{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T18:09:30Z","timestamp":1778868570702,"version":"3.51.4"},"reference-count":14,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000276","name":"Department of Health and Social Care","doi-asserted-by":"publisher","award":["CWPAMS 2.5 A.01 awarded to Cambridge Global Health Partnerships through the Fleming Fund"],"award-info":[{"award-number":["CWPAMS 2.5 A.01 awarded to Cambridge Global Health Partnerships through the Fleming Fund"]}],"id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]}],"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>Antimicrobial resistance (AMR) is a major global health threat, with sub-Saharan Africa bearing a disproportionate burden. Community-level antibiotic dispensing practices remain poorly described in Kenya outside Nairobi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 504 antibiotic dispensing events were recorded across 22 community pharmacies in Kakamega County, western Kenya, between 3rd and 22nd August 2025. Data collected included dispensing source (over-the-counter [OTC] versus prescription), clinical indication, antibiotics dispensed, course completion, and self-reported repeat antibiotic use within the preceding month. Descriptive analyses were performed, and \u03c7\u00b2 tests were used to examine associations between dispensing source and selected non-antibiotic dispensing characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 504 dispensing events, 224 (44.4%) involved OTC dispensing and 278 (55.2%) were prescription-based. The most frequent indications for antibiotic dispensing were upper respiratory tract infections (URTI; n\u2009=\u2009156, 31.0%), lower respiratory tract infections (LRTI; n\u2009=\u200995, 18.8%), gastrointestinal infections (n\u2009=\u200965, 12.9%), and skin or soft-tissue infections (n\u2009=\u200955, 10.9%). Across all events, amoxicillin, azithromycin, and metronidazole were the most frequently dispensed antibiotics, with cephalosporins and other broad-spectrum agents used across several indications. Partial antibiotic courses were supplied in 33 (6.5%) dispensing events, most commonly due to financial constraints (15\/33, 45.5%). Self-reported antibiotic use within the preceding month occurred in 156 (31.0%) cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>OTC antibiotic access remains widespread in Kakamega County, with substantial use of broad-spectrum agents across multiple clinical indications. Financial barriers contribute to incomplete antibiotic courses. These findings highlight the importance of incorporating community pharmacy dispensing data into county-level antimicrobial stewardship programmes and informing national strategies to optimise antibiotic use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0342353","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T17:26:31Z","timestamp":1778865991000},"page":"e0342353","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic dispensing practices and antimicrobial stewardship gaps in community pharmacies in Kakamega County, Kenya"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0428-6248","authenticated-orcid":true,"given":"Eleanor","family":"Turnbull-Jones","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susannah","family":"Langtree","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Mogoi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Sifuna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsay","family":"Gadaffi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony","family":"Jewell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"issue":"10325","key":"pone.0342353.ref001","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","author":"CJL Murray","year":"2022","journal-title":"Lancet"},{"key":"pone.0342353.ref002","volume-title":"Global action plan on antimicrobial resistance","author":"World Health Organization","year":"2015"},{"key":"pone.0342353.ref003","first-page":"144","article-title":"To sell or not to sell; the differences between regulatory and community demands regarding access to antibiotics in Ghana","volume":"8","author":"S Afari-Asiedu","year":"2020","journal-title":"Front Public Health"},{"key":"pone.0342353.ref004","first-page":"82","article-title":"Dispensing of antibiotics without prescription in community pharmacies in Kenya: a point prevalence survey","volume":"32","author":"MM Mukokoma","year":"2023","journal-title":"J Glob Antimicrob Resist"},{"key":"pone.0342353.ref005","volume-title":"WHO AWaRe classification of antibiotics for evaluation and monitoring of use: 2023 update","author":"World Health Organization","year":"2023"},{"issue":"1","key":"pone.0342353.ref006","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jinf.2018.07.001","article-title":"Global access to antibiotics without prescription in community pharmacies: A systematic review and meta-analysis","volume":"78","author":"A Auta","year":"2019","journal-title":"J Infect"},{"issue":"6","key":"pone.0342353.ref007","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.ijantimicag.2018.09.022","article-title":"Non-prescription sales of antimicrobial agents at community pharmacies in developing countries: a systematic review","volume":"52","author":"MHF Sakeena","year":"2018","journal-title":"Int J Antimicrob Agents"},{"key":"pone.0342353.ref008","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1186\/s12889-015-2109-3","article-title":"Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries","volume":"15","author":"M Ocan","year":"2015","journal-title":"BMC Public Health"},{"key":"pone.0342353.ref009","first-page":"291","article-title":"Community pharmacists\u2019 involvement in antibiotic stewardship in developing countries: a systematic review","volume":"25","author":"RN Okoro","year":"2021","journal-title":"J Glob Antimicrob Resist"},{"issue":"3","key":"pone.0342353.ref010","article-title":"Low sale of antibiotics without prescription: a cross-sectional study in Zimbabwean community pharmacies","volume":"5","author":"N Nyazema","year":"2020","journal-title":"BMJ Global Health"},{"key":"pone.0342353.ref011","first-page":"291","article-title":"Status of antimicrobial stewardship programmes in Nigeria: a systematic review","volume":"15","author":"JO Fadare","year":"2022","journal-title":"Infect Drug Resist"},{"key":"pone.0342353.ref012","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s13756-017-0208-x","article-title":"The threat of antimicrobial resistance in developing countries: causes and control strategies","volume":"6","author":"JA Ayukekbong","year":"2017","journal-title":"Antimicrob Resist Infect Control"},{"issue":"2","key":"pone.0342353.ref013","first-page":"68","article-title":"Pharmacy staff practices regarding antibiotic dispensing without prescription: a multi-country study","volume":"8","author":"S Afari-Asiedu","year":"2020","journal-title":"Pharmacy"},{"key":"pone.0342353.ref014","volume-title":"Antimicrobial resistance: global report on surveillance","author":"World Health Organization","year":"2014"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0342353","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T17:26:35Z","timestamp":1778865995000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0342353"}},"subtitle":[],"editor":[{"given":"Sarah","family":"Nanzigu","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":14,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0342353","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]}}}