The Sale of Antibiotics without Prescription in Pharmacies in Catalonia, Spain

Llor, Carles; Cots, Josep M.

doi:10.1086/598183

Cited by 155 publications

(133 citation statements)

References 18 publications

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“…86 Non-prescription use of antimicrobials is inherently associated with little guidance regarding appropriate antimicrobial selection for individual syndromes and safe practices to minimise adverse drug effects (even when provided by a pharmacist). 76,81,82,87 Appropriate antimicrobial use is complex and must be based on local susceptibility patterns. In areas where antimicrobial susceptibility data is unavailable, antimicrobial selection is difficult, even for skilled providers.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16] Uninformed patients or undertrained pharmacy staffrarely have access to basic information regarding appropriate antimicrobial use and do not appreciate the complexity involved in decisions surrounding drug selection. 64,67,76,83 As a result, financial concerns often guide antimicrobial selection resulting in short duration of treatment. 15,35,119 The conflict of interest inherent in the same individual prescribing and dispensing antimicrobials is a potential target for regulatory intervention.…”

Section: Discussionmentioning

confidence: 99%

“…39,64,67 Studies with patients simulated by actors showed that inappropriate antimicrobial dispensing by pharmacists without a prescription occurred frequently. [74][75][76][77][78][79][80][81][82][83]85 In low-income to medium-income countries, training of health-care workers as part of WHO's Integrated Management of Childhood Illness strategy has been shown to increase appropriate use of antimicrobials and decrease inappropriate use. [122][123][124][125] Non-physician health-care workers trained in integrated management of childhood illness might use antimicrobials more judiciously than physician providers.…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacists dispensing non-prescription antimicrobials had no knowledge of patients' allergies 83-100% of the time. 76,82 Potential side-effects were discussed in about 50% of non-prescription antimicrobial purchases. 81,87 Duration of antimicrobial use was shorter without than with a prescription.…”

Section: Frequency Of Non-prescription Usementioning

confidence: 99%

See 3 more Smart Citations

Non-prescription antimicrobial use worldwide: a systematic review

Morgan

Okeke

Laxminarayan

et al. 2011

The Lancet Infectious Diseases

771

670

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In much of the world antimicrobial drugs are sold without prescription or oversight by health-care professionals. The scale and effect of this practice is unknown. We systematically reviewed published works about non-prescription antimicrobials from 1970-2009, identifying 117 relevant articles. 35 community surveys from five continents showed that non-prescription use occurred worldwide and accounted for 19-100% of antimicrobial use outside of northern Europe and North America. Safety issues associated with non-prescription use included adverse drug reactions and masking of underlying infectious processes. Non-prescription use was common for non-bacterial disease, and antituberculosis drugs were available in many areas. Antimicrobial-resistant bacteria are common in communities with frequent non-prescription use. In a few settings, control efforts that included regulation decreased antimicrobial use and resistance. Non-prescription antimicrobial and antituberculosis use is common outside of North America and northern Europe and must be accounted for in public health efforts to reduce antimicrobial resistance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Frequency Of Non-prescription Usementioning

confidence: 99%

See 2 more Smart Citations

Non-prescription antimicrobial use worldwide: a systematic review

Morgan

Okeke

Laxminarayan

et al. 2011

The Lancet Infectious Diseases

771

670

View full text Add to dashboard Cite

show abstract

“…Antimicrobials may lose e¤ectiveness since they are frequently prescribed for viral infections [1] or can be obtained without an o¢ cial medical prescription [2,3]. Large volumes of antimicrobials are also used in agriculture and veterinary medicine, and in many consumer products where bene…ts are often unclear [4].…”

Section: Introductionmentioning

confidence: 99%

Assessing the impact of national antibiotic campaigns in Europe

2012

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Because of evidence of causal association between antibiotic use and bacterial resistance, the implementation of national policies has emerged as a interesting tool for controlling and reversing bacterial resistance. The aim of this study is to assess the impact of public policies on antibiotic use in Europe using a di¤erences-in-di¤erences approach. Comparable data on systemic administered antibiotics in 21 European countries are available for a 11-years panel between 1997 and 2007. Data on national campaigns are drawn from the public health literature. We estimate an econometric model of antibiotic consumption with country …xed e¤ects and control for the main socioeconomic and epidemiological factors. Lagged values and the instrumental variables approach are applied to address endogeneity aspects of the prevalence of infections and the adoption of national campaigns. We …nd evidence that public campaigns signi…cantly reduce the use of antimicrobials in the community by 1:3 to 5:6 de…ned daily doses per 1; 000 inhabitants yearly. This roughly represents an impact between 6:5% and 28:3% on the mean level of antibiotic use in Europe between 1997 and 2007. The e¤ect is robust across di¤erent measurement methods. Further research is needed to investigate the e¤ectiveness of policy interventions targeting di¤erent social groups such as general practitioners or patients.

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Investigation of early antibiotic use in pediatric patients with acute respiratory infections by high‐performance liquid chromatography

Toi

Doan

Minh

et al. 2019

Biomedical Chromatography

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In this study, we developed and validated two reliable high‐performance liquid chromatography (HPLC) methods for the qualitative detection of six oral β‐lactams, which are commonly used in pediatric patients with acute respiratory infections (ARIs). Two distinct reverse‐phase chromatographic separations of six β‐lactams were obtained. Four β‐lactams (cefadroxil, cephalexin, cefaclor and cefixime) in urine were separated using a gradient program with a mobile phase consisting of K2HPO4 buffer (20 mm, pH 2.8) and acetonitrile on a LichroCART 250 × 4.6 mm, Purospher STAR C18 end‐capped (5 μm) column. Two remained β‐lactams (amoxicillin and cefuroxime) were analyzed using a gradient elution with the mobile phase containing K2HPO4 buffer (20 mm, pH 3.0) and acetonitrile on a LichroCart® Purospher Star C8 end‐capped column (5 μm, 125 × 4.6 mm). Good linearity within the range of 0.3–30 μg/ml for cefadroxil, cephalexin, cefaclor and cefixime, and 0.2–20 μg/ml for amoxicillin and cefuroxime, was attained. The precisions were <14%. The accuracies ranged from 85.87 to 102.8%. The two validated methods were then applied to determine these six antibiotics in 553 urine samples of pediatric patients with ARIs. As a result, 32.2% were positive with one or more of six tested β‐lactams. Cefixime was the most commonly detected agent, accounting for 9.8% of enrolled patients.

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The Sale of Antibiotics without Prescription in Pharmacies in Catalonia, Spain

Abstract: These results demonstrate that, although illegal, the sale of antibiotics without a prescription continues in Spain. This should be taken into account by countries that are currently considering the possibility of making some antibiotics available over the counter.

Cited by 155 publications

References 18 publications

Non-prescription antimicrobial use worldwide: a systematic review

Non-prescription antimicrobial use worldwide: a systematic review

Assessing the impact of national antibiotic campaigns in Europe

Investigation of early antibiotic use in pediatric patients with acute respiratory infections by high‐performance liquid chromatography

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