OVER-THE-COUNTER AVAILABILITY OF ANTIMICROBIAL AGENTS, SELF-MEDICATION AND PATTERNS OF RESISTANCE IN KARACHI, PAKISTAN

To determine whether the free availability of antimicrobial agents lea ds to misuse through self-medication, a house-to-house semi-structured interview was held in three different socio-economic areas of Karachi , Pakistan. Of the 2348 households visited, 1342 (57%) participated; t his included 9209 individuals. Three hundred and twenty-two (3.5%) had used one or more antimicrobial in the previous 4 weeks, equivalent to 43 agents per 1000 persons per month. The most frequently used agents were amoxycillin (16.7%), co-trimoxazole (15.7%), erythromycin (10.9% ), ampicillin/cloxacillin (Ampiclox, 9.1%) and metronidazole (4.5%). O f these, 91.4% were prescribed by a physician, 2.3% were advised by a chemist and 6.3% were used as self-medication. Self-medication increas ed with socio-economic status. High levels of resistance were found to ampicillin, co-trimoxazole, chloramphenicol and erythromycin. If thes e high resistance levels are related to the high frequency of antimicr obial use, over-the-counter availability cannot be held responsible. E ducation of the medical profession seems to be the single most importa nt tool to control misuse of antimicrobial agents. Innovative approach es for continuous medical education are urgently needed.