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1 in 5 pharmacies in Spain dispenses antibiotics without prescription

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November 7, 2018

Approximately one in five pharmacies in Spain dispenses antibiotics without a prescription, especially when pressured by patients, according to a recently published study.

Researchers identified being a rural pharmacy as a risk factor associated with getting an antibiotic without a prescription.

“Resistance to antibiotics is a major challenge facing public health, due to the morbidity, mortality and costs it generates. It is not only a local problem, but also a global one because travelers contribute to the spread of antimicrobial drug resistance,” Adolfo Figueiras Guzmán, PhD, MPH, professor of preventive medicine and public health at the University of Santiago de Compostela, and colleagues wrote.

“Currently, no one doubts that it is linked to the excessive and inappropriate use of antibiotics. The majority of consumption is outside hospitals and, except for North America and some European countries, part of this is due to self-medication. Controlling access to nonprescribed antibiotics is a key element in decreasing it, and pharmacies play a fundamental role in this.”

According to the researchers, Spain is one of the largest consumers of antibiotics in the European Union. They noted that 30% of the country’s dispensed antibiotics are not charged to the public reimbursement system and that it is unknown how much of this is due to illegal dispensing of antibiotics without a prescription.

Guzmán and colleagues used a simulated patient study to determine the magnitude of antibiotic dispensing without prescription in Spain and the associated factors. Between December 2016 and January 2017, four actors simulating respiratory infections visited pharmacies in northwest Spain complaining of symptoms including sore throat, difficulty swallowing, congestion, cough and feeling feverish. During visits, the actors used four incremental levels of pressure to receive antibiotics, according to the study: requesting medication to relieve their symptoms; requesting stronger medicine than what was offered; requesting an antibiotic; and specifically requesting amoxicillin.

Actors received an antibiotic in 184 pharmacies — 18.83% — mostly when using the third and fourth levels of pressure, according to the researchers. Location influenced dispensing, with rural and semirural areas dispensing more unprescribed antibiotics, they reported

Study findings recently presented at IDWeek showed that antibiotics in the United States are often prescribed without an in-person encounter or infection-related diagnosis. Another study showed that antibiotic expenditures in outpatient clinics has grown by 148%. Experts have reported that 80% of all antibiotic prescriptions in the U.S. are made in the outpatient setting, and the CDC has previously said that 30% of them are unnecessary.

“Reducing self-medication with antibiotics is essential in the fight against drug resistance,” Guzmán and colleagues wrote. “This study showed that 19% of pharmacies still carry out [the dispensing of antibiotics without a medical prescription] at the insistence of a client, and it has identified the rural area as a risk factor. Interventions aimed at reducing dispensing of nonprescribed antibiotics should be carried out, prioritizing them in rural pharmacies.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.