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Antibiotics commonly dispensed without prescription in China
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It is still common for antibiotics to be dispensed without a prescription at community pharmacies throughout China, though the practice is less prevalent in chain pharmacies, in urban areas and in places where a pharmacist is on duty, according to a recently published study.
The findings add to the evidence that more antimicrobial stewardship measures are needed in retail settings, researchers said.
“The inappropriate use of antibiotics is a major driver of antimicrobial resistance and leads to other adverse effects, including unnecessary costs, avoidable adverse outcomes, and masking of underlying infectious processes,” Jie Chang, PhD, from the School of Pharmacy at Xi’an Jiaotong University, and colleagues wrote. “Indiscriminate dispensing of antibiotics without a diagnosis and a medical prescription in community settings, which is largely associated with unnecessary use, incomplete or short treatment courses, and inappropriate dose choice, is still prevalent in many parts of the world, and global action is needed urgently to tackle this problem.”
Chang and colleagues used a simulated client method to measure nonprescription antibiotic dispensing based on scenarios of pediatric diarrhea and adult acute upper respiratory tract infections presented at 2,411 community pharmacies in 2017. According to the study, the researchers then evaluated factors associated with nonprescription dispensing of antibiotics.
In total, nonprescription antibiotic dispensing was observed during 1,169 of 2,411 (48.5%) diarrhea interactions and 1,690 of 2,411 (70.1%) adult acute upper respiratory tract infection interactions, Chang and colleagues reported.
According to the study, nonprescription antibiotic dispensing was more prevalent in rural compared with urban areas, 54.4% vs. 39.9% for diarrhea and 75.2% vs. 62.7% for upper respiratory tract infections. They found that it was negatively associated with on-site pharmacists (OR = 0.66) and being part of a chain pharmacy (OR = 0.75).
Recent studies have explored the topic of nonprescription antibiotics in other countries, including the United States and India.
In a U.S. study, researchers found that nonprescription antibiotic use is a clear public health problem in all racial and ethnic groups, but is understudied. According to the study, the prevalence of nonprescription antibiotic use varied from 1% of adults surveyed in health care settings to 66% of Latino migrant workers in Florida.
In India, researchers found that Indian pharmacies frequently dispense antibiotics, steroids and fluoroquinolones to patients with suspected pulmonary tuberculosis instead of referring them for proper treatment.
“Our findings point to the need for further public stewardship measures, not only to control nonprescription antibiotic sales, but also to improve the quality of service at community pharmacies,” Chang and colleagues concluded. “Eliminating nonprescription antibiotic dispensing at community pharmacies will be impossible without timely multifaceted interventions, including stricter regulation, better enforcement of existing regulation, staff training, public education, and surveillance.”– by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
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