Antibiotic resistance is a global health priority. Many studies have pinpointed the causes and risk factors of the rising antibiotic resistance. Among the many causes identified, over-the-counter (OTC) use of antibiotics is one of the major causes, especially in low and middle-income countries like India, Nepal, Kenya, etc. Hence, it is imperative to know why people are preferring over the counter antibiotics. This study is trying to answer this question in the context of Nepal. 

This study takes into account the multiple factors driving the OTC antibiotics as described by dispensers, patients, and clinicians. The dispensers at the drug shops were aware that they were selling broad-spectrum antibiotics to the patients without knowing the disease history, which was against the existing public health recommendations. Selling antibiotics is a daily affair at the shops. They usually prescribed broad-spectrum antibiotics for 2-3 days at substandard doses. Through this, they believed that they are meeting the patient demands and bridging the gap between patients and formal healthcare centers.

The patients preferred drug shops to the formal healthcare system due to the cost, accessibility, time, and complexity factors. The patients visited the drug shops wherein the interactions were brief “resembling retail transactions”. They considered the practice of OTC antibiotics were inherited through generations.

The clinicians attributed the OTC antibiotic sales to the miscommunication between patient and doctor as well as the complexity of the formal healthcare system which the patient prefers to avoid. 

The pressure from pharmaceutical companies to prescribe particular antibiotics also drives the OTC sale of antibiotics. 

To know more on this topic, kindly visit the website of the journal BMJ Global Health. (Link)