Examining Over-the-Counter Antibiotic Sales in Astana: A Qualitative Study of Patients’ and Pharmacists’ Perceptions and Experiences

Abstract

Background. Antimicrobial resistance (AMR) is a global health issue that can lead to 10 million deaths by 2050. One of the factors contributing to AMR is the sale of Over-The-Counter (OTC) antibiotics. Despite regulatory restrictions, the persistence of OTC antibiotic sales in Astana suggests a gap between policy and practice. However, little is known about how patients and pharmacists perceive and justify these practices in the Kazakhstani context. Therefore, this qualitative study aimed to explore patients’ and pharmacists’ perceptions of OTC antibiotic sales. Methods. The qualitative study applied semi-structured interviews with 7 patients and 6 pharmacists in Astana. Data were documented verbatim, anonymized, and analyzed using a thematic analysis. Results. Patients accessed OTC antibiotics through both online and offline channels. Online purchases were driven by the convenience of rapid delivery and weak regulatory enforcement. Offline purchases were shaped by structural barriers to healthcare access, including time and financial constraints, as well as low awareness of AMR and reliance on prior experience. Trust-based interactions further facilitated non-prescription dispensing. Additionally, pharmacists reported dispensing antibiotics without prescriptions due to profit incentives and persistent patient demand, with variations linked to age and professional training. These findings reveal the importance of a comprehensive approach that involves patients, pharmacists, physicians, and state efforts to combat AMR. Conclusion. Addressing OTC antibiotic use requires not only stricter enforcement of regulations across digital and physical pharmacy markets, but also systemic implementation of e-prescriptions, re-evaluation of pharmacists’ salary system, targeting healthcare access, public awareness, and professional training. By illuminating how regulatory gaps are enacted in everyday practice, this study contributes to ongoing efforts to mitigate the spread of AMR in Kazakhstan.