Understanding the role of knowledge and attitudes of community pharmacy staff in non-prescribed antibiotic dispensing practices in Bangladesh: a cross-sectional study.

BACKGROUND: Antimicrobial resistance (AMR) is a critical public health issue in Bangladesh, exacerbated by the widespread practice of non-prescribed antibiotic dispensing. This study seeks to assess their knowledge and attitudes, particularly how these factors influence non-prescribed antibiotic dispensing practices in Bangladesh. METHODS: A total of 287 pharmacy staff across four regions of Bangladesh were included in the study. Data were collected using a structured questionnaire assessing knowledge, attitudes and practices regarding non-prescribed antibiotic dispensing. RESULTS: The study found that 92.4% of respondents dispensed antibiotics without prescriptions. The practice was significantly more prevalent among those with poor knowledge (99.28% in below-average vs 86.09% in above-average knowledge groups, p<0.001) and negative attitudes (97.6% in below-average vs 88.41% in above-average attitude groups, p=0.004) regarding antibiotic use. Only 11.9% respondents understood antibiotics' ineffectiveness against viral infections and 47.0% were unaware of prescription requirements. While 93.0% recognised non-prescribed antibiotic dispensing as a risk of AMR, 65.9% cited profit concerns as a barrier to refusing non-prescribed sales. Multivariable analysis identified poor knowledge (adjusted OR 15.7, p=0.01) as a key predictor of inappropriate dispensing. CONCLUSION: These findings highlight knowledge and attitude towards antibiotic dispensing play a vital role where weak regulation, education and economic incentives further worsen the situation. Urgent interventions, including improved pharmacist training, prescription monitoring and public awareness campaigns, are essential to reduce non-prescribed antibiotic dispensing and align practices with Bangladesh's National Action Plan on AMR.