A Research Protocol to Assess the Impact of a Pharmacy-Based Syndromic Management Algorithm on Appropriate Antibiotic Dispensing for Urinary Tract Infections in Community Pharmacies in Lusaka, Zambia

Inappropriate antibiotic dispensing for urinary tract infections (UTIs) in community pharmacies is a key driver of antimicrobial resistance. In Zambia, where access to primary healthcare can be limited, pharmacies are often the first point of contact. Dispensing practices for UTIs are largely unregulated, leading to empirical and often incorrect antibiotic use. This protocol describes a study to assess the impact of a syndromic management algorithm on the appropriateness of antibiotic dispensing for suspected UTIs in community pharmacies in Lusaka. The primary objective is to compare the proportion of appropriate antibiotic dispensing episodes before and after the algorithm's implementation. A pre-post intervention study will be conducted. A syndromic management algorithm for UTIs, aligned with national guidelines, will be developed and validated. A sample of community pharmacies will be selected. Pre-intervention, simulated patient visits will establish a baseline. Pharmacy staff will then be trained on the algorithm. Post-intervention, simulated patient visits using identical scenarios will be repeated. Appropriateness will be judged against the algorithm criteria. Data will be analysed using comparative statistics. As this is a protocol, no empirical findings are available. The expected outcome is an increase in the proportion of appropriate antibiotic dispensing episodes, defined by correct drug, dose, and duration. A decrease in the dispensing of antibiotics for non-bacterial syndromes is also anticipated. The study will generate evidence on the feasibility and potential effectiveness of a standardised tool to improve antibiotic dispensing practices for UTIs in a resource-limited urban setting. If effective, the algorithm should be considered for integration into national pharmacy practice standards and scaled up with appropriate training. Further research should explore its applicability in rural settings. Antimicrobial resistance, community pharmacy, syndromic management, urinary tract infection, Zambia, antibiotic stewardship This protocol contributes a structured approach to evaluating a practical intervention for improving antibiotic dispensing in a commonly used but under-regulated healthcare access point. It addresses a critical evidence gap in antimicrobial stewardship within the Zambian context.