Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales

Abstract

BackgroundImproper antibiotic use is one of the main drivers of bacterial resistance to antibiotics, increasing infectious diseases morbidity and mortality and raising costs of healthcare. The level of antibiotic consumption has been shown to vary according to socioeconomic determinants (SED) such as income and access to education. In many Latin American countries, antibiotics could be easily purchased without a medical prescription in private pharmacies before enforcement of restrictions on over-the-counter (OTC) sales in recent years. Brazil issued a law abolishing OTC sales in October 2010. This study seeks to find SED of antibiotic consumption in the Brazilian state of São Paulo (SSP) and to estimate the impact of the 2010 law.MethodsData on all oral antibiotic sales having occurred in the private sector in SSP from 2008 to 2012 were pooled into the 645 municipalities of SSP. Linear regression was performed to estimate consumption levels that would have occurred in 2011 and 2012 if no law regulating OTC sales had been issued in 2010. These values were compared to actual observed levels, estimating the effect of this law. Linear regression was performed to find association of antibiotic consumption levels and of a greater effect of the law with municipality level data on SED obtained from a nationwide census.ResultsOral antibiotic consumption in SSP rose from 8.44 defined daily doses per 1,000 inhabitants per day (DID) in 2008 to 9.95 in 2010, and fell to 8.06 DID in 2012. Determinants of a higher consumption were higher human development index, percentage of urban population, density of private health establishments, life expectancy and percentage of females; lower illiteracy levels and lower percentage of population between 5 and 15 years old. A higher percentage of females was associated with a stronger effect of the law.ConclusionsSSP had similar antibiotic consumption levels as the whole country of Brazil, and they were effectively reduced by the policy.

Prevalence and Determinants of Antibiotic Consumption in the Elderly during 2006–2017

“…On the other hand, educational level was not associated with antibiotic consumption. In that sense, it has been reported the different role of education in developing countries, where it may improve access to medical treatment, than in developed countries, where access to medical treatment may not depend on educational levels [53,54]. Furthermore, in line with other studies [20,55], no relationship was found between antibiotic consumption and marital status.…”

Time trends in antibiotic consumption in the elderly: Ten-year follow-up of the Spanish National Health Survey and the European Health Interview Survey for Spain (2003–2014)

“…Low educational level [ 35 ] was also significantly associated with antibiotic consumption. In a study conducted in São Paulo (Brazil), Kliemann et al [ 36 ] reported how antibiotic consumption was more frequent in larger populations with higher educational levels. It is possible that education acts differently in developing countries, where it may improve access to medical treatment, than in developed countries, where access to medical treatment may not depend on educational levels, despite increasing knowledge about health patterns and correct antibiotic use.…”

Public target interventions to reduce the inappropriate use of medicines or medical procedures: a systematic review

“…Gonzales et al found that the state-wide “Get Smart Colorado” campaign did not improve prescription rates, but might be associated with a reduction in antibiotic use in the community through decreases in office visit rates among children [ 56 , 64 ]. Four studies evaluated the effectiveness of the restrictions on OCT purchases on antibiotic consumption in five Latin American countries with mixed results [ 33 – 35 , 80 ].…”