Antibiotic dispensing by drug retailers in Kathmandu, Nepal

Abstract

Summaryobjectives To assess over-the-counter antimicrobial dispensing by drug retailers in Kathmandu, Nepal, for rationality, safety, and compliance with existing government regulations.methods Standardized cases of dysuria in a young adult male and acute watery diarrhoea in a child were presented by a mock patient to retailers at 100 randomly selected pharmacies. Questions asked by retailers and advice and medications given at their initiative were recorded.results All retailers engaged in diagnostic and therapeutic behaviour beyond their scope of training or legal mandate. Historical information obtained by retailers was inadequate to determine the nature or severity of disease or appropriateness of antimicrobial therapy. 97% (95% CI ϭ 91.5-99.4%) of retailers dispensed unnecessary antimicrobials in diarrhoea, while only 44% (95% CI ϭ 34.1-54.3%) recommended oral rehydration therapy and only 3% (95% CI ϭ 0.6-8.5%) suggested evaluation by a physician. 38% (95% CI ϭ 28.5-48.2%) gave antimicrobials in dysuria, yet only 4% (95% CI ϭ 1.1-9.9%) adequately covered cystitis. None covered upper urinary tract or sexually transmitted infections, conditions which could not be ruled out based on the interviews, and only 7% (95% CI ϭ 2.9-13.9%) referred for a medical history and physical examination necessary to guide therapy.conclusions Although legislation in Nepal mandates a medical prescription for purchase of antibiotics, unauthorized dispensing is clearly problematic. Drug retailers in our study did not demonstrate adequate understanding of the disease processes in question to justify their use of these drugs. Risks of such indiscretion include harm to individual patients as well as spread of antimicrobial resistance. More intensive efforts to educate drug retailers on their role in dispensing, along with increased enforcement of existing regulations, must be pursued.

Comparative Prevalence of Antimicrobial Resistance in Community-Acquired Urinary Tract Infection Cases from Representative States of Northern and Southern India

“…Unqualified practitioners, untrained pharmacists and nurses all over the country use antimicrobials indiscriminately [22]. Similar practices have also been reported from other developing countries, such as Nepal and Vietnam [23][24][25]. Our findings strongly suggest that empirical treatment with these drugs should no longer be practiced.…”

Establishing a Hospital Pharmacy in Nepal: Experiences and Challenges

“…The retail shops have most of their staffs that lack sufficient knowledge on drugs and disease process leading to unwanted effects like antimicrobial resistance. [18] They are found doing unethical competition like providing discounts on the medicines they sell. They also try to mention flaws of the hospital pharmacy to the people so that patients won't seek medicines from hospital pharmacy.…”

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“…Keeping this in mind, it is not surprising that an increasing number of new antimicrobials agents are being made available regularly. With widespread use of antibiotics, the prevalence of resistance has increased 6 . The association of resistance with the use of antimicrobials agents has been documented both in patient 7 and outpatient setting 8 .…”