Sale of antibiotics without prescription in stand-alone pharmacies in Tamil Nadu

BACKGROUND: Non-prescription sale of antibiotics is one of the major causes for increased consumption of antibiotics which facilitates the emergence of drug resistance. Over-the-counter sale of antibiotics in India, without prescription and often at partial doses, is quite common even though the practice is not legal. OBJECTIVES: (1) To interview pharmacists about the sale of over-the-counter medication, and prescription drugs sold without a prescription, in particular; (2) to obtain an understanding of the reasons for such sale from the perspective of the pharmacist. METHODS: Pharmacists were interviewed with the help of a pre-validated questionnaire in 15 stand-alone pharmacies in a metropolitan city and a tier-2 city in Tamil Nadu. Major points of interest were characteristics of customers requesting antibiotics without a valid prescription, common diseases for which they were sold without prescription, whether patients asked for antibiotics by name or as treatment for their symptoms, and reasons for such requests. RESULTS: Pharmacists readily admitted to selling prescription drugs, including antibiotics without a valid prescription. While they know of antibiotic resistance, not a single pharmacist interviewed by us knew of the causes of antibiotic resistance. CONCLUSION: The intervention listed in the National Action Plan on Antimicrobial Resistance to develop awareness campaigns targeted at dispensers regarding existing rules and appropriate use of antimicrobials and mandatory training programs on optimal antimicrobial use must be implemented immediately.