{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T22:59:44Z","timestamp":1786489184773,"version":"build-2736575974"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T00:00:00Z","timestamp":1658793600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019223","name":"Ministry of Health, Saudi Arabia","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100019223","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>High rates of non-prescription dispensing of antimicrobials have led to a significant increase in the antimicrobial overuse and misuse in Saudi Arabia (SA). The objective of this study was to evaluate the antimicrobial utilization following the enforcement of a new prescription-only antimicrobial dispensing policy in the community pharmacy setting in SA.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data were extracted from the IQVIA database between May 2017 and May 2019. The antimicrobial utilization rates, based on sales, defined daily dose in grams (DDD), DDD\/1000 inhabitants\/day (DID), and antimicrobial-claims for the pre-policy (May 2017 to April 2018) and post-policy (June 2018 to May 2019) periods were assessed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Overall antimicrobial utilization declined slightly (~9\u201310%) in the post-policy versus pre-policy period (sales, 31,334 versus 34,492 thousand units; DDD, 183,134 versus 202,936), with higher claims (~16%) after policy implementation. There was a sudden drop in the utilization rate immediately after policy enforcement; however, the values increased subsequently, closely matching the pre-policy values. Utilization patterns were similar in both periods; penicillin was the most used antimicrobial (sales: 11,648\u201314,700\u2013thousand units; DDD: 71,038\u201391,227; DID: 2.88\u20133.78). For both periods, the highest dip in utilization was observed in July (sales: 1,027\u20131,559 thousand units; DDD: 6,194\u20139,399), while the highest spike was in March\/October (sales: 3,346\u20133,884 thousand units; DDD: 22,329\u201319,453).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Non-prescription antimicrobial utilization reduced minimally following policy implementation in the community pharmacies across SA. Effective implementation of prescription-only regulations is necessary.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0271188","type":"journal-article","created":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T17:29:18Z","timestamp":1658856558000},"page":"e0271188","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Restriction on antimicrobial dispensing without prescription on a national level: Impact on the overall antimicrobial utilization in the community pharmacies in Saudi Arabia"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4730-9086","authenticated-orcid":true,"given":"Ahmed Hamdan","family":"Al-Jedai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0155-6986","authenticated-orcid":true,"given":"Yasser","family":"Almogbel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8355-8637","authenticated-orcid":true,"given":"Khalid","family":"Eljaaly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasser M.","family":"Alqahtani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0985-6193","authenticated-orcid":true,"given":"Hajer Yousef","family":"Almudaiheem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Awad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2601-8853","authenticated-orcid":true,"given":"Dema Abdulrahman","family":"Alissa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Assiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tareef","family":"Alaama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,7,26]]},"reference":[{"key":"pone.0271188.ref001","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ijid.2017.01.014","article-title":"Self-medication and self-prescription with antibiotics in the Middle East-do they really happen? A systematic review of the prevalence, possible reasons, and outcomes","volume":"57","author":"F Alhomoud","year":"2017","journal-title":"Int J Infect Dis"},{"issue":"1","key":"pone.0271188.ref002","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1186\/s12889-018-6088-z","article-title":"\"Antibiotics kill things very quickly\"\u2014consumers\u2019 perspectives on non-prescribed antibiotic use in Saudi Arabia","volume":"18","author":"F Alhomoud","year":"2018","journal-title":"BMC Public Health"},{"issue":"3","key":"pone.0271188.ref003","doi-asserted-by":"crossref","first-page":"278","DOI":"10.3201\/eid0803.010192","article-title":"A European study on the relationship between antimicrobial use and antimicrobial resistance","volume":"8","author":"SL Bronzwaer","year":"2002","journal-title":"Emerg Infect Dis"},{"issue":"9459","key":"pone.0271188.ref004","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/S0140-6736(05)17907-0","article-title":"Outpatient antibiotic use in Europe and association with resistance: a cross-national database study","volume":"365","author":"H Goossens","year":"2005","journal-title":"Lancet"},{"key":"pone.0271188.ref005","unstructured":"Antimicrobial resistance: global report on surveillance [Internet]. World Health Organization; 2014 [Cited 2021 Aug 31]. https:\/\/apps.who.int\/iris\/handle\/10665\/112642."