Knowledge and behavior of consumers towards the non-prescription purchase of antibiotics: An insight from a qualitative study from New Delhi, India

Abstract

Background: In Low-and Middle-Income Countries, including India, consumers often purchase antibiotics over-the-counter (OTC) from retail pharmacies. This practice leads to the inappropriate use of antibiotics in the community which is an important driver for the development of antimicrobial resistance. A better understanding of consumers’ views towards this grave public health concern is critical to developing evidence-based intervention programs for awareness among the general population.
 Objective: To explore knowledge, practice and, behavior of consumers towards antibiotics, antibiotic use, antimicrobial resistance, purchasing behavior of consumers for antibiotics, and to gain insight which will help in developing evidence-based policy interventions.
 Methods: 72 in-depth consumer interviews were conducted in all 11 districts of the National Capital Territory of Delhi. The qualitative data were analyzed using thematic analysis.
 Results: Our study found that retail pharmacies were the first point of consultation for common ailments for patients/consumers once home remedies failed; they were largely unaware of the threat of antimicrobial resistance. Consumers’ knowledge of antibiotic use and about antimicrobial resistance was low, they used old prescriptions, and bought antibiotics OTC to save time and money. Despite the presence of regulations constituted to regulate the sale of antibiotics by the Government and the implementation of national campaigns, the practice of self-medication and behaviors such as OTC purchase, non-adherence to prescribed antibiotics was prevalent. Consumers perceive that antibiotics provide quick relief and accelerate the curing process and retail pharmacy shops try to protect their retail business interests by honoring old prescriptions and self-medication for antibiotics.
 Conclusions: The lack of awareness and insufficient knowledge about what antibiotics are and issues such as antimicrobial resistance or antibiotic resistance resulted in misuse of antibiotics by consumers. Limited access to public healthcare and affordability of private healthcare are factors that contribute towards the self-medication/OTC purchase of antibiotics. The regular misuse of antibiotics through irrational use reinforces the need for strong enactment of strategies like continuous community awareness campaigns. Mitigation efforts should focus upon educating consumers continuously and sustainably for the understanding of antibiotic misuse, antimicrobial resistance, and promote better compliance with regulations.

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

“…The retail pharmacies must have at least one qualified pharmacist to obtain a license. However, most retail pharmacies have unqualified personnel who run the business and dispense medicines, including “OTC antibiotics.” This is a common practice, as reported earlier in a study from New Delhi, India [ 20 , 25 ].…”

“…These practices of antibiotic dispensing clearly indicate that retail pharmacies not only flout the rules for dispensing drugs (both Schedule H and H1) without a prescription, but also give antibiotics in cases where they are not required. Earlier studies have indicated that consumers can easily obtain antibiotics without a prescription in LMICs [ 13 , 25 , 33 ].…”

“…This amendment was implemented to curb the widespread practice of antibiotic purchase from retail pharmacies without a valid prescription (old or outdated) or to prevent the pharmacists from dispensing antibiotics on their advice to the consumer/patient. However, several studies before and after 2014 indicate that consumers can still purchase antibiotics without a valid prescription as pharmacists still dispense antibiotics to their customers/clients/patients by attending to their symptoms [ 20 , 23 , 24 , 25 ].…”

“…All these pharmacies are private pharmacies and no medicine is available for free. Patients visit these pharmacies to purchase medication directly and avoid visiting a professionally trained doctor to save time and money [ 25 ].…”

Over-the-counter sales of antibiotics for human use in India: The challenges and opportunities for regulation

“…Yet reports suggest a degree of confusion among members of the Indian public around some messages in the campaigns conducted to date. 113 Further media campaigns can be pursued on a sustained basis by relevant government agencies; perhaps in conjunction with NGOs and civil society organisations. Techniques and principles used successfully in other countries can also be considered and possibly applied in future campaign designs in India.…”