Pharmacy-based dispensing of antimicrobial agents without prescription in India: appropriateness and cost burden in the private sector

Abstract

BackgroundInappropriate antibiotic use for treatment of common self-limiting infections is a major problem worldwide. We conducted this study to determine prevalence of non-prescription sale of antimicrobial drugs by pharmacies in Bangalore, India, and to assess their associated avoidable cost within the Indian private healthcare sector.MethodsBetween 2013 and 2014, two researchers visited 261 pharmacies with simulated clinical scenarios; upper respiratory tract infection in an adult and acute gastroenteritis in a child. Using a pre-defined algorithm, the researchers recorded questions asked by the pharmacist, details of medicines dispensed, and instructions regarding drug allergies, dose and side effects.ResultsAntimicrobial drugs were obtained without prescription from 174 of 261 (66.7 %) pharmacies visited. Instructions regarding dose of these drugs were given by only 58.0 % pharmacies. Only 18.4 % (16/87) of non-antimicrobial-dispensing pharmacies cited the need for a prescription by a medical practitioner. None gave advice on potential side effects or possible drug allergies. In the upper respiratory infection simulation, 82 (71.3 %) of the 115 pharmacies approached dispensed antimicrobials without a prescription. The most common antimicrobial drug prescribed was amoxicillin (51.2 %), followed by azithromycin and ciprofloxacin (12.2 % each). Among 146 pharmacies where acute gastroenteritis was simulated, 92 (63.0 %) dispensed antimicrobials. Common ones were fluoroquinolones (66.3 %), particularly norfloxacin in combination with metronidazole. Standard treatment for diarrhea such as oral rehydration solution and zinc was prescribed by only 18 of 146 (12.3 %) pharmacies. Assuming the average cost of a 5-day course of common antimicrobials in India is $1.93, with 2.5 and 2.1 annual episodes of adult upper respiratory and childhood gastrointestinal infections respectively, and with 30–45 % of the population of 1.3 billion visiting pharmacies, the estimated cost of unnecessary antimicrobial drugs dispensed by pharmacies in India would range from $1.1 to 1.7 billion.ConclusionsThe study shows that dispensing of antimicrobial drugs without prescription by pharmacies in the private sector in India within an urban setting was unacceptably high, thus placing a high burden on healthcare expenditure. There is an urgent need to institute measures to curb unnecessary antimicrobial usage in India, address market incentives and involve pharmacists as partners for creating awareness among communities.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-015-0098-8) contains supplementary material, which is available to authorized users.

Pharmacists’ Knowledge Attitude and Practice Regarding the Dispensing of Antibiotics without Prescription in Tanzania: An Explorative Cross-Sectional Study

“…Despite the majority of pharmacists having excellent knowledge about legal requirements to dispense antibiotics and consequences of the irrational use of antibiotics, 74.0% pharmacists agreed that they dispense without prescription in their practice. These results were considered similar to a study conducted in Syria where 89.3% pharmacists admitted to dispensing antibiotics without prescription [7] while a simulated research conducted in India and Kilimanjaro region in Tanzania revealed that 66.7% and 90.0% pharmacies dispense antibiotics without prescription respectively [11,19] Patients, pharmacists and the regulatory authorities' practices may all contribute to this malpractice. The tendency of patients to visit pharmacy without a legal prescription was claimed by pharmacists to be among the reason for them to dispense without prescription to meet customer demands and expectations.…”

Factors influencing knowledge and practice of self-medication among college students of health and non-health professions

“…A similarly high prevalence (84.0%) of self-medication was observed among undergraduate nursing students in India [14]. In another study of the medicines dispensed in pharmacies in Bangalore, India, 66.7% (174/261) pharmacies dispensed antimicrobials without a valid prescription [15]. The prevalence of selfmedication was 69.2% (465/672) in a crosssectional study in Italy [16].…”

Non-prescription sale of antibiotics in pharmacies across Puducherry, India

“…A similar study reported in 2015 by Shet A et al suggests that a similar situation exists in Bengaluru, India, and perhaps throughout the country. 12 To further limit the inappropriate dispensing of antibiotics without prescription, the Government of India has introduced Schedule H1 in the Indian Drugs and Cosmetics Act from Mar 1, 2014. 6 However, how effective this will be is a question difficult to answer.…”