Abstract
India has one of the highest rates of antimicrobial resistance (AMR) worldwide. Despite being prescription drugs, antibiotics are commonly available over-the-counter (OTC) at retail pharmacies. We aimed to gain insight into the OTC sale of antibiotics at retail pharmacies and to elucidate its underlying drivers. We conducted face-to-face, in-depth interviews using convenience sampling with 22 pharmacists and 14 informal dispensers from 36 retail pharmacies across two Indian states (Haryana and Telangana). Thematic analysis revealed that antibiotics were often dispensed OTC for conditions e.g., fever, cough and cold, and acute diarrhea, which are typically viral and self-limiting. Both Access and Watch groups of antibiotics were dispensed for 1–2 days. Respondents had poor knowledge regarding AMR and shifted the blame for OTC practices for antibiotics onto the government, prescribers, informal providers, cross practice by alternative medicine practitioners, and consumer demand. Pharmacists suggested the main drivers for underlying OTC dispensing were commercial interests, poor access to public healthcare, economic and time constraints among consumers, lack of stringent regulations, and scanty inspections. Therefore, a comprehensive strategy which is well aligned with activities under the National Action Plan-AMR, including stewardship efforts targeting pharmacists and evidence-based targeted awareness campaigns for all stakeholders, is required to curb the inappropriate use of antibiotics.
Highlights
Antimicrobial resistance (AMR) is recognized as a global public health threat
In our study conducted across two Indian states, the inappropriate OTC dispensing of antibiotics by pharmacists and informal dispensers in retail pharmacies was found to be common
We observed a low awareness about AMR and the adverse effects of antibiotics among dispensers
Summary
With increasing AMR, especially antibacterial resistance in bacteria, common infections are becoming difficult to treat [1]. It is estimated that worldwide, 700,000 people die of drug-resistant infections every year, and this could increase to 10 million by 2050 if no proactive actions are taken to mitigate AMR [2]. The major driver for the rapid development and spread of antibiotic resistance is the total volume of antibiotic use, which exerts unnatural selective pressure on bacteria and potentiates the development of AMR [6]. The per-capita consumption of antibiotics in India is lower than that in several other countries [7], the proportion of broad-spectrum antibiotic consumption which are recommended for restricted use by the World Health Organization (WHO) is high [8,9]
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