OBJECTIVES: To quantify the OTC azithromycin dispensing pattern in community pharmacies in the peri-covid period, and to determine the factors associated with the response of the pharmacies.

METHODS: Five pharmacy students were trained as standardized patients (SPs) to collect the data from 150 pharmacies from November 2021 to June 2022. The SPs directly demanded half a course of Azithromycin and presented flu-like symptoms if questioned. The response was noted on a questionnaire within half an hour of the pharmacy visit.

RESULTS: 99.3% of pharmacies were willing to dispense Azithromycin without a prescription (103 were in urban and 47 in rural). 72.8% of urban pharmacies and 80.9% of rural pharmacies were willing to dispense half a course of azithromycin without further questioning, whereas 6.73% of urban and 2.1% of rural pharmacies enquired about the need. Only 24.2% of urban and 17.02% of rural pharmacies emphasized finishing a full course. On the other hand, 18.45% of urban and 14.89% of rural pharmacies denied selling half course. However, none were enquired about medication history, medication allergies, or referred to a medical practitioner. Of 150 pharmacies, four did not have the drug, three were willing to dispense an alternative brand, and four enquired about clinical symptoms. Ultimately only one urban pharmacy denied selling the drug without a prescription.

CONCLUSIONS: We found a remarkable difference in OTC dispensing compared to a similar study in the same setting during pre-covid. This difference could be presumably attributed to the SP case scenarios used and the different time periods both studies were conducted in. Moreover, the disparity could also be due to increased self-medication, and increased demand for antibiotics generated during the peri-covid. The study highlights the need for stringent measures for controlling OTC dispensing through empowering antimicrobial stewardship programs in outpatient settings.