TY - JOUR
T1 - Over-the-counter antibiotic dispensing by pharmacies
T2 - A standardised patient study in Udupi district, India
AU - Nafade, Vaidehi
AU - Huddart, Sophie
AU - Sulis, Giorgia
AU - Daftary, Amrita
AU - Miraj, Sonal Sekhar
AU - Saravu, Kavitha
AU - Pai, Madhukar
N1 - Funding Information:
1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada 2McGill International Tuberculosis Center, McGill University, Montreal, Québec, Canada 3Faculty of Health, York university, Toronto, Ontario, Canada 4Department of Pharmacy Parctice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India 5Manipal McGill Program for Infectious Diseases, Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi, India 6Department of Infectious Diseases, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal, India
Funding Information:
Funding The study was funded by a TMA Pai Endowment Chair at the Manipal Academy of Higher Education, Manipal.
Publisher Copyright:
© 2019 Author(s).
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Background Antimicrobial resistance is a global health emergency, and one of the contributing factors is overuse and misuse of antibiotics. India is one of the world's largest consumers of antibiotics, and inappropriate use is potentially widespread. This study aimed to use standardised patients (SPs) to measure over-the-counter antibiotic dispensing in one region. Methods Three adults from the local community in Udupi, India, were recruited and trained as SPs. Three conditions, in both adults and children, were considered: diarrhoea, upper respiratory tract infection and acute fever. Adult SPs were used as proxies for the paediatric cases. Results A total of 1522 SP interactions were successfully completed from 279 pharmacies. The proportion of SP interactions resulting in the provision of an antibiotic was 4.34% (95% CI 3.04% to 6.08%) for adult SPs and 2.89% (95% CI 1.8% to 4.4%) for child SPs. In the model, referral to another provider was associated with an OR 0.38 (95% CI 0.18 to 0.79), the number of questions asked was associated with an OR 1.54 (95% CI 1.30 to 1.84) and an SP-pharmacist interaction lasting longer than 3 min was associated with an OR 3.03 (95% CI 1.11 to 8.27) as compared with an interaction lasting less than 1 min. Conclusion Over-the-counter antibiotic dispensing rate was low in Udupi district and substantially lower than previously published SP studies in other regions of India. Dispensing was lowest when pharmacies referred to a doctor, and higher when pharmacies asked more questions or spent more time with clients.
AB - Background Antimicrobial resistance is a global health emergency, and one of the contributing factors is overuse and misuse of antibiotics. India is one of the world's largest consumers of antibiotics, and inappropriate use is potentially widespread. This study aimed to use standardised patients (SPs) to measure over-the-counter antibiotic dispensing in one region. Methods Three adults from the local community in Udupi, India, were recruited and trained as SPs. Three conditions, in both adults and children, were considered: diarrhoea, upper respiratory tract infection and acute fever. Adult SPs were used as proxies for the paediatric cases. Results A total of 1522 SP interactions were successfully completed from 279 pharmacies. The proportion of SP interactions resulting in the provision of an antibiotic was 4.34% (95% CI 3.04% to 6.08%) for adult SPs and 2.89% (95% CI 1.8% to 4.4%) for child SPs. In the model, referral to another provider was associated with an OR 0.38 (95% CI 0.18 to 0.79), the number of questions asked was associated with an OR 1.54 (95% CI 1.30 to 1.84) and an SP-pharmacist interaction lasting longer than 3 min was associated with an OR 3.03 (95% CI 1.11 to 8.27) as compared with an interaction lasting less than 1 min. Conclusion Over-the-counter antibiotic dispensing rate was low in Udupi district and substantially lower than previously published SP studies in other regions of India. Dispensing was lowest when pharmacies referred to a doctor, and higher when pharmacies asked more questions or spent more time with clients.
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U2 - 10.1136/bmjgh-2019-001869
DO - 10.1136/bmjgh-2019-001869
M3 - Article
AN - SCOPUS:85074657504
SN - 0027-2507
VL - 4
JO - Journal of the Mount Sinai Hospital, New York
JF - Journal of the Mount Sinai Hospital, New York
IS - 6
M1 - e001869
ER -