Non-prescription acquisition of antibiotics in community pharmacies in Marib, Yemen: a cross-sectional study

Background: Antimicrobial resistance is largely caused by non-prescription antibiotic access, especially in low-resource and conflict-affected areas where formal healthcare is scarce. This study assessed the prevalence and determinants of non-prescription antibiotic acquisition in community pharmacies in Marib city, Yemen. Methods: A cross-sectional study was conducted among adults (≥ 18 years) visiting community pharmacies to obtain antibiotics. A total of 468 participants were recruited using probability-proportionate-to-size sampling. Individuals purchasing antibiotics for professional use were excluded. The main goal was to get antibiotics without a prescription. Sociodemographic characteristics, displacement status, residential location (urban or rural), and motivations for antibiotic use were all independent variables. Data were collected through in-person interviews and subsequently analyzed to identify correlated factors. Results: Of the 468 participants, 321 (68.6%) acquired antibiotics without a prescription. Internally displaced persons, rural residents, males, and individuals with low education, unemployment, and low income were more likely to get drugs without a prescription. The most common reasons for going to the doctor were symptoms of upper respiratory tract infections, such as the common cold, fever, and cough (47.4%). Of these, 91.0% were treated without a prescription. Pharmacists (43.6%) and self-knowledge (25.9%) were the main sources of information guiding antibiotic use. In addition, 66.9% reported keeping leftover antibiotics for future use, and only 33.1% completed the full treatment course. Conclusions: In Marib, it is very common for people to get antibiotics without a prescription, especially among vulnerable groups like people who have been displaced from their homes. To stop people from using antibiotics inappropriately and stop antimicrobial resistance, we need to strengthen drug regulation, make it easier for people to get health care, and start community-based antimicrobial stewardship and public education programs.