title: Irrational use of antibiotics and role of the pharmacist: an insight from a qualitative study in New Delhi, India.
abstract: OBJECTIVE
  The overall volume of antibiotic consumption in the community is one of the foremost causes of antimicrobial resistance. In developing countries like India, pharmacists often dispense 'prescription-only' drugs, like antibiotics, to patients who do not have a prescription. Not much data is available regarding detailed information on behaviour of antibiotic use by community pharmacists which is of particular significance to develop a suitable and sustainable intervention programme to promote rational use of antibiotics. A qualitative study was conducted to understand the dispensing practices and behaviour of community pharmacists to develop policy interventions that would improve the use of antibiotics at the community level.
  
  
  METHODS
  Focus group discussions (FGDs) were held for five municipal wards of Delhi with retail pharmacists, public sector pharmacists and the office bearers of pharmacists' associations. Data on antibiotic use and resistance were collected earlier from these five wards. FGDs (n = 3 with 40 pharmacists) were analysed through grounded theory.
  
  
  CONCLUSIONS
  Four broad themes identified were as follows: prescribing and dispensing behaviour; commercial interests; advisory role; and intervention strategies for rational use of antibiotics. FGDs with pharmacists working in the public sector revealed that, besides the factors listed above, overstock and near-expiry, and under-supply of antibiotics promoted antibiotic misuse. Suggestions for interventions from pharmacists were the following: (i) education to increase awareness of rational use and resistance to antibiotics; (ii) involving pharmacists as partners for creating awareness among communities for rational use and resistance to antibiotics; (iii) developing an easy return policy for near-expiry antibiotics in public sector facilities; and (iv) motivating and showing appreciation for community pharmacists who participate in intervention programmes.
  
  
  CONCLUSIONS
  Inappropriate antibiotic dispensing and use owing to commercial interests and lack of knowledge about the rational use of antibiotics and antibiotic resistance were the main findings of this in-depth qualitative study. Community pharmacists were willing to participate in educational programme aimed at improving use of antibiotics. Such programmes should be initiated within a multidisciplinary framework including doctors, pharmacists, social scientists, government agencies and non-profit organizations.
authors: Department of Pharmacology, V P Chest Institute, University of Delhi, Delhi, India. anitakotwani@gmail.com
authors: A
authors: A
authors: Kotwani
authors: C
authors: C
authors: Wattal
authors: P C
authors: PC
authors: Joshi
authors: K
authors: K
authors: Holloway
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use; D003157:Community Pharmacy Services / Q000191:economics / Q000941:ethics; D003415:Crime / Q000191:economics / Q000208:ethnology; D003906:Developing Countries; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004512:Education, Pharmacy; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006300:Health Services Misuse / Q000191:economics; D006801:Humans; D007194:India; D004366:Nonprescription Drugs / Q000009:adverse effects / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use; D010353:Patient Education as Topic; D010595:Pharmacists / Q000941:ethics; D055553:Prescription Drugs / Q000009:adverse effects / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use; D024382:Professional Role; D036301:Qualitative Research; D012651:Self Medication / Q000009:adverse effects* / Q000191:economics / Q000941:ethics; D012957:Societies, Pharmaceutical; D014505:Urban Population
chemical_list: D000900:Anti-Bacterial Agents; D004366:Nonprescription Drugs; D055553:Prescription Drugs