Evaluating the Dispensing of Non-Prescription Antibiotics in Baghdad's Community Pharmacies: A Public Health Concern.

Background: Despite existing regulatory restrictions from the Iraqi Ministry of Health and global guidance from the World Health Organization, the practice of dispensing antibiotics without prescriptions remains prevalent. Objectives: This study aimed to assess the prevalence of non-prescription antibiotic dispensing in community pharmacies across Iraq and to evaluate pharmacy personnel’s perceptions and practices concerning antimicrobial use. Methods: A cross-sectional survey was conducted between January and February 2025, targeting 63 pharmacists working in independent pharmacies across Baghdad and other Iraqi governorates. Data were obtained through a predefined questionnaire administered both in person and online. Descriptive statistics summarized participant demographics and responses, while Chi-square and Fisher’s exact tests were used to explore associations between dispensing practices and various demographic and attitudinal factors. Results: Among the 63 respondents, 76.2% reported dispensing antibiotics without prescriptions, with a median of 60 such cases per month. Misconceptions were widespread, with 77.8% of respondents believing that antibiotics possess analgesic and anti-inflammatory properties. While most pharmacists reported encouraging patients to complete the full course of treatment, brand substitution and dispensing under patient pressure were frequently observed. No significant associations were found between dispensing behavior and demographic characteristics (P > 0.05). However, significant associations (P < 0.05) emerged in relation to beliefs about the legality of the practice, patient expectations, and concerns about financial loss. Conclusion: Non-prescription antibiotic dispensing remains widespread and is shaped primarily by pharmacists’ perceptions of legality, patient expectations, and financial pressures rather than demographic factors. Strengthening regulatory enforcement, improving pharmacist training, and increasing public awareness are essential to support responsible antimicrobial use and national antimicrobial resistance containment efforts.