1

2}

Affiliations

¹ Second Department of Pediatrics, National and Kapodisitrian University, Athens, Greece.
² Center for Clinical Epidemiology and Outcomes Research, Athens, Greece.

Abstract

Objective: To assess the effect of new legislation on the dispensing of antimicrobials without prescription from pharmacies in Greece.

Design: In-person survey.

Setting: The study included 110 pharmacies in the greater Athens Metropolitan area.

Methods: Volunteer collaborators visited 110 pharmacies in the greater Athens Metropolitan area in December 2021 and January 2022. They asked for either ciprofloxacin or amoxicillin-clavulanate acid (6:5 ratio) without providing a prescription, without simulating symptoms, and without offering justification or insisting. Fluoroquinolones have additional dispensing restrictions in Greece. Results were compared to a 2008 study. In 2020, legislation allowed the dispensing of antibiotics from pharmacies only with an electronic prescription, overriding the 1973 forbidding the dispensing of all medications without prescriptions.

Results: All pharmacists refused to dispense ciprofloxacin without a prescription. Only 1 pharmacy dispensed amoxicillin-clavulanate without a prescription. Compared to the 2008 study, dispensing of amoxicillin-clavulanate without a prescription dropped from 100% in 2008 to 1% in 2021 and dispensing ciprofloxacin without a prescription dropped from 53% in 2008 to 0% in 2021.

Conclusions: A new and enforced law that requires electronic prescribing led to a dramatic reduction of antibiotic dispensing without prescription compared to 12 years ago. Similar initiatives could help solve the problem of antibiotic consumption and resistance in Greece and elsewhere.