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Research
Over-the-counter antibiotic dispensing by pharmacies: a standardised patient study in Udupi district, India
  1. Vaidehi Nafade1,2,
  2. Sophie Huddart1,2,
  3. Giorgia Sulis1,2,
  4. Amrita Daftary3,
  5. Sonal Sekhar Miraj4,5,
  6. Kavitha Saravu5,6,
  7. Madhukar Pai1,2,5
  1. 1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
  2. 2McGill International Tuberculosis Center, McGill University, Montreal, Québec, Canada
  3. 3Faculty of Health, York university, Toronto, Ontario, Canada
  4. 4Department of Pharmacy Parctice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
  5. 5Manipal McGill Program for Infectious Diseases, Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
  6. 6Department of Infectious Diseases, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
  1. Correspondence to Dr Kavitha Saravu; kavithasaravu{at}gmail.com

Abstract

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.

  • global health
  • antibiotic
  • pharmacy
  • India

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2019-001869

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    Footnotes

    • Handling editor Seye Abimbola

    • Twitter @@vnafade, @@SKHuddart, @@giorgiasulis, @DaftaryAmrita, @@KavithaSaravu, @paimadhu

    • Contributors The study was designed by MP, KS and VN. The SP case scenarios and field visit plan were developed by MP, KS, VN and SSM. VN and KS supervised SP training, field visits and data collection. VN and GS coded the data, and VN and SH analysed the data. The data were interpreted by VN, GS, AD, KS and MP. The report was written by VN, MP and KS, and all authors provided review and comments.

    • Funding The study was funded by a TMA Pai Endowment Chair at the Manipal Academy of Higher Education, Manipal.

    • Disclaimer The funding source was not involved in the study design, data collection or analysis or data interpretation and manuscript writing.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Approval for the study was obtained from the ethics committees of the Manipal Academy of Higher Education in Manipal, India, and McGill University in Montreal, Canada.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.