OBJECTIVES: Pakistan ranked 6^th in antibiotic consumption and patients often receive antibiotics plus prescription-only drugs directly from pharmacies. Here in this study, we aimed to assess drug dispensing practices of pharmacies for presumed and confirmed tuberculosis in standardized patients.

METHODS: In this cross-sectional study, carried out in three cities (Lahore, Rawalpindi and Sialkot), we adopted 2 standardized patient cases: first, a presumed TB patient presenting with 2–3 weeks of cough and fever (pulmonary tuberculosis symptoms (Case-1) and 2^nd, a confirmed TB patient who was carrying microbiologically confirmed TB results (Case-2). Standardized patients were asked to present these cases once to sampled pharmacies. Ideal management for Cases-1 and Case-2 a priori as referral to a health-care provider without dispensing antibiotics or steroids or both. The differences in antibiotic use or steroid and number of medicines dispensed in referred and non-referred patients between Case-1 and Case-2 were mentioned using the descriptive statistics.

RESULTS: Between 1 April, 2020, and, 31 July 2020, standardized patients completed 575 of 598 interactions among pharmacies in Lahore, Rawalpindi and Sialkot. We recorded ideal management in 115 (37.7%) of 305 Case-1 interactions and 130 (48.1%) of 270 in Case-2 interactions. Antibiotic dispensing was higher in Case-1 [71 of 305 instances (23.3%)] than in Case-2 interactions [27 (10.0%) of 270]. Anti-tuberculosis drugs were dispensed for 1 patient in Case-1 (0.3%) and 19 (7.0%) patients for Case-2 occasions

CONCLUSIONS: Slightly higher than one third of pharmacies in Punjab, Pakistan correctly managed patients with presumed tuberculosis, but almost half of them correctly managed a case of confirmed tuberculosis. Pharmacies un-orthodoxically dispensed anti-tuberculosis drugs for Case-1 and Case-2. Presence of confirmed diagnosis is slightly changing the behavior in correct management of patients. Antibiotic misuse could lead to antibiotic resistance and we need to implement antimicrobial stewardship interventions.