Advertisement of antibiotics for upper respiratory infections and equity in access to treatment: a cross-sectional study in Nepal

Abstract

Background: Pharmaceutical companies actively advertise their branded antibiotics, which influence their sales at community pharmacies. The major proportion of out of pocket health spending is on medicine; and affordability of antibiotics has always been a crucial issue in most developing countries. This study identified promotional activities adopted by pharmaceutical companies in community pharmacies and medicine shops and the affordability of selected antibiotics to clients with lowest wages in Kavrepalanchok district of Nepal. Methods: A cross-sectional study was conducted among all community pharmacies and medicine shops (n = 34) in Dhulikhel and Banepa. Available pharmacists / personnel were interviewed, using a structured questionnaire, on the characteristics of the pharmacies, promotional activities, and sales and prices of antibiotics used to treat acute upper respiratory tract infections. This study looked at the association of promotional activities (financial bonus, free samples, and books/brochure/gifts) with the type of antibiotics. Further, affordability was assessed of the most popular antibiotics by comparing the total treatment cost against the lowest wage for unskilled workers in Nepal. Results: Financial bonus, free samples, and brochures were the most popular promotional activities. It is also noticed that antibiotics which are top selling were those with a high number of promotional activities. Amoxicillin, azithromycin and amoxicillin+clavulanate had 42, 29 and 17 promotional activities respectively. Irrespective of the prices of antibiotics, almost all of the most popular antibiotics for acute upper respiratory infections were unaffordable for unskilled workers costing them more than a day's wage. Conclusions: Upper respiratory tract antibiotics are widely promoted at community pharmacies. The treatment cost of antibiotics is unaffordable for unskilled workers in Nepal irrespective of the type and unit cost of antibiotics.

Accounting for variation in and overuse of antibiotics among humans

“…However, studies that examined financial incentives found a positive association with prescribing. [ 104,153 ] The fact that pharmaceutical companies have extensive marketing practices indicates per se that they believe that such campaigns are effective for shaping physician attitudes, and ultimately their own sales. [ 154 ]…”

Perspectives of pharmacy employees on an inappropriate use of antimicrobials in Kathmandu, Nepal

“…Acute upper respiratory infections (ARTIs) are considered to be the most common diagnosis for prescription of antimicrobials [11]. As viruses are the most common etiological agents, ARTIs are also associated with an increased burden of inappropriate antimicrobials use and subsequent AMR [11,12]. In our study, 68% of pharmacy respondents replied that respiratory infections were the most common complaints for patients requesting antimicrobials, followed by urinary and gastrointestinal infections.…”

“…Further, azithromycin was also ranked as the first most commonly sold antimicrobials in our study, followed by amoxicillin and cefixime. Koju et al reported that amoxicillin, azithromycin, amoxi-clavulanate, cefixime, and ciprofloxacin were the top five most commercially promoted antimicrobials for ARTIs in the community pharmacies of Nepal, which could have a direct influence on an increased prescription and sell of these antimicrobials [12]. Another study from Nepal found that cefixime (38%), amoxicillin (29.3%), ciprofloxacin (13.7%), and azithromycin (8.1%) were the most commonly dispensed antimicrobials by community pharmacies [13].…”

The first national survey of antimicrobial use among dentists in Japan from 2015 to 2017 based on the national database of health insurance claims and specific health checkups of Japan

“…The frequent use of cephalosporins in Japan may be due in part to the active promotion of these antimicrobials by pharmaceutical companies. A study conducted in Nepal showed that the top-selling antimicrobials were those that were subjected to intensive promotional activities [21]. Although such promotional activities have since diminished in Japan, the situation was similar to that of Nepal as recently as 10 years ago.…”