Availability of over-the-counter antibiotics in Guatemalan corner stores.

Purificación Moreno,Karen Sosa,Marinees Morales,Maria Renee Lopez,Laura M Grajeda,Alejandro Cerón,John P Mccraken,Guy H Palmer,Celia Cordón-Rosales,Brooke M Ramay,Douglas R Call

doi:10.1371/journal.pone.0239873

Purificación Moreno, Karen Sosa + Show 9 more

Open Access

https://doi.org/10.1371/journal.pone.0239873

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Abstract

Widespread availability of antibiotics without prescription potentially facilitates overuse and contributes to selection pressure for antimicrobial resistant bacteria. Prior to this study, anecdotal observations in Guatemala identified corner stores as primary antibiotic dispensaries, where people purchase antibiotics without prescriptions. We carried out a cross sectional study to document the number and types of antibiotics available in corner stores, in four study areas in Guatemala. A total of 443 corner stores were surveyed, of which 295 (67%) sold antibiotics. The most commonly available antibiotics were amoxicillin, found in 246/295 (83%) stores, and tetracycline, found in 195/295 (66%) stores. Over the counter sales result from laissez-faire enforcement of antibiotic dispensing regulations in Guatemala combined with patient demand. This study serves as a baseline to document changes in the availability of antibiotics in informal establishments in light of new pharmacy regulations for antibiotic dispensing, which were adopted after this study was completed.

Highlights

Antimicrobial resistance (AMR) is a global public health threat that challenges our ability to respond to infectious diseases [1]
From a population dynamics perspective, the more that bacteria are exposed to antibiotics, the greater the probability that new resistant strains will emerge in a population, and that resistant strains already in the population will expand in prevalence
Of the 472 corner stores approached, 443 (94%) accepted to participate and were enrolled in the study: all corner stores approached in Guatemala City and San Juan Ostuncalco participated in the study and 76% (62/82) and 95% (72/77) of corner stores participated in Antigua and Coatepeque respectively

Summary

Introduction

Antimicrobial resistance (AMR) is a global public health threat that challenges our ability to respond to infectious diseases [1]. From a population dynamics perspective, the more that bacteria are exposed to antibiotics, the greater the probability that new resistant strains will emerge in a population, and that resistant strains already in the population will expand in prevalence. This “amplification” of resistant bacteria translates into higher probabilities that resistant strains will be transmitted to new hosts [2]. One potential driver of amplification is unregulated availability of antibiotics. When this occurs, people are more likely to access and use antibiotics without any medical oversight [3].

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