Over-the-counter antibiotic dispensing by pharmacies: A standardised patient study in Udupi district, India

Vaidehi Nafade, Sophie Huddart, Giorgia Sulis, Amrita Daftary, Sonal Sekhar Miraj, Kavitha Saravu, Madhukar Pai

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article numbere001869
JournalBMJ Global Health
Volume4
Issue number6
DOIs
Publication statusPublished - 01-11-2019

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Pharmacies
India
Anti-Bacterial Agents
Proxy
Pharmacists
Respiratory Tract Infections
Diarrhea
Emergencies
Fever
Referral and Consultation
Pediatrics

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Nafade, Vaidehi ; Huddart, Sophie ; Sulis, Giorgia ; Daftary, Amrita ; Miraj, Sonal Sekhar ; Saravu, Kavitha ; Pai, Madhukar. / Over-the-counter antibiotic dispensing by pharmacies : A standardised patient study in Udupi district, India. In: BMJ Global Health. 2019 ; Vol. 4, No. 6.
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title = "Over-the-counter antibiotic dispensing by pharmacies: A standardised patient study in Udupi district, India",
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.",
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Over-the-counter antibiotic dispensing by pharmacies : A standardised patient study in Udupi district, India. / Nafade, Vaidehi; Huddart, Sophie; Sulis, Giorgia; Daftary, Amrita; Miraj, Sonal Sekhar; Saravu, Kavitha; Pai, Madhukar.

In: BMJ Global Health, Vol. 4, No. 6, e001869, 01.11.2019.

Research output: Contribution to journalArticle

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

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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