Exploring behavioral determinants of antimicrobial dispensing in drug retail outlets of Addis Ababa, Ethiopia: a mixed methods study

A mixed-methods study in Addis Ababa, Ethiopia, explored why pharmacy professionals often dispense antimicrobials inappropriately. Among 240 respondents from 120 outlets, more than half (53.8%) reported dispensing antibiotics without proper prescriptions. Although most had good knowledge of antimicrobial stewardship, social, economic, and environmental pressures—such as patient demand, fear of losing customers, and weak regulatory enforcement—strongly influenced behaviour. Older age and being female predicted more appropriate dispensing, whereas longer experience was paradoxically linked to poorer practices, likely due to commercial pressures. Interviews confirmed that incomplete prescriptions, prescriber influence, and punitive rather than supportive inspections hinder good practice. The authors conclude that improving antimicrobial dispensing in such settings requires not only education but also behavioural and systemic interventions addressing capability, opportunity, and motivation—through mentoring, public awareness, and regulatory reform—to effectively support antimicrobial stewardship and curb AMR.