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Impact of Community Pharmacist Counselling on Appropriate Antibiotic Use among Adults in Nigeria

Abstract

Inappropriate antibiotic use remains an important public health concern in Nigeria and contributes to antimicrobial resistance, treatment failure, avoidable adverse drug reactions, and increased healthcare costs. Adults may use antibiotics inappropriately through self-medication, use of leftover medicines, incorrect dosing, premature discontinuation of treatment, use of antibiotics for viral infections, or obtaining antibiotics without appropriate professional guidance. Community pharmacies are important points of contact between the public and the healthcare system and may provide opportunities for pharmacists to promote rational antibiotic use through patient counselling, medication education, assessment of symptoms, appropriate referral, and guidance on antibiotic administration. Effective counselling by community pharmacists may improve adults' knowledge and practices regarding antibiotic use and reduce inappropriate use. Against this background, this study investigates the impact of community pharmacist counselling on appropriate antibiotic use among adults in Nigeria. The study will be anchored on the Health Belief Model, Theory of Planned Behavior, and Andersen's Behavioral Model of Health Services Use. The Health Belief Model explains how adults' perceptions of the risks and consequences of inappropriate antibiotic use, perceived benefits of appropriate use, perceived barriers, and cues to action may influence antibiotic-use behaviour. The Theory of Planned Behavior explains how attitudes, subjective norms, perceived behavioural control, and behavioural intentions may influence adults' decisions regarding antibiotic use. Andersen's Behavioral Model emphasizes predisposing, enabling, and need factors influencing healthcare and medication utilization, with access to community pharmacist counselling serving as an enabling factor. Collectively, these theoretical perspectives provide a suitable framework for explaining how pharmacist counselling may influence appropriate antibiotic use among adults in Nigeria. The study will adopt a quantitative quasi-experimental or analytical comparative research design. The study population will comprise adults aged 18 years and above who obtain antibiotics or seek advice regarding antibiotic treatment from selected community pharmacies in Nigeria, as well as community pharmacists providing counselling services. A multistage sampling technique will be used to select states, local government areas, communities, community pharmacies, pharmacists, and eligible adult participants. Community pharmacist counselling will be assessed using indicators such as frequency of counselling, explanation of antibiotic indications, dosage instructions, duration of treatment, adherence guidance, advice against sharing or reusing antibiotics, counselling on adverse effects, information on antimicrobial resistance, assessment of patients' understanding, referral of patients requiring medical evaluation, and follow-up where appropriate. Appropriate antibiotic use will be assessed using indicators such as use of antibiotics only when clinically indicated or appropriately prescribed, correct medicine selection, correct dosage, correct frequency, appropriate treatment duration, adherence to prescribed therapy, avoidance of unnecessary antibiotic use, avoidance of leftover antibiotics, avoidance of sharing antibiotics, appropriate response to adverse effects, and compliance with professional or treatment guidelines. Data will be collected using structured questionnaires, pharmacy records, prescription records where available, patient interviews, pharmacist interviews, counselling checklists, and follow-up assessments. Descriptive statistics will be used to summarize participants' demographic characteristics, antibiotic-use patterns, exposure to pharmacist counselling, and knowledge and practices related to antibiotic use. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of community pharmacist counselling on appropriate antibiotic use. Where a quasi-experimental design is adopted, antibiotic-use practices before and after structured pharmacist counselling may be compared, or adults receiving standardized counselling may be compared with similar adults receiving routine pharmacy services. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community pharmacist counselling has a significant positive impact on appropriate antibiotic use among adults in Nigeria. Adults who receive structured and comprehensive counselling are expected to demonstrate better knowledge of antibiotic use, improved adherence to prescribed treatment, more appropriate dosing and duration, and reduced use of antibiotics without appropriate indication compared with adults receiving limited counselling. Pharmacists may also help identify situations in which antibiotics are unnecessary and refer clients to healthcare facilities for appropriate assessment. Counselling on antimicrobial resistance, medicine sharing, leftover antibiotics, and treatment adherence may further promote responsible antibiotic use. However, high workload, limited counselling time, inadequate pharmacist training, commercial pressures, patient expectations for antibiotics, limited access to diagnostic services, and weak regulation of antibiotic dispensing may reduce the effectiveness of pharmacist counselling. The study therefore expects accessible, standardized, patient-centred, and professionally delivered community pharmacist counselling to contribute significantly to improved antibiotic-use practices among adults in Nigeria. The study is expected to contribute to the literature on community pharmacist counselling, appropriate antibiotic use, antimicrobial stewardship, antibiotic self-medication, antimicrobial resistance, community pharmacy practice, rational medicine use, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Pharmacists Council of Nigeria, Nigeria Centre for Disease Control and Prevention, state ministries of health, community pharmacies, pharmacists, healthcare providers, antimicrobial stewardship programmes, professional pharmacy organizations, development partners, and policymakers regarding strategies for improving responsible antibiotic use. The study will also provide evidence-based recommendations for strengthening pharmacist-led antimicrobial stewardship, standardizing antibiotic counselling, improving pharmacists' training, promoting patient education, strengthening referral practices, improving regulation of antibiotic dispensing, incorporating antimicrobial resistance education into community pharmacy services, and establishing routine monitoring of antibiotic-use practices to support appropriate antibiotic use across Nigeria.

Keywords: Community pharmacist counselling, appropriate antibiotic use, antimicrobial stewardship, antibiotic self-medication, antimicrobial resistance, community pharmacy, rational medicine use, antibiotic counselling, adults, Nigeria, public health.