Antimicrobials sales comparison before and after the implementation of nationwide restriction policy in Saudi Arabia

Abstract Background: Antimicrobials dispensing without a prescription is recognized as a pathway for the emergence of antimicrobial resistance; a serious global public health issue in need of urgent regulatory responses. In mid-2018, the Saudi Ministry of Health initiated a nationwide antimicrobial restriction policy, in which pharmacies are strictlyprohibited from dispensing antimicrobial drugs without physicians’ prescription. Therefore, the objective of this study was to determine if this restriction policy implemented by the Saudi Ministry of Health has led to decrease in antimicrobial drugs sales. Methods: The annual retail sales information of antimicrobials was obtained from the pharmaceutical database, IQVIA-Multinational Integrated Data Analysis System (IQVIA-MIDAS®) between 2017 and 2019 to compare sales before and after the intervention. Antimicrobial drugs include the following: antibiotics; antifungals; antimycobacterials; combinations and other drugs. Nonparametric Wilcoxon Signed Rank test was used to assess changes in antimicrobials sales from pre- to post- intervention periods. Results: Our results showed that this intervention policy has achieved significate effects in reducing total antimicrobials sales by 23.2% from 818,916,437 SAR in 2017 to 648,383,630 SAR in 2019. Wilcoxon Signed Rank test showed a statistically significant median decrease in total antimicrobials sales after the intervention with a p-value = 0.0397. Reduction in the antibiotic amoxicillin was responsible for most of the decrease in antimicrobials sales with 70% less in 2019 compared to 2017. On the contrary, continuous increase in sales of some antimicrobial drugs following the restriction policy was observed led by the antibiotic amoxicillin/clavulanic acid. Conclusion: Our data support the implementation of antimicrobials restriction measures as an effective means of controlling excessive antimicrobials sales and dispensing without prescriptions.