Podcast: What are the effects of interventions on sales of antimicrobial drugs without prescription in community pharmacies?

The Cochrane Collaboration has produced several systematic reviews of interventions focusing on the problem of antimicrobial resistance. In January 2025, these were added to with a new review about the role of community pharmacies and, in this podcast, Sadatoshi Matsuoka, talks with lead author Moe Moe Thandar from the National Center for Global Health and Medicine in Japan about this pressing issue.

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Mike: Hello, I’m Mike Clarke podcast editor for the Cochrane Library. The Cochrane Collaboration has produced several systematic reviews of interventions focusing on the problem of antimicrobial resistance. In January 2025, these were added to with a new review about the role of community pharmacies and, in this podcast, Sadatoshi Matsuoka, talks with lead author Moe Moe Thandar from the National Center for Global Health and Medicine in Japan about this pressing issue.

Sadatoshi: Hello, Moe Moe. First, please tell us a little about antimicrobial drugs and antimicrobial resistance?

Moe Moe: Hello Sadatoshi. Antimicrobial drugs are essential in fighting harmful microorganisms such as bacteria, viruses, parasites, and fungi; and the drugs are categorised based on the types of microorganisms they target. For instance, antibiotics are used to combat bacteria, while antivirals are designed to fight viruses. However, there is growing concern about antimicrobial resistance or AMR. This is when microorganisms develop the ability to survive or even thrive despite the presence of the antimicrobial drugs.

Sadatoshi: How does that happen?

Moe Moe: A significant factor is the misuse and overuse of antimicrobial drugs, particularly in community settings. This is made worse by some pharmacists and non-pharmacists in community pharmacies, drug stores or other shops selling the drugs without a prescription.

Sadatoshi: Which leads us on to the importance of your Cochrane review of ways to reduce non-prescription antimicrobial sales in community pharmacies, right?

Moe Moe: Yes. To address this issue, we tried to identify effective interventions to help pharmacists and non-pharmacists reduce the sales of antimicrobial drugs without a prescription, especially in countries where such sales are not legally permitted.

Sadatoshi: Can you tell us about the evidence that you looked for?

Moe Moe: We searched for studies that evaluated the impact of interventions, such as educational training, government regulations, financial incentives, and peer monitoring. We focused on studies that randomly assigned pharmacists or non-pharmacists to either an intervention or control group and grouped these according to whether they tested a single-component or a combination of several components in the intervention group. 

Sadatoshi: And what do these trials tell us?

Moe Moe: We were able to include four relevant trials conducted in five countries: Portugal, Scotland, Thailand, Vietnam, and Uganda. These studies involved a total of 942 community pharmacies and drug stores, with pharmacists and non-pharmacists participating. The tested interventions included regulations on antimicrobial drug sales, education for pharmacists and non-pharmacists, and peer monitoring.
One study looked at the effects of single interventions and it did not report any differences between the intervention and control groups for scenarios in which antifungal drugs should not have been sold without a prescription.
The study also included a group who received a combination of interventions, which means that all four studies tested a multi-component intervention, but these differed widely across the studies. Two studies reported on sales of antimicrobial drugs without a prescription by pharmacists or non-pharmacists, and both seemed to favour the multi-component interventions. However, because of the size of the studies and the large differences between the interventions that were tested, the evidence is of very low certainty.

Sadatoshi: Overall then, what’s your take-home message about non-prescription antimicrobial sales in community pharmacies?

Moe Moe: In summary the limited data available from our search in September 2022 makes it difficult to draw a firm conclusion about the effectiveness of single-component interventions and multi-component interventions made little to no difference to sales of antimicrobial drugs without a prescription. This highlights the need for higher-quality studies to determine the most effective ways to enhance the practices of pharmacists and non-pharmacists. If these studies are done, we will bring them into an update of the review, along with the evidence from some types of non-randomised study, such as interrupted time series and controlled before-after studies.

Sadatoshi: Thanks Moe Moe. How can listeners access the current evidence and watch for the update if they would like to find out more?

Moe Moe: Thanks Sadatoshi. The review is available online at CochraneLibrary.com. If people go to the website and search ‘antimicrobials and community pharmacies’ they’ll find it easily.

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