Decrease in Penicillin Sales in Brazil after Over-the-Counter Restrictions

Abstract

b W e read with great interest the recently published paper by Santa- . In that work, the authors measured the changes in the seasonal variation in penicillin use before and after the restrictions on over-the-counter (OTC) antibiotic sales went into effect in Mexico and Brazil in 2010.Santa-Ana-Tellez et al. (1) found that following the implementation of policies to restrict OTC sales of antibiotics, the seasonal variation in antibiotic usage decreased in Mexico but not in Brazil. On the basis of these findings, the authors concluded that in Mexico, the inappropriate use of penicillin may have diminished after the restrictions were enforced. However, the authors suggested that in Brazil, the increased use of penicillin with no change in the seasonal variation of penicillin use might indicate that further efforts are needed to reduce inappropriate antibiotic use.We would like to further discuss the results related to Brazil. We also evaluated the repercussions of antimicrobial control in Brazil (2). The unpublished data were collected from approximately 3,000 pharmacies (4.5% of Brazilian pharmacies) located in approximately 1,500 municipalities (27% of Brazilian municipalities). The information regarding pharmacy antibiotic sales was obtained from the Acode Electronic System, which is used by pharmacies associated with the Brazilian Pharmaceutical Federation (Febrafar), Sao Paulo, Brazil, to monitor the data on the acquisition and sale of medicines by these pharmacies.Amoxicillin, cephalexin, and azithromycin were the most commonly sold antibiotics in both the precontrol (December 2009 to November 2010) and postcontrol (December 2010 to November 2011 periods. The most significant reductions in the number of units sold were observed for the following classes of antibiotics: tetracyclines (Ϫ30.47%), sulfonamides (Ϫ28.54%), macrolides (Ϫ24.99%), and penicillins (Ϫ20.46%). There was a reduction in the number of units sold by the pharmaceutical establishments for all penicillins except amoxicillin in combination with clavulanic acid (Table 1).The trend of increased sales of penicillins observed in Brazil even after the implementation of restrictive measures reflects the growth of the Brazilian pharmaceutical market as a whole. Thus, it should not be understood as reflecting the ineffectiveness of the restrictive measures.In our study, the sale of amoxicillin was reduced by approximately 30% despite the pharmaceutical market growth. This change clearly shows that the restriction of sales in pharmacies resulted in decreased amoxicillin consumption, often associated with self-medication and OTC sales for the treatment of upper respiratory infections.In our study, the number of units of amoxicillin in combination with clavulanic acid sold increased by 9%, similar to the results reported by Santa-Ana-Tellez et al. (1); however, the increase was not statistically significant. A possible explanation is that this combination is more frequently associated with the use of prescribed antibiotics than self-medication, perhaps be...

Assessing the impact of law enforcement to reduce over-the-counter (OTC) sales of antibiotics in low- and middle-income countries; a systematic literature review

“…Several studies examined data from more than one country. The included studies reported on law enforcement in Brazil ( n = 5) [16–20], Mexico ( n = 2) [18, 19], Chile ( n = 2) [15, 21], Colombia ( n = 1) [21], Venezuela ( n = 1) [21], Bosnia and Herzegovina ( n = 2) [22, 23], Azerbaijan ( n = 1) [24], North Macedonia ( n = 1) [25], Vietnam ( n = 3) [5, 26, 27] and Thailand ( n = 2) [27, 28]. Countries were grouped by WHO region to account for potential regional and cultural differences in antibiotic use and implementation of regulations.…”

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…C. Study Three -Brazil 2015 373 . Sales data were collected from approximately 3000 private pharmacies pre and post the new legislation in Brazil.…”

Reply to “Decrease in Penicillin Sales in Brazil after Over-the-Counter Restrictions”

“…This robust quasiexperimental method controls for most threats to internal validity by adjusting for preexisting trends in study outcomes that are unrelated to the policy (4). Nevertheless, we agree with Lopes-Júnior et al (1) that the surveillance of antimicrobial prescription should be a common practice, not only in Brazil but in other Latin American countries. As recommended by international organizations (5), we also urge the implementation of nationally representative standardized data collection to accurately describe and compare the utilization of medicines in Latin American countries.…”