Exploring awareness of planetary health and antibiotic disposal advice across Australian Pharmacies: A mystery shopping expedition

Background information: Inappropriate disposal of unused antimicrobials can push the environment out of balance, and increase the likelihood of antimicrobial-resistant organisms to grow. We aimed to investigate the recommendations for the disposal of unwanted antibiotics given as advice to consumers by community pharmacists practising in Australia. Methods: A cross-sectional study using mystery shopping explored pharmacists' recommendations for disposing of unwanted antibiotics. Simulated patients called community pharmacies across Australia for advice on disposing of leftover antibiotic mixtures. Findings: Of 1577 pharmacists called across Australia, over 59 % recommended incorrect disposal methods, i.e., putting the leftover antibiotic syrup in the home rubbish bin or down the sink or toilet, 28.4 % recommended putting the unused antibiotic straight into the rubbish bin, and 10 pharmacists recommended throwing the leftover syrup on the grass, soil, or in a street drain. There were 19 pharmacists who did not want to recommend disposal at all; some recommended calling the prescriber to ask. Of the pharmacists who advised consumers to return unwanted antibiotic liquid to their pharmacy, 21 (1.3 % overall) indicated that they would pour it down the sink at the pharmacy upon being returned. Interpretation: Pharmacists' advice on antibiotic disposal varied despite the availability of a national scheme enabling consumers to return unwanted medicines to pharmacies for this purpose. Enhanced education and policies could help pharmacists guide the public on proper disposal.