Non-Prescription Dispensing of Antibiotics in Community Pharmacies in Port Sudan: A Simulated Patient Study Using a Sore Throat Scenario in a Conflict-Affected Setting

Background: Antibiotics are essential medicines that save millions of lives around the world. However, the emergence of antimicrobial resistance (AMR) threatens their effectiveness. Inappropriate use of antibiotics by healthcare professionals is one of the reasons that aggravates the global burden of AMR. Therefore, we aimed to evaluate the dispensing of antibiotics without prescription in community pharmacies in Port Sudan, Sudan. Methods: This study was a cross-sectional observational study conducted in Port Sudan state, Sudan between February 2025 and May 2025. The simulated patient (SP) method was used to evaluate the dispensing practice of antibiotics. A total of 113 community pharmacies were included in the study, each of which was visited by a SP presenting a scenario of acute sore throat. Descriptive statistics were used to present the data. Results: In this study 70.8% of the pharmacies were run by pharmacists. Before dispensing, of the 113 pharmacy staff in this study, 61.9% asked at least one question before dispensing, and the most asked question in the history taking practice was the associated symptoms (37.2%). Antibiotic was dispensed either alone or in combination in 80.5% of the visits. Azithromycin was the most dispensed antibiotic representing 76.1% of the dispensed antibiotics, and cefixime was dispensed in 4.4% of the visits. Significant association was found between the dispensing of antibiotics by the pharmacy staff and their gender (P value = 0.021). Conclusion: The findings revealed that dispensing antibiotics without prescriptions using the sore throat scenario in the selected community pharmacies in Port Sudan city is high, and patient assessment practice was inappropriate. Corrective measures should be endorsed by stakeholders and health authorities to enhance the practice of pharmacy staff and restrict the inappropriate dispensing of antibiotics.