},{"issue":"7","key":"pone.0271188.ref006","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1179\/2047773215Y.0000000030","article-title":"Antimicrobial resistance: a global multifaceted phenomenon","volume":"109","author":"F Prestinaci","year":"2015","journal-title":"Pathog Glob Health"},{"issue":"9","key":"pone.0271188.ref007","doi-asserted-by":"crossref","first-page":"935","DOI":"10.15537\/smj.2016.9.16139","article-title":"Antimicrobial resistance in Saudi Arabia. An urgent call for an immediate action","volume":"37","author":"HM Zowawi","year":"2016","journal-title":"Saudi Med J"},{"key":"pone.0271188.ref008","unstructured":"Antibiotic \/ Antimicrobial Resistance [Internet]. Centers for Disease Control and Prevention [Cited 2021 April 1]. https:\/\/www.cdc.gov\/drugresistance\/about.html."},{"issue":"10325","key":"pone.0271188.ref009","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","year":"2022","journal-title":"Lancet"},{"key":"pone.0271188.ref010","article-title":"Antimicrobial resistance: one world, one fight!","author":"S Harbarth","year":"2015","journal-title":"Antimicrob Resist Infect Control"},{"key":"pone.0271188.ref011","unstructured":"Gupta-Smith V. WHO\u2019s first global report on antibiotic resistance reveals serious, worldwide threat to public health [Internet]. World Health Organization; 2014 [Cited 2021 April 1]. https:\/\/www.who.int\/southeastasia\/news\/detail\/30-04-2014-who-s-first-global-report-on-antibiotic-resistance-reveals-serious-worldwide-threat-to-public-health"},{"issue":"1","key":"pone.0271188.ref012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13756-020-0678-0","article-title":"Ten-year resistance trends in pathogens causing healthcare-associated infections; reflection of infection control interventions at a multi-hospital healthcare system in Saudi Arabia, 2007\u20132016","volume":"9","author":"HH Balkhy","year":"2020","journal-title":"Antimicrobial Resistance & Infection Control"},{"key":"pone.0271188.ref013","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.jgar.2021.03.009","article-title":"Five-year resistance trends in pathogens causing healthcare-associated infections at a multi-hospital healthcare system in Saudi Arabia, 2015\u20132019","volume":"25","author":"A Al Mutair","year":"2021","journal-title":"Journal of global antimicrobial resistance"},{"issue":"1","key":"pone.0271188.ref014","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/2047-2994-1-26","article-title":"The prevalence of antimicrobial resistance in clinical isolates from Gulf Corporation Council countries","volume":"1","author":"M Aly","year":"2012","journal-title":"Antimicrob Resist Infect Control"},{"issue":"4","key":"pone.0271188.ref015","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.jiph.2016.03.003","article-title":"The strategic plan for combating antimicrobial resistance in Gulf Cooperation Council States","volume":"9","author":"HH Balkhy","year":"2016","journal-title":"J Infect Public Health"},{"issue":"5","key":"pone.0271188.ref016","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/j.jiph.2016.09.016","article-title":"Over-the-counter antibiotics in Saudi Arabia, an urgent call for policy makers","volume":"10","author":"S Bin Nafisah","year":"2017","journal-title":"J Infect Public Health"},{"key":"pone.0271188.ref017","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1186\/1471-2458-11-538","article-title":"Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: a cross sectional study","volume":"11","author":"AAB Abdulhak","year":"2011","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0271188.ref018","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jsps.2011.11.003","article-title":"Dispensing medications without prescription at Saudi community pharmacy: Extent and perception","volume":"21","author":"A Al-Mohamadi","year":"2013","journal-title":"Saudi Pharm J"},{"issue":"3","key":"pone.0271188.ref019","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1097\/PTS.0000000000000087","article-title":"Pharmacists Views and Practices in Regard to Sales of Antibiotics Without a Prescription in Madinah, Saudi Arabia","volume":"12","author":"A. Bahnassi","year":"2016","journal-title":"J Patient Saf"},{"key":"pone.0271188.ref020","unstructured":"MOH Warns Against Selling Antibiotics without Prescription [Internet]. [Cited 2022 March 31]. https:\/\/www.moh.gov.sa\/en\/Ministry\/MediaCenter\/News\/Pages\/news-2018-04-17-004.aspx."