Antibiotic dispensing by drug retailers in Kathmandu, Nepal

OBJECTIVES To assess over-the-counter antimicrobial dispensing by drug reta ilers in Kathmandu, Nepal, for rationality, safety, and compliance with exi sting government regulations. METHODS Standardized cases of dysuria in a young adult male and acute water y diarrhoea in a child were presented by a mock patient to retailers at 100 randomly selected pharmacies. Questions asked by retailers and advice and medications given at their initiative were recorded. RESULTS All retailers engaged in diagnostic and therapeutic behaviour beyon d their scope of training or legal mandate. Historical information obtained by retailers was inadequate to determine the nature or severity of disease or appropriateness of antimicrobial therapy. 97% (95% CI = 91.5-99.4%) of retailers dispensed unnecessary antimicrobials in diarrhoea, while only 44% (95% CI = 34.1-54.3%) recommended oral rehydration therapy and only 3% (95 % CI = 0.6-8.5%) suggested evaluation by a physician. 38% (95% CI = 28.5-48 .2%) gave antimicrobials in dysuria, yet only 4% (95% CI = 1.1-9.9%) adequa tely covered cystitis. None covered upper urinary tract or sexually transmi tted infections, conditions which could not be ruled out based on the inter views, and only 7% (95% CI = 2.9-13.9%) referred for a medical history and physical examination necessary to guide therapy. CONCLUSIONS Although legislation in Nepal mandates a medical prescription f or purchase of antibiotics, unauthorized dispensing is clearly problematic. Drug retailers in our study did not demonstrate adequate understanding of the disease processes in question to justify their use of these drugs. Risk s of such indiscretion include harm to individual patients as well as sprea d of antimicrobial resistance. More intensive efforts to educate drug retai lers on their role in dispensing, along with increased enforcement of exist ing regulations, must be pursued.