PT  - JOURNAL ARTICLE
AU  - Bipin Adhikari
AU  - Sunil Pokharel
AU  - Shristi Raut
AU  - Janak Adhikari
AU  - Suman Thapa
AU  - Kumar Paudel
AU  - Narayan G C
AU  - Sandesh Neupane
AU  - Sanjeev Raj Neupane
AU  - Rakesh Yadav
AU  - Sirapa Shrestha
AU  - Komal Raj Rijal
AU  - Sujan B Marahatta
AU  - Phaik Yeong Cheah
AU  - Christopher Pell
TI  - Why do people purchase antibiotics over-the-counter? A qualitative study with patients, clinicians and dispensers in central, eastern and western Nepal
AID  - 10.1136/bmjgh-2021-005829
DP  - 2021 May 01
TA  - BMJ Global Health
PG  - e005829
VI  - 6
IP  - 5
4099  - http://gh.bmj.com/content/6/5/e005829.short
4100  - http://gh.bmj.com/content/6/5/e005829.full
SO  - BMJ Global Health2021 May 01; 6
AB  - Introduction Over-the-counter (OTC) use of antibiotics contributes to the burgeoning rise in antimicrobial resistance (AMR). Drawing on qualitative research methods, this article explores the characteristics of OTC sales of antibiotic in Nepal, its drivers and implications for policy.Methods Data were collected in and around three tertiary hospitals in eastern, western and central Nepal. Using pre-defined guides, a mix of semi-structured interviews and focus group discussions were conducted with dispensers at drug stores, patients attending a hospital and clinicians. Interviews were audio-recorded, translated and transcribed into English and coded using a combination of an inductive and deductive approach.Results Drug shops were the primary location where patients engaged with health services. Interactions were brief and transactional: symptoms were described or explicit requests for specific medicine made, and money was exchanged. There were economic incentives for clients and drug stores: patients were able to save money by bypassing the formal healthcare services. Clinicians described antibiotics as easily available OTC at drug shops. Dispensing included the empirical use of broad-spectrum antibiotics, often combining multiple antibiotics, without laboratory diagnostic and drug susceptibility testing. Inappropriately short regimens (2–3 days) were also offered without follow-up. Respondents viewed OTC antibiotic as a convenient alternative to formal healthcare, the access to which was influenced by distance, time and money. Respondents also described the complexities of navigating various departments in hospitals and little confidence in the quality of formal healthcare. Clinicians and a few dispensers expressed concerns about AMR and referred to evadable policies around antibiotics use and poor enforcement of regulation.Conclusions The findings point to the need for clear policy guidance and rigorous implementation of prescription-only antibiotics.Data are available on request. Data cannot be shared publicly because of the nature of the data being qualitative that contains personal quotes and clues to where the study occurred and can be potentially identifiable. However, anonymised data are available on request to the research department complying with the data access policy outlined by Institutional Review Committee (IRC) of Manmohan Memorial Institute of Health Sciences (https://www.mmihs.edu.np/irc.php).