Pathways for inappropriate dispensing of antibiotics for rhinosinusitis: Arandomized trial

We evaluated the extent of and factors that determine the inappropriate use of antibiotics that are obtained without a physician's prescription. Ninet y-eight Greek pharmacists were visited by actress-researchers who played cl ients requesting antibiotics without a physician's prescription. Pharmacist s were randomly challenged in a scenario that involved simulated cases of a cute uncomplicated rhinosinusitis with either low fever (38.5 degreesC) or high fever (40 degreesC). Antibiotics were offered by 34 (69%) of 49 pharma cists who were presented with the high-fever scenario and by 42 (86%) of 49 pharmacists who were presented with the low-fever scenario (risk differenc e, 16.3%; P = .05). Thirty-two (65%) and 35 (71%) pharmacists in the high- and low-fever study arms, respectively, agreed to sell the actress-research ers broad-spectrum antibiotics. Only 28 (57%) and 17 (35%) pharmacists, res pectively, recommended that the patient visit a physician (P = .03). Inappr opriate recommendations regarding antibiotic use were very common in the st udied setting. Antibiotics were more likely to be offered to persons who di d not have a prescription when they were less likely to be clinically indic ated.