The Chinese who buy antibiotics in pharmacies even without a prescription

People in China can buy antibiotics at over-the-counter retail pharmacies, although dispensing the over-the-counter medication is not allowed by regulations, according to a new study.

Antibiotic resistance is a global health problem, with around 500,000 people suspected of having bacterial infections in 22 countries in 2018, reports the World Health Organization. The most commonly reported resistant bacterial strains include Klebsiella pneumoniae, Escherichia coli, Salmonella, Streptococcus pneumoniae, Y Staphylococcus aureus.

In the study, published in the magazine. Antimicrobial resistance and infection control, The researchers wanted to determine the prevalence of pharmacies in the three regions of China that dispense or sell over-the-counter antibiotics.

Image credit: Nokwalai / Shutterstock

The team conducted a survey in 13 provinces of the country, using a simulated patient method. Between July and September 2017, about 40 medical students pretended to be real patients and went to pharmacies complaining about the symptoms of the upper respiratory tract. Students have no real symptoms and have no prescription for medications.

Students tracked the pharmacies they visited, noting the location, if the pharmacy is independent or part of a chain, and the distance from the pharmacy from a hospital. In addition, students also noted their experiences, for example, the symptoms they described, if they asked for antibiotics or specific and if they were offered antibiotics.

The researchers revealed that of 1,106 pharmacies involved in the study, patients can get antibiotics without a prescription in an amazing 925 (83.6 percent) cases. In addition, approximately 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 requested, and 6.3 percent or 70 pharmacies dispensed a specific type of antibiotics that were requested by patients, such as cephalosporins or penicillin.
In the 181 pharmacies that did not dispense antibiotics, 10.2 percent said a prescription was needed, and 5.2 percent said antibiotics were not indicated, and 0.5 percent had no antibiotics in stock. The study also revealed that the same scenario happened in urban or rural places, or in independent places or belonging to chains or companies. However, the researchers found that it is easier to obtain drugs in pharmacies more than 2 kilometers from a hospital.

“Following strong leadership from the Chinese government, the administration of antimicrobials has improved in Chinese hospitals 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 over-the-counter pharmacies. Care must be taken to enforce regulations around these sales, as part of the broader management efforts to control AMR, “said Thérèse Hesketh, of Zhejiang University and University College London (UCL) , author of the study.

The results of the study show that only small progress has been made to achieve the country’s goal of regulating the dispensation of antibiotics and obtaining antibiotics only with prescriptions by 2020 in all provinces of China. The country’s goal was based on the comprehensive plan to stop antimicrobial resistance (AMR), which was announced at the G20 summit in China in 2016.

In addition, pharmacists need additional training to explain to clients why antibiotics are not administered or dispensed without a prescription. The public also needs education and awareness about the misuse of antibiotics and their possible consequences.

What is antibiotic resistance?

Antibiotic resistance occurs when microorganisms develop the ability to fight and defeat drugs designed to kill them. It is a growing threat to global health 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.

The misuse of antibiotics can lead to the development of superbugs, which are pathogens resistant to all known antibiotics. When bacteria become resistant, they can cause serious infections that are more difficult to treat, which can lead to higher medical costs, increased mortality or death, and prolonged hospital stays.

Journal reference:

Chen et al. Alabama. (2019) Generalized illegal sales of antibiotics in Chinese pharmacies: a national cross-sectional study, Chen et al. Antimicrobial resistance and infection control. https://dx.doi.org/10.1186/s13756-019-0655-7

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