Economic and social drivers of antibiotic dispensing practices among community pharmacies in Nepal

Abstract

objective To assess economic and social drivers of dispensing antibiotics without prescription by community pharmacies in Nepal. method A survey was conducted among 111 pharmacy owners and managers in five districts. Information on demographic and economic characteristics of the pharmacies (e.g. revenue and profits from antibiotics) and their inclination to sell antibiotics without a physician's prescription under various scenarios (e.g. diarrhoea in a child) was collected. Univariate analysis was conducted to assess the demographic and economic characteristics. Bivariate analysis was conducted to examine the relationship between dispensing antibiotics without prescription and economic and social factors.results Azithromycin and amoxicillin were the most commonly dispensed antibiotics. The proportions of pharmacies reporting that they would 'most likely' or 'likely' dispense antibiotics without prescription to adult patients ranged from 36.9% (sore throat) to 67.6% (cough). The proportions for paediatric patients ranged from 62.2% (sore throat) to 80.2% (cough or diarrhoea). There was no consistent relationship between the likelihood of dispensing antibiotics and revenues, profits or the number of patients. Instead, dispensing behaviour was influenced by the pressure from the patient; the respondents were more likely to dispense antibiotics when the patient specifically asked for 'an antibiotic' rather than for 'a medicine', and 68.5% respondents ranked 'customer satisfaction' as the most important factor motivating their work.conclusions In Nepal, inappropriate sale of antibiotics by community pharmacists is high, particularly for paediatric patients. Additional research is needed to establish key drivers of this behaviour and to help design effective approaches to reducing AMR. keywords antibiotics, Nepal, economic factors, community pharmacies Sustainable Development Goals (SDGs): Good health and well-being, strengthen capacity to manage health risks

Over-the-Counter Sale of Antibiotics in India: A Qualitative Study of Providers’ Perspectives across Two States

“…Another factor was the lack of time for a detailed medical consultation among the consumers. Similar findings have also been reported in Nepal [ 39 ], where OTC antibiotic use is driven by the intention of dispensers to prevent the cost of consultation and travel to the hospital, and patients also save money by bypassing the formal system of care.…”

A Formative Assessment of Antibiotic Dispensing/Prescribing Practices and Knowledge and Perceptions of Antimicrobial Resistance (AMR) among Healthcare Workers in Lahore Pakistan

“…For the first four symptoms, healthcare providers were significantly more likely to prescribe/dispense antibiotics for adults. This is different than in Nepal where pharmacists were more likely to prescribe/dispense antibiotics for children for these same symptoms [ 12 ].…”

“…The survey instrument was adapted from a similar AMR and stewardship study conducted in Kathmandu, Nepal with physicians and pharmacists by one of the co-PIs [ 12 ]. Modifications were made to the survey to account for the socio-economic and health infrastructure in Lahore.…”

“…A generic formula was used for cross sectional surveys to assess prevalence of dispensing antibiotics without prescriptions [ 38 ]. To estimate prevalence, data from other dispensing studies in Pakistan was used, as well as data from a similar study with pharmacists in Nepal [ 12 ]. Because of the difference in context and the range in different types of respondents (e.g., physicians, nurses, pharmacists) a low-end conservative estimate of 0.20 (20%) prevalence was used.…”

“…In a study in Kathmandu Nepal, 36.9% to 67.6% of community pharmacists stated they would ‘mostly likely’ or likely’ dispense antibiotics to adult patients with sore throat and diarrhea, respectively. The proportions for pediatric patients were even higher at 62.2% for sore throat and 80.2% for cough or diarrhea [ 12 ]. Utilizing a medical audit database in India, an estimated 412 antibiotics/1000 persons were dispensed in a one-year period.…”