@article {Nafadee001869, author = {Vaidehi Nafade and Sophie Huddart and Giorgia Sulis and Amrita Daftary and Sonal Sekhar Miraj and Kavitha Saravu and Madhukar Pai}, title = {Over-the-counter antibiotic dispensing by pharmacies: a standardised patient study in Udupi district, India}, volume = {4}, number = {6}, elocation-id = {e001869}, year = {2019}, doi = {10.1136/bmjgh-2019-001869}, publisher = {BMJ Specialist Journals}, 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{\textquoteright}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{\textendash}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.}, URL = {https://gh.bmj.com/content/4/6/e001869}, eprint = {https://gh.bmj.com/content/4/6/e001869.full.pdf}, journal = {BMJ Global Health} }