| Brazil and Mexico, 2013—private pharmacies [307] |
Enforcement—assessing the impact of legislation to ban self-purchasing of antibiotics on dispensing patterns between 2007 and 2012 in private pharmacies in Brazil and Mexico (has always been the case among public pharmacies in Brazil [137,308]) Variable results seen
Total antibiotic usage increased in Brazil (from 5.7 to 8.5 DDD/TID) but decreased in Mexico (10.5 to 7.5 DDD/TID) A change in the level of dispensing of −1.35 DDD/TID (p < 0.01) for Brazil and −1.17 DDD/TID (p < 0.00) for Mexico In Brazil, there was a decrease in the level of consumption of the penicillins, sulfonamides and macrolides by 0.64 DDD/TID (p = 0.02), 0.41 DDD/TID (p = 0.02) and 0.47 DDD/TID (p = 0.01) respectively The authors concluded that whilst the effect of the restrictions was similar across the countries; in Brazil, the trend of increased dispensing of antibiotics without a prescription was tempered after the restrictions were introduced whilst in Mexico the trend of decreasing dispensing accelerated |
| Brazil—Both private and public pharmacies—2015 to 2017 |
Enforcement:
Moura et al. (2015) [308] showed a decrease in antibiotic use of 1.87 DDD/TID (p < 0.001) immediately after restrictions banning the sales of antibiotics without a prescription among private pharmacies (2008 to 2012), with a greater decrease in the more developed regions as well as in the State Capitals Not surprisingly, Moura et al. (2015) [308] found no difference in sales among public pharmacies where there had always been restrictions and it is generally impossible to sell antibiotics without a prescription (p = 0.643) Lopes-Junior et al. (2015) [309] found that sales of amoxicillin (commonly sold antibiotic) in private pharmacies fell by approximately 30% post-legislation despite a general growth in the pharmaceutical market, with falls in sales of other popular antibiotics including tetracyclines (30.5% decrease), sulfonamides (28.5% decrease), and macrolides (25% decrease) Mattos et al. (2017) [310] documented an increase in antibiotic sales among private pharmacies from 2008 to 2011 including the cephalosporins, quinolones, and aminopenicillins. Following changes in the law with restrictions in private pharmacies, there was a decrease in dispensing in 2012 for the cephalosporins (−19.4%), quinolones (−12.7%) and aminopenicillins (−11.1%) The differences in the findings in Brazil between the different studies may well reflect differences in datasets and methodologies |
| Thailand, 2015 [311] |
Principally Education involving a multidisciplinary intervention among grocery stores in a rural province in Thailand using trained community leaders Grocery stores in the intervention group had 87% fewer antibiotics available postintervention compared with preintervention Grocery stores in the control group saw only an 8% reduction in antibiotic availability between the 2 time periods
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| Republic of Srpska, 2017 [157,312] |
Education and Enforcement including guidelines for pharmacists and greater enforcement of the regulations resulted in self-purchasing of antibiotics for self-diagnosed URTIs significantly decreasing from 58% of requests to 18.5% Encouragingly, the most common reason for not dispensing an antibiotic was that antibiotics cannot be dispensed without a prescription
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| Kenya—2018 [99] and 2021 [313] |
Monitoring of antibiotics dispensed among pharmacies linked to the University of Nairobi showed a low level of dispensing of antibiotics without a prescription, with 94.1% of antibiotics dispensed with a valid prescription (Education) No antibiotics were dispensed for patients with ARIs including influenza or a common cold, with over-the-counter (OTC) medicines such as cough and cold syrups and lozenges typically dispensed A more recent study conducted during the COVID-19 pandemic showed no dispensing of either antimalarials or antibiotics without a prescription
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| Saudi Arabia, 2020 [183] |
Principally Economics and Enforcement In May 2018, the law and regulations surrounding self-purchasing without a prescription were enforced alongside fines Before enforcement, 70.7% of pharmacies reported self-purchasing was common, with 96.6% and 87.7% of participating pharmacies dispensed antibiotics without a prescription for pharyngitis and urinary tract infections (UTIs) respectively Following law enforcement and fines, only 12.9% reported self-purchasing still common, with only 12.1% and 5.2% dispensing antibiotics without prescriptions for pharyngitis and UTIs respectively When antibiotics were dispensed without a prescription, typically this only happened following considerable pressure from patients
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| India, Malaysia and Vietnam, 2021 [153,299] |
There have been ongoing educational and other initiatives in recent years in India, Malaysia and Vietnam to try and reduce unnecessary self-purchasing of antimicrobials These initiatives seem to be working with no change or a decrease in the dispensing of antimicrobials among 83.3% to 100% of pharmacies surveyed in Malaysia and Vietnam in the initial months following the start of the COVID-19 pandemic despite the hype and concerns generally with increasing use of antibiotics In India—no change in up to 57.7% of pharmacists surveyed
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