},{"issue":"1","key":"pone.0271188.ref021","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1128\/AAC.03629-14","article-title":"Seasonal variation in penicillin use in Mexico and Brazil: analysis of the impact of over-the-counter restrictions","volume":"59","author":"Y Santa-Ana-Tellez","year":"2015","journal-title":"Antimicrob Agents Chemother"},{"issue":"6","key":"pone.0271188.ref022","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1111\/tmi.12096","article-title":"Analysing policy interventions to prohibit over-the-counter antibiotic sales in four Latin American countries","volume":"18","author":"VJ Wirtz","year":"2013","journal-title":"Trop Med Int Health"},{"issue":"1","key":"pone.0271188.ref023","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1186\/s12913-019-4359-8","article-title":"Assessing the impact of law enforcement to reduce over-the-counter (OTC) sales of antibiotics in low- and middle-income countries; a systematic literature review","volume":"19","author":"TG Jacobs","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"pone.0271188.ref024","unstructured":"DDD Indicators [Internet]. World Health Organization; [Cited 2021 April 1]. https:\/\/www.who.int\/tools\/atc-ddd-toolkit\/indicators."},{"key":"pone.0271188.ref025","unstructured":"WHO Collaborating Centre for Drug Statistics Methodology Norwegian Institute of Public Health (2022). ATC\/DDDIndex. WHO CC, Oslo, Norway. [Cited 2022 March 31]. https:\/\/www.whocc.no\/."},{"key":"pone.0271188.ref026","unstructured":"Studies and Research General Department [Internet]. [Cited 2022 March 31]. https:\/\/www.moh.gov.sa\/en\/Ministry\/Forms\/Studies-and-Researches\/Pages\/default.aspx."},{"key":"pone.0271188.ref027","unstructured":"Bagozzi D. WHO releases the 2019 AWaRe Classification Antibiotics. World Health Organization; 2019 [Cited 2021 April 1]. https:\/\/www.who.int\/news\/item\/01-10-2019-who-releases-the-2019-aware-classification-antibiotics."},{"issue":"8","key":"pone.0271188.ref028","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/S1473-3099(14)70780-7","article-title":"Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data","volume":"14","author":"TP Van Boeckel","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"pone.0271188.ref029","unstructured":"Summary of the latest data on antibiotic consumption in the European Union. Stockholm: European Centre for Disease Prevention and Control; 2017 [Cited 2021 August 31]. Summary of the latest data on antibiotic consumption in EU: 2017 (europa.eu)."},{"issue":"10","key":"pone.0271188.ref030","doi-asserted-by":"crossref","first-page":"e0204805","DOI":"10.1371\/journal.pone.0204805","article-title":"Community level antibiotic utilization in India and its comparison vis-a-vis European countries: Evidence from pharmaceutical sales data","volume":"13","author":"HH Farooqui","year":"2018","journal-title":"PLoS One"},{"key":"pone.0271188.ref031","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.ijid.2016.06.003","article-title":"Community pharmacists\u2019 knowledge, attitude, and practices towards dispensing antibiotics without prescription (DAwP): a cross-sectional survey in Makkah Province, Saudi Arabia","volume":"47","author":"MA Hadi","year":"2016","journal-title":"Int J Infect Dis"},{"issue":"38","key":"pone.0271188.ref032","doi-asserted-by":"crossref","first-page":"e1605","DOI":"10.1097\/MD.0000000000001605","article-title":"The Impact of Restricting Over-the-Counter Sales of Antimicrobial Drugs: Preliminary Analysis of National Data","volume":"94","author":"ML Moura","year":"2015","journal-title":"Medicine (Baltimore)"},{"issue":"10","key":"pone.0271188.ref033","doi-asserted-by":"crossref","first-page":"e75550","DOI":"10.1371\/journal.pone.0075550","article-title":"Impact of over-the-counter restrictions on antibiotic consumption in Brazil and Mexico","volume":"8","author":"Y Santa-Ana-Tellez","year":"2013","journal-title":"PLoS One"},{"issue":"11","key":"pone.0271188.ref034","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.4067\/S0034-98872002001100009","article-title":"Impact of regulatory measures in the trends of community consumption of antibiotics in Chile","volume":"130","author":"L Bavestrello","year":"2002","journal-title":"Rev Med Chil"},{"issue":"1","key":"pone.0271188.ref035","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S1473-3099(09)70305-6","article-title":"Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries","volume":"10","author":"B Huttner","year":"2010","journal-title":"Lancet Infect Dis"},{"key":"pone.0271188.ref036","article-title":"Misuse of antibiotic: A systemic review of Saudi published studies","author":"AR Alnemri","year":"2016","journal-title":"Current Pediatric Research"},{"issue":"3","key":"pone.0271188.ref037","first-page":"18","article-title":"Physicians\u2019 knowledge, expectations, and practice regarding antibiotic use in primary health care","volume":"12","author":"HT Al-Homaidan","year":"2018","journal-title":"Int J Health Sci (Qassim)"},{"issue":"3","key":"pone.0271188.ref038","doi-asserted-by":"crossref","first-page":"e001239","DOI":"10.1136\/bmjgh-2018-001239","article-title":"How to improve antibiotic awareness campaigns: findings of a WHO global survey","volume":"4","author":"B Huttner","year":"2019","journal-title":"BMJ Glob Health"},{"key":"pone.0271188.ref039","unstructured":"Defined Daily Dose [Internet]. 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