Barriers and determinants of over-the-counter antibiotic sales de-escalation: perspectives of community pharmacists in Aseer, Saudi Arabia

The study highlights that systemic and educational factors strongly influence pharmacists' roles in antimicrobial stewardship. This indicates that targeted interventions such as continuous professional education, digital prescription monitoring, and stronger regulatory enforcement are necessary to support pharmacists and reduce the dispensing of inappropriate antibiotics. These measures also align with Saudi Arabia's Vision 2030 healthcare priorities. To our knowledge, this is the first study to investigate these barriers within the Aseer region, offering novel evidence on how organizational and educational contexts shape stewardship practices. The findings provide insights that extend beyond Saudi Arabia, informing global antimicrobial resistance containment strategies.