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 Over-the-Counter Sale of Antibiotics

The discovery of antibiotics is one of the world’s greatest advances in medicine of all time as it meant the end of fatal bacterial infections. Antibiotics are essential more specifically in the developing world where the most common cause of death is infectious diseases. Antimicrobial resistance (AMR) is one of the most rapidly increasing global health threats which is responsible for a mortality rate of more than 700, 000 lives annually (Damisie et al., 2019).  In the vast majority of the countries, the practice of the over-the-counter (OTC) sale of antibiotics is prohibited by the law, even though the same does not imply that antibiotics are not sold OTC in those nations.  Adhikari et al. (2021) state that for law enforcement to be effective, there is a need for a well-functioning and effective registration systems for drugs and drug suppliers, effective inspection capacity and the ability to impose penalties for the breaching of the regulations which is not in place in the majority of the countries.  However, in most of the rural areas and resource-limited settings, pharmacies serve as the first point of care. Consequently, strict prohibition of the OTC sale of antibiotics can result in worse health outcomes because of the inaccessibility of the same drugs (Kotwani et al., 2021).  The significant majority of the low to middle-income countries are moving towards prescription-only access to antibiotics as evidenced in the study conducted by Guinovart et al. (2018).  The sale of antibiotics without a prescription is hazardous but a compromise can be made by trained pharmacists with enough experience in bacterial infections management.

The OTC sale of antibiotics is the rationale behind the steady increase in self-medication as well as the storage of leftover antimicrobials. Self-medication with antibiotics is very common in countries where the OTC sale has not been prohibited (Llor & Cots, 2013).  Self-medication with antibiotics is linked to an increased risk of inappropriate drug use which predispose patients to drug interactions, masking symptoms of underlying conditions, as well as the development of antimicrobial resistance (Gebretekle & Serbessa, 2016).  Antibiotic resistance is reducing the number of effective antibiotics making it one of the major global health issues which demand immediate attention.  The most common inappropriate drug use in self-medication entails a short duration of treatment, inadequate dose, medicines sharing and treatment avoidance after the symptoms resolve (Afari-Asiedu et al., 2018).  The emergence of multi-drug resistant bacterial strains which are greatly resistant to many classes of antibiotics has led to a major concern in relation to  antibiotic resistance globally.

There is an established correlation between the OTC sale of antibiotics and overconsumption of the products.  There is evidence that Southern European countries have the highest rates of antibiotic consumption with the over-the-counter sale of antibiotics being commonplace.  According to a study conducted by Kotwani et al. (2021) using a mystery shopper that presented at the community pharmacy seeking an antibiotic for a clinical scenario that did not require an antibiotic, 54% of the pharmacies in Spain sell antibiotics without a prescription. However, the percentage increased when the actress simulated uncomplicated UTI, which is similar to another study conducted by Adhikari et al. (2021). Therefore, there is high consumption of antibiotics even in cases that did not require an antibiotic.

It is a fact that people are now bypassing their general physicians (GPs) and directly going to pharmacies. People moving from areas where the sale of antibiotics is prohibited into areas that the same practice is allowed leads to the development of the culture of not making appointments with the physicians for proper management of their conditions (Jacobs et al., 2019).  According to a study conducted by Guinovart et al. (2018) in a Finnish community living in Spain, antibiotics that are regarded as prescription-only drugs in Finland were bought OTC by immigrants who confessed to having used more than one antibiotic in the previous 6 months.

It is a fact that pharmacists are the most accessible healthcare professionals to the general population. It stems from the fact that they are available to offer professional and personalized advice regarding the health of patients on a walk-in basis without necessarily having an appointment. Therefore, antibiotics can be sold OTC to patients by qualified pharmacists. The current trend of training of pharmacists has made sure that they can assess patients and provide empirical therapy (Llor & Cots, 2013).  Pharmacists can be instrumental in treating patients that face prejudice in a majority of the healthcare systems of developing countries. For example, women should be able to get antibiotics to treat urinary tract infections devoid of a prescription (Damisie et al., 2019). The practice will play an essential role in avoiding visits to the GPs. The same is true for a majority of women that have recurrent uncomplicated UTIs provided that the recurrent uncomplicated UTIs are effective and have a narrow spectrum. Community pharmacists play a significant role in antimicrobial stewardship by offering patients self-care advice, delivering drugs, and recommending the most appropriate OTC treatments of the most common infections(ReAct.ORG, 2021). Community-based interventions that pharmacists provide have the potential to curb the increase of bacteremia and enhance the use of antibiotics for bacterial-based UTIs through enhanced patient knowledge of self-care.

Pharmacists have not only specialized in the science of drugs and their mechanism of action but also patient care. Consequently, pharmacists are endowed with wide knowledge, experience and skills in the management of various illnesses which are more likely to be presented at the community pharmacy such as urinary tract infections and upper respiratory infections. It should be noted that all professionally trained pharmacists are aware of antimicrobial resistance and the dispensing of antibiotics safely and rationally is common practice in the majority of the countries. Therefore, antibiotics for minor illnesses can be sold over the counter provided the clients have provided a comprehensive explanation of their symptoms and physical assessment by the pharmacists is carried out.

Concisely, antimicrobial resistance is one of the biggest health challenges globally.  The impact of antibiotic resistance is that it leads to inappropriate use of antibiotics and use of sub-optimal doses. However, prohibiting the OTC sale of antibiotics will lead to negative health outcomes for the majority of the population that live in rural areas with poor access to physicians.  Prohibiting the OTC sale of antibiotics is not the only way of preventing the spread of antibiotic resistance.           Funds that are directed towards enforcement of the laws against the over-the-counter sale of drugs should be directed towards the provision of clean water and efficient sanitation to prevent infectious diseases thereby preventing the need for use of antibiotics. Even though the over-the-counter sale of antibiotics should be sold to clients, it should be done judiciously by qualified pharmacists who have sufficient experience in the management of bacterial infections.

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