Small pharmacies are more likely to dispense antibiotics without a medical prescription than large pharmacies in Catalonia, Spain.

The aim of this study was to explore the relationship between pharmacy size and the likelihood of obtaining antibiotics without medical prescription at a pharmacy. In 2008 in Catalonia, two actors presented three different cases in a randomised sample of pharmacies and asked pharmacists for an antibiotic. Pharmacies were considered as small when having limited space with only one counter and a maximum of two professionals selling medicines, as medium sized with three or four attending professionals, and as large with a large selling space and more than four attending professionals. Of the 197 pharmacies visited, 88 (44.7%) were considered as small while only 25 (12.7%) were large. Antibiotics were obtained without a medical prescription in 89 (45.2%) pharmacies, mainly in small pharmacies (63.6%), followed by medium-sized pharmacies (35.7%) and large pharmacies (12%) (p<0.001). Large pharmacies, that probably have a greater income, more closely followed the prevailing legislation of not selling antibiotics to patients without a medical prescription. This observation should now be confirmed in other countries where over-the-counter sales of antibiotics are prevalent and should be taken into account by programmes aiming at achieving a more prudent use of antibiotics.