People in China can acquire antibiotics from retail pharmacies without a prescription, even though dispensing the medicine without a prescription isn’t allowed by regulations, a new study found.
Antibiotic resistance is a worldwide health problem, with about 500,000 people with suspected bacterial infections across 22 countries in 2018, the World Health Organization reports. The most commonly reported resistant bacterial strains include Klebsiella pneumoniae, Escherichia coli, Salmonella, Streptococcus pneumoniae, and Staphylococcus aureus.
In the study, published in the journal Antimicrobial Resistance & Infection Control, the researchers wanted to determine the prevalence of pharmacies in the three regions in China that dispense or sell antibiotics without a prescription.
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The team performed a survey in 13 provinces in the country, utilizing a Simulated Patient method. Between July and September 2017, about 40 medical students pretended to be real patients, going to pharmacies complaining of upper respiratory tract symptoms. The students don’t have actual symptoms and they don’t have prescriptions for medicines.
The students tracked the pharmacies they visited, taking note of the location, whether the pharmacy is independent or part of a chain, and the distance of the pharmacy from a hospital. Further, the students also noted their experiences, for instance, the symptoms they described, if they asked for antibiotics or specific ones and if they were offered antibiotics.
The researchers revealed that from 1,106 pharmacies involved in the study, patients can get antibiotics without prescriptions in a staggering 925 (83.6 percent) cases. Also, about 25.2 percent or 279 pharmacies dispensed antibiotics even if the patient described only mild symptoms, while 576 or 52.1 percent sold antibiotics when specifically asked for them, and 6.3 percent or 70 pharmacies dispensed a specific type of antibiotics that were requested by the patients, such as cephalosporins or penicillin.
In the 181 pharmacies which didn’t dispense antibiotics, 10.2 percent said that a prescription is needed, and 5.2 percent said the antibiotics were not indicated, and 0.5 percent had no antibiotics in stock. The study also unveiled that the same scenario happened in urban or rural locations, or either independent ones or those belonging to chains or companies. Yet, the researchers found that it’s easier to get the medicines in pharmacies more than 2 kilometers away from a hospital.
“Following strong leadership by the Chinese government, antimicrobial Stewardship has improved in hospitals in China over the past 10 years, but little is known about access to antibiotics in retail pharmacies. We document the ease of access to antibiotics in pharmacies without prescriptions. Care needs to be taken to enforce the regulations around these sales, as part of wider stewardship efforts to control AMR,” Thérèse Hesketh, from Zhejiang University and University College London (UCL), a study author, said.
The results of the study show that only a little progress has been made to attain the country’s goal to regulate dispense of antibiotics and obtaining antibiotics only with prescriptions by 2020 in all provinces in China. The country’s goal was based on the comprehensive plan to stem antimicrobial resistance (AMR), which was announced at the G20 summit in China in 2016.
Further, pharmacists need further training in explaining to customers why antibiotics are not given or dispensed without a prescription. The public also needs education and awareness about antibiotic misuse and its possible consequences.
What is antibiotic resistance?
Antibiotic resistance happens when microorganisms develop the ability to fight and defeat the drugs designed to kill them. It is a growing global health threat and in the United States alone, it causes more than 2 million infections and about 23,000 deaths each year, according to the Centers for Disease Control and Prevention.
Antibiotic misuse can lead to the development of superbugs, which are pathogens that are resistant to all known antibiotics. When bacteria become resistant, they may cause severe infections that are harder to treat, which can lead to higher medical costs, increased mortality or death, and prolonged hospital stays.
Chen, et. al. (2019). Widespread illegal sales of antibiotics in Chinese pharmacies - a nationwide cross-sectional study, Chen et al. Antimicrobial Resistance and Infection Control. https://dx.doi.org/10.1186/s13756-019-0655-7