“Two-colour capsules”: Commonly used non-prescribed antibiotics in the self-management of self-diagnosed illness amongst pharmacy customers in Maputo city.

Abstract Background: After analgesics, antibiotics are the most commercialized, prescribed and utilized drugs worldwide. The persistent inappropriate use of these precious drugs is developing, with non-prescription sales and the consequent practices of self-medication with antibiotics (SMA) undermining the global efforts to rationalize their use and contain the antimicrobial resistance (AMR). This study aimed to identify the commonly used antibiotics and the main health conditions leading to the practice of self-medication with antibiotics. Methods: We conducted a qualitative study with 32 pharmacy customers and 17 pharmacists working in nine private pharmacies in Maputo city. In-depth interviews and focus group discussions (FGD) were conducted with customers while in-depth interviews were held with pharmacists. The interviews were audio-recorded, transcribed, coded and analysed using latent content analysis. The COREQ (Tong, 2007) checklist for interviews and FGD was performed. Results: Frequent use of non-prescribed antibiotics (NPA) was admitted by 30 of the 32 customers while 15 of the 17 pharmacists admitted NPA dispensing. Antibiotics such as amoxicillin cotrimoxazole, azithromycin, and metronidazole, amoxicillin with acid clavulanic, tetracycline, doxycycline and erythromycin were used after participants self-diagnosed or self-perceived health conditions related to sore throat, fever, cough, vaginal discharge, eye problem, common flu, urinary infection, respiratory infection, wounds, and toothaches. Conclusion: The therapeutic itineraries customers adopt, such as practicing SMA and/or seeking healthcare at the pharmacy, together with the suboptimal dispensing practices of pharmacists, and weak regulatory and law enforcement, are enabling the growing but dangerous practice of SMA among Maputo city private pharmacies customers. Multifaceted interventions are needed to involve public health stakeholders, pharmacists and healthcare professionals to enlighten customers through public education regarding the inappropriate use of antibiotics at all levels.