Open Access Highly Accessed Research article

Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: A Cross Sectional Study

Aref A Bin Abdulhak1, Mohamad A Al Tannir2, Mohammed A Almansor1, Mohammed S Almohaya1, Atallah S Onazi1, Mohammed A Marei1, Oweida F Aldossary1, Sadek A Obeidat3, Mustafa A Obeidat3, Muhammad S Riaz2 and Imad M Tleyjeh1245*

Author Affiliations

1 Internal Medicine Department, King Fahd Medical City, Aldabab Street, Riyadh, 11525, Saudi Arabia

2 Research and Scientific Publication Center, King Fahd Medical City, Aldabab street, Riyadh, 11525, Saudi Arabia

3 Alfaisal University, Takhassusi Street, Riyadh, 11533, Saudi Arabia

4 Infectious Diseases Division, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA

5 Division of Epidemiology, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA

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BMC Public Health 2011, 11:538  doi:10.1186/1471-2458-11-538

Published: 7 July 2011



Antibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. We aimed to determine the percentage of pharmacies who sell antibiotics without medical prescriptions, examining the potential associated risks of such practice in Riyadh, Saudi Arabia, by simulation of different clinical scenarios.


A cross sectional study of a quasi-random sample of pharmacies stratified by the five regions of Riyadh. Each pharmacy was visited once by two investigators who simulated having a relative with a specific clinical illness (sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection (UTI) in childbearing aged women).


A total of 327 pharmacies were visited. Antibiotics were dispensed without a medical prescription in 244 (77.6%) of 327, of which 231 (95%) were dispensed without a patient request. Simulated cases of sore throat and diarrhea resulted in an antibiotic being dispensed in (90%) of encounters, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%). Metronidazole (89%) and ciprofloxacin (86%) were commonly given for diarrhea and UTI, respectively, whereas amoxicillin/clavulanate was dispensed (51%) for the other simulated cases. None of the pharmacists asked about antibiotic allergy history or provided information about drug interactions. Only 23% asked about pregnancy status when dispensing antibiotics for UTI-simulated cases.


We observed that an antibiotic could be obtained in Riyadh without a medical prescription or an evidence-based indication with associated potential clinical risks. Strict enforcement and adherence to existing regulations are warranted.