Internationally, the most frequently purchased drugs areantimicrobials1. They areindispensable treatments especially in countries like India, where theinfectious disease burden is among the highest in the world2. The success of antimicrobial therapy criticallydepends on the use of drugs which are active and effective against common pathogens.
Hence, the outcome is beneficial for the patient when antimicrobial drugs areused against a vulnerable pathogen3.Nevertheless, habitual use of antimicrobials at the population level is linkedto the rise of bacterial resistance, narrowing the effective range of theavailable drugs 4,5.The increased resistance is a result of many factors, butthe leading cause is the overall volume of antibiotic consumption6.
With each use, whetherappropriate or not, the probability of the development and spread ofantibiotic-resistant bacteria escalates7.In developing countries antibiotics can be obtained easily from private retailpharmacies without prescription and pharmacists also advise and dispenseantibiotics to patients8.Hence, self-medication is rampant and inappropriate antimicrobial use ispersistent. To prevent this problem, an all-inclusive method is advised whichincludes proper awareness and education of the public regarding self-medication9.
Recognizing the reasons and rationale ofindividuals for consumption of self-prescribed antimicrobials enables theformation of effectual strategies that directly tackle these key influences ofnon-prescription antimicrobial use. Maintenance of antimicrobial success is a universally sharedresponsibility but the actions needed to achieve this goal cannot be decidedglobally. Each region must adopt approaches adapted to its own conditions.Hence this study brings to light the factors driving individuals to purchaseantibiotics without a prescription or oversight by healthcare professionals inKaraikal, Puducherry.OBJECTIVESThe primary objective of this study is to determine thefactors driving individuals to acquire over the counter antibiotics without aprescription in Karaikal. Secondarily, this study ascertains the prevalence andpractice of consumption of non-prescribed antibiotics in Karaikal to depict thesituation in this particular region.
METHODOLOGYStudy Design: ACross Sectional Study Data CollectionPeriod: 1st May 2018 to 31st July 2018 (3 Months)Sample Size Calculation: Assuming that the prevalence rate of purchaseof antibiotics without prescriptions is 11.6%10, confidence interval of 99.9% and 5% absoluteprecision, the estimated sample size is 444, calculated using Open Epi Software3.01 version. Taking into account a non-response rate of 10%, sample size willbe 488; rounded off to 500.
Study Population: Patientsand their relatives visiting the Out-Patient Departments in the KaraikalGeneral HospitalSampling Technique: ConvenienceSamplingSelection Criteria: 1. Adults(above the age of 18), living in Karaikal, who visit the Karaikal GH OPD duringthe data collection period, with no disabilities that would hamper theirunderstanding the questionnaire. 2. Individualsfrom medical and paramedical fields are going to be excluded from the study toevade selection bias. 3.
Purchaseand usage of non-prescribed antibiotics only in the last 6 months shall bejudged in order to avoid recall bias.Data collectionprocedures & instruments usedFirst a brief introductionof the study shall be given to the participant. After receiving verbal consentto carry out the study, a written consent form shall be given to theparticipant to obtain written consent as well. Data will be collected using astructured validated questionnaire. The questionnaire will be divided into 5parts: 1.
Sociodemographic Details2. Prevalence of purchase of non-prescriptionantibiotics3. Reasons for purchasing antibiotics withoutprescriptions4. Signs and symptoms for which antibiotics werepurchased5.
Attitude of the participant towards thispracticeThe questionnaire shall also be back-translated to Tamil,the regional language, so that participants can have the option to respond ineither Tamil or English. Their responses, if in Tamil, will be translated backto English while recording the data. Quality control: Thequestionnaire will be developed through a series of focus group discussionswith subject experts (two pharmacologists, two clinical pharmacists and oneinternal medicine specialist) and review of literature11,12. The translated questionnaire will be backtranslated into English for accuracy of translation.
Confidentiality: Confidentialityshall be maintained.Plan of Analysis/ Statistical Tools: Data analysis will be done using SPSS version 24. Means andproportions will be calculated and Pearson Chi-square test of significance willbe used to identify association among the variables. Ethical Considerations:Ethics approval will be obtained from the IEC. Verbal and written informedconsent shall be taken from all of the participants and only those who agreewillingly to participate in the study shall be registered.
IMPLICATION After identifying the reasons that trigger individuals tobuy antibiotics with neither prescriptions nor superintendence of healthcare professionals, a context specific guidelinecan be drawn for Karaikal which shall be very effective in reducing the rate ofnon-prescribed antimicrobial use, ultimately lowering the pace of antimicrobialresistance in the area.From a broader perspective, this information could be usedto form and enforce strict regulations and form structured educationalcampaigns for the public to control and limit sales of antibiotics withoutprescriptions. Lastly, this project gives me not just experience inresearch but the opportunity to work on a distressing medical topic thatprofoundly preoccupies my mind.REFERENCES1. Col NF, Oconnor RW. Estimating Worldwide CurrentAntibiotic Usage: Report of Task Force 1.
Clinical Infectious Diseases. 1987Jan;9(Supplement_3).2. Bulletin of the World Health Organization.Bulletin of the World Health Organization. 2011Jan;89(2).
3. Pillai SK, Elioppoulos GM, Mollering RC.Principles of anti-infective therapy. In: Mandell GL, Bennett JE, Dolin R,editors. Principles and Practice of Infectious Diseases. 7th edn. Philadelphia:Churchill Livingstone; 2010. pp.
267–279.4. Okeke I. Socioeconomic and Behavioral FactorsLeading to Acquired Bacterial Resistance to Antibiotics in DevelopingCountries. Emerging Infectious Diseases. 1999;5(1):18–27.5.
Boucher HCAW, Talbot GH, Bradley JS, Edwards JE,Gilbert D, Rice LB, et al. Bad Bugs, No Drugs: No ESKAPE! An Update from theInfectious Diseases Society of America. Clinical Infectious Diseases.2009;48(1):1–12.
6. Wise R, Hart T, Cars O, Streulens M, Helmuth R,Huovinen P, et al. Antimicrobial resistance. Bmj. 1998May;317(7159):609–10.7.
Austin DJ, Kristinsson KG, Anderson RM. Therelationship between the volume of antimicrobial consumption in humancommunities and the frequency of resistance. Proceedings of the NationalAcademy of Sciences. 1999Feb;96(3):1152–6.8. Shankar P, Partha P, Shenoy N. Self-medicationand non-doctor prescription practices in Pokhara valley, Western Nepal: aquestionnaire-based study.
BMC Family Practice. 2002;3(1).9. Bennadi D.
Self-medication: A current challenge.Journal of Basic and Clinical Pharmacy. 2014;5(1):19.10.
S G, Selvaraj K, Ramalingam A. Prevalence ofself-medication practices and its associated factors in Urban Puducherry,India. Perspectives in Clinical Research. 2014;5(1):32.11.
Ayalew MB. Self-medication practice in Ethiopia:a systematic review. Patient Preference and Adherence. 2017;Volume 11:401–13.
12. HalappaM. Research On Self Medication: A Hype Or A Hope? A Literature Review. AsianJournal of Pharmaceutical and Clinical Research. 2016Jan;9(6):28.