Should oral antimicrobial drugs be available over the counter?

Self medicated antibiotics in Bangladesh: a cross-sectional health survey conducted in the Rajshahi City

BACKGROUND

Antibiotic self medication is highly prevalent in the developing countries due to easy availability and poor regulatory controls for selling these drugs. The purpose of this study was to evaluate the prevalence of self-medication with antibiotics for the treatment of various diseases by the peoples of Rajshahi city in Bangladesh.

METHODS

A cross-sectional survey was conducted to the patient's (n = 1300) at eight locations of Rajshahi city in Bangladesh from March to April, 2014. The locations were selected by convenience and the study population within each study area was randomly selected. The survey was self-administered and included questions pertaining to self medicated drugs and antibiotic usage patterns as well. Data were analyzed using descriptive statistics.

RESULTS

It was found that 347 (26.69%) out of 1300 participants experienced self medication with antibiotics. Over fifty percent of the patients studied were between the ages of 21-30 years with 83.57% of them being males and 16.43% females. The highest percentage of self medicated antibiotics was metronidazole (50.43%) followed by azithromycin (20.75%), ciprofloxacin (11.53%), amoxicillin (10.37%) and tetracycline (7.49%) respectively. The key reasons for the self medication of antibiotics was the pre-experience (45.82%), suggestions from others (28.24%) and knowledgeable of the antibiotics (16.14%). The perceived symptoms to purchase the antibiotics independently was dysentery, diarrhea and food poisoning (36.02%), cold, cough and fever (28.24%), infection (12.97%), dental carries and toothache (9.22%), irritable bowel syndrome (3.46%), acne (4.32%), ear and throat pain (2.31%). The duration of maximum antibiotics usage was ranges between 0-10 years. Only 4.32% patient's used self medicated antibiotics longer than 10 years. The patient's compliance for self medication of antibiotics varies from excellent to no comments whereas only 6.92% patients reported side effects for the self medication of antibiotics.

CONCLUSIONS

The results of this study confirm that antibiotic self-medication is a relatively frequent problem in Bangladesh. Drug Administration of Bangladesh should implement the regulatory controls immediately on the distribution and selling of antibiotics in order to reduce the frequency of antibiotic misuse.

The cost-effectiveness of placing urinary tract infection treatment over the counter

We use cost-effectiveness analysis to estimate the economic and health implications of approving the over-the-counter sale of oral antibiotics for treatment of urinary tract infection (UTI). We consider two alternatives for over-the-counter availability and examine the reduced economic cost from avoided doctors' visits, along with the potential additional costs associated with higher over-the-counter treatment prices or increased use due to greater access. We also consider important noneconomic costs such as reduced symptom days, restricted activity days, and growing resistance to antibiotics. Our analysis covers a 20-year time horizon to capture the long-term effects, from a societal perspective, of a policy decision to place UTI treatment over the counter today. In addition, we present sensitivity analyses to test the effects of the assumptions in our model. We estimate that the economic costs of placing UTI treatment over the counter outweigh the benefits, unless there is extensive patient education and a mechanism for allowing patients to properly self-diagnose to reduce markedly the number of doctors' visits, mistreated symptoms, and threat of resistance to antibiotics. Only if doctors' visits were reduced to 64.6% of current levels would the economic benefits of over-the-counter treatment begin to be realized. UTI is one of the most common complaints among women and accounts for a large number of doctor visits each year. However, the costs of over-the-counter distribution of UTI treatment, particularly those due to the risk of decreasing the time until standard treatments become ineffective due to bacterial resistance, outweigh the short-term gains of decreased symptom days and increased access to treatment.