Self-medication in Central Saudi Arabia

Discussion

The results revealed several interesting findings regarding the knowledge, attitudes, and perception of self-medication among consumers attending community pharmacies in Riyadh city. Almost half of the medications that consumers bought from community pharmacies without a prescription were actually prescription-only medications, and 45% of the participants did not tell the pharmacist of the prescribed medication(s) that they were using at home. Overall, most participants had poor knowledge, positive attitude, and negative perception toward self-medications. Information regarding medications was most commonly obtained from a physician and pharmacist, medicine pamphlets, followed by friends and family, and online sources. Minor illnesses, time saving, and perceived knowledge, and treatment of disease were common reasons for seeking self-medication.

Several studies have been conducted on self-medication worldwide. A study by Bawazir (1992)5 in Riyadh showed that 35% of medications bought by patients from community pharmacies without a prescription were prescription only medications; however, in the current study, after 2 decades, we found a higher rate. A study in Tanzania found that 37% of medications requested by customers without a prescription from community pharmacies were prescription only medications,4 which is lower than our study findings. A study from Kuwait,6 a neighboring country of Saudi Arabia, investigating self-medication among adolescents reported that the main source of information regarding medications was the parents. This is also consistent with the findings of our study in which family and friends were one of the most common sources of medication information. In Bahrain, another neighboring country, it was found that the most common reasons for seeking self-medication were time saving, involved minor illness that does not need a visit to a doctor, and cost saving.7 This was similar to our findings with the exception of financial reasons, as only 9% of respondents in our study sought self-medication due to financial difficulties. Our study revealed that around 45% of the participants did not inform the pharmacist of other medications that they used at home. This is similar to a finding from a recent study in Malaysia,13 in which it was reported that 60% of community pharmacy customers did not inform the pharmacist of prescription medications that they used at home.

The unauthorized prescribing of antibiotics is associated with multiple-drug resistance and therefore, they must be prescribed under physician advice.14 Our results suggest that the practice of community pharmacy customers in Saudi Arabia regarding antibiotic use has not changed over the past 2 decades. The frequency of dispensing antibiotics without a prescription reported in our study (22.3%) was the same as that (20.9%) in a study conducted in 1992 in Riyadh.5 Another recent study in Riyadh using simulated clinical scenarios reported that 78% of community pharmacies in Saudi Arabia dispense antibiotics without prescriptions.14 In Spain,15 a simulation study reported that the prevalence of antibiotics dispensing without prescription for urinary tract infection was 79.7%, 34.8% for sore throat, and 16.9% for bronchitis.16 Another simulation study from Europe reported that Ciprofloxacin was dispensed without prescription in 53% of the cases.17

The study emphasizes several aspects of medication safety with regard to self-medication. Benefits, risks, and precautions of self-medication need to be explained to the consumers. This can be accomplished partially through activities organized by educational institutions and non-governmental organizations. The role of community pharmacists is important in guiding the consumer to ensure appropriate medication use. The WHO emphasizes that pharmacists should help patients to undertake appropriate and responsible self-medication, and if necessary refer the patient for medical advice.1 Healthcare authorities have responsibilities in enforcing the rules and regulations governing the sale of prescription only medications without a prescription. Pharmacists should be instructed not to sell prescription medications without prescription. In addition, educational workshops for pharmacists and undergraduate pharmacy curriculum updates are necessary to ensure appropriate community pharmacy practice regarding the sale of prescription/non-prescription medications.

Irresponsible self-medication is common in Saudi Arabia. Sources of information were not appropriate, and knowledge and perception of self-medication were inadequate. Community pharmacists should take the initiative to actively counsel consumers and provide information regarding possible drug interactions when dispensing medications. Educational campaigns for the public on self-care, and responsible self-medication should be strengthened. Future studies should focus on improving the consumers’ awareness of self-medication and the proper use of medications.

Our study has several limitations that can limit the generalization of the findings. Although we used a standard sampling method, selection bias could be present as not all community pharmacies in Riyadh were included. In addition, almost three-quarters of the participants were male due to the social consideration in Saudi Arabia as females rarely visit community pharmacies and tend to send their male relatives or drivers to buy their medications. The most common source of information mentioned by the consumers was physicians and pharmacists; however, we could not clearly distinguish between them. We could not ascertain if patient economic status was contributing to self-medication because patient monthly income data was not collected. In addition, the study was conducted in the summer and perhaps if similar study was conducted in the winter the prevalence might be higher as many consumers visit community pharmacies asking for antibiotics to treat cold symptoms.