Table 1 Detailed scenarios with rationale and expected outcome

1

Pseudo-patient’s sister (25 years old) is having difficulty swallowing; it is painful when swallowing. She has a slight fever too. She has had symptoms for past three days.

Requested some medicine to relieve her symptoms.

1. No known allergies.

2. No concurrent medicine.

3. No co-morbidities.

4. Gargled with salt water but didn’t help much.

5. Not tried any medicine.

6. No cough.

7. No headache.

8. Not visited a physician.

9. Not pregnant.

10. Not breast feeding.

URTIs are common self-limiting viral infections for which antibiotics are widely prescribed in Sri Lanka [5].

No antibiotic should be dispensed.

The pseudo-patient should be advised to gargle with salt water; provide an OTC antipyretic e.g. paracetamol, for the fever. Advice on proper dose. The pseudo-patient should be advised to see the physician if symptoms continue for more than a week or get worse.

2

The antibiotic is for pseudo-patient’s niece (4 years old). She has been suffering from a productive cough, runny nose (clear mucus), slight fever, occasional sneezing and some loss of appetite. The symptoms started three days ago. Requested medicine to relieve the condition.

1. No known allergies.

2. No concurrent medicine.

3. No co-morbidities.

4. Tried chlorpheniramine maleate and paracetamol.

5. No difficulties in breathing.

6. No sore throat.

7. Clear nasal discharge.

8. No headache.

9. 1–2 coughs per hour.

10. Not visited a physician.

11. Brings up a little phlegm when she coughs.

12. The cough is not worse at night.

URTIs are common self-limiting viral infections for which antibiotics are widely prescribed in Sri Lanka [5].

No antibiotic should be dispensed.

The pseudo-patient should be advised to use paracetamol for fever. Advice on proper dose. Advice to see the physician if symptoms continue for more than a week, or they get worse (in particular fever and aches).

3

The antibiotic is for pseudo-patient’s younger brother (20 years old) who is having acute loose bowel motion for the past two days (watery diarrhoea). He has to go to toilet almost every 3–4 h. The pseudo-patient requested some medicine to alleviate the reported symptoms.

1. No known allergies.

2. No concurrent medicine.

3. No co-morbidities.

4. Tried diphenoxylate hydrochloride, it has helped a little but still has watery diarrhoea and going to toilet every 3–4 h.

5. Taking oral rehydration solution as well.

6. No vomiting.

7. No mucus or blood in stools.

8. No abdominal pain.

9. No appetite.

10. Not visited a physician.

11. No fever.

12. Currently, no family member is having similar symptoms.

Acute respiratory infections, diarrhoea, and neonatal infections remain major problems particularly in children in South Asian countries [56].

No antibiotic should be dispensed.

Advice to take Oral rehydration solution.

Proper Oral rehydration solution preparation method should be discussed.

Hygiene advice should be provided such as hand washing.

The pseudo-patient should be advised to see a physician, if the diarrhoea continues for a week or gets worse.

4

The antibiotic request is for pseudo-patient herself. Reported symptoms are discomfort on urination with a burning sensation and the need to urinate more frequently. She has been drinking more water than usual to alleviate the symptoms. She also has a slight fever. The symptoms started two days ago.

Requested some medicine to cure the reported symptoms.

1. No known allergies.

2. No concurrent medicine.

3. No comorbidities.

4. Not tried anything.

5. Low grade fever.

6. No back pain.

7. No genital ulcer.

8. She is not pregnant/not expecting to be pregnant in near future.

9. Not visited a physician.

10. Last time had the same problem about 12 months ago

Approximately 50% of women are treated for UTIs with antibiotics at some point in their lifetime [57].

No antibiotic should be dispensed.

The pseudo-patient should be advised to see a physician.