title: The Impact of Restricting Over-the-Counter Sales of Antimicrobial Drugs: Preliminary Analysis of National Data.
abstract: To describe the nationwide impact of a restrictive law on over-the-counter sales of antimicrobial drugs, implemented in Brazil in November 2010. Approximately 75% of the population receives healthcare from the public health system and receives free-of-charge medication if prescribed. Total sales in private pharmacies as compared with other channels of sales of oral antibiotics were evaluated in this observational study before and after the law (2008-2012). Defined daily dose per 1000 inhabitants per day (DDD/TID) was used as standard unit. In private pharmacies the effect of the restrictive law was statistically significant (P < 0.001) with an estimated decrease in DDD/TID of 1.87 (s.e. =  0.18). In addition, the trend of DDD/TID before the restrictive law was greater than after the intervention (P < 0.001). Before November 2010, the slope for the trend line was estimated as 0.08 (s.e. = 0.01) whereas after the law, the estimated slope was 0.03 (s.e. = 0.01). As for the nonprivate channels, no difference in sales was observed (P = 0.643). The impact in the South and Southeast (more developed) regions was higher than in the North, Northeast, and Mid-West. The state capitals had a 19% decrease, compared with 0.8% increase in the rest of the states. Before the law, the sales of antimicrobial drugs were steadily increasing. From November 2010, with the restrictive law, there was an abrupt drop in sales followed by an increase albeit at a significantly lower rate. The impact was higher in regions with better socio-economic status.
authors.affiliation: From the Infection Control Department, Hospital das Clínicas (MLM, IB, NM, RDL, ASL); Department of Geography, Faculdade de Filosofia, Letras e Ciências Humanas (LVB); Department of Epidemiology, Faculdade de Saúde Pública (FCN); Department of Statistics, Institute of Mathematics and Statistics, (ACPDL); and Department of Infectious Diseases and LIM 54, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil (ASL).
authors.forename: Maria Luísa
authors.initials: ML
authors.lastname: Moura
authors.forename: Icaro
authors.initials: I
authors.lastname: Boszczowski
authors.forename: Naíma
authors.initials: N
authors.lastname: Mortari
authors.forename: Lígia Vizeu
authors.initials: LV
authors.lastname: Barrozo
authors.forename: Francisco Chiaravalloti
authors.initials: FC
authors.lastname: Neto
authors.forename: Renata Desordi
authors.initials: RD
authors.lastname: Lobo
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Pedroso de Lima
authors.forename: Anna S
authors.initials: AS
authors.lastname: Levin
mesh_terms: D000890:Anti-Infective Agents / Q000191:economics*; D001938:Brazil; D006801:Humans; D007880:Legislation, Drug; D004366:Nonprescription Drugs / Q000191:economics
chemical_list: D000890:Anti-Infective Agents; D004366:Nonprescription Drugs