THE USE OF ANTIMICROBIAL DRUGS IN NAGPUR, INDIA - A WINDOW ON MEDICAL-CARE IN A DEVELOPING-COUNTRY

The objective of the study was to determine the patterns of use of ant imicrobial drugs in the general population of the large, industrial ci ty of Nagpur, India, Interviews of pharmacists and clients were carrie d out in a stratified, random sample of 34 pharmacies to determine bel iefs and practices in prescribing and self-prescribing of antibiotics by complaint, choice of drug, dose, duration, cost, age and sex of the consumers. The study showed that drugs were dispensed without prescri ption despite prohibition by the Indian Pharmaceutical Act. Sales of a ntimicrobial drugs accounted for 17.5% of 511 purchases and 23.3% of e xpenditures for drugs. Proprietary brands of penicillins, co-trimoxazo le and tetracyclines were dispensed most often (64.8%). The most commo n indications were upper respiratory, gastrointestinal and nonspecific complaints. The median number of units obtained was 5.0 (95% range 1- 20), at a median cost of $0.50 per purchase, usually taken for less th an five days. Repeat purchases were made without consulting a physicia n. Almost two thirds of purchases (63.9%) were for males, mainly under the age of ten years. Clients had poor knowledge of the indications, side effects, adverse reactions and appropriate duration of therapy. T he dispenser viewed himself as a businessman rather than a professiona l and rarely offered unsolicited advice. Co-prescribing of 'tonics' ad ded to costs and decreased the purchasing power for antimicrobial drug s. Most purchases of antimicrobial drugs in community pharmacies in Na gpur were for minor indications and were limited by the purchasing pow er of the consumers. It is doubtful that the choice of drag and the sh ort duration of therapy would be effective for serious infections. The more frequent use of antimicrobial drugs in males may reflect greater susceptibility to infectious diseases and/or sex bias. Constraints of poverty and culture severely limit effective medical care in this cit y.