Antibiotic distribution channels in Thailand: results of key-informant interviews, reviews of drug regulations and database searches

Abstract

Objective To analyse how antibiotics are imported, manufactured, distributed and regulated in Thailand. Methods We gathered information, on antibiotic distribution in Thailand, in in-depth interviews – with 43 key informants from farms, health facilities, pharmaceutical and animal feed industries, private pharmacies and regulators– and in database and literature searches. Findings In 2016–2017, licensed antibiotic distribution in Thailand involves over 700 importers and about 24 000 distributors – e.g. retail pharmacies and wholesalers. Thailand imports antibiotics and active pharmaceutical ingredients. There is no system for monitoring the distribution of active ingredients, some of which are used directly on farms, without being processed. Most antibiotics can be bought from pharmacies, for home or farm use, without a prescription. Although the 1987 Drug Act classified most antibiotics as “dangerous drugs”, it only classified a few of them as prescription-only medicines and placed no restrictions on the quantities of antibiotics that could be sold to any individual. Pharmacists working in pharmacies are covered by some of the Act’s regulations, but the quality of their dispensing and prescribing appears to be largely reliant on their competences. Conclusion In Thailand, most antibiotics are easily and widely available from retail pharmacies, without a prescription. If the inappropriate use of active pharmaceutical ingredients and antibiotics is to be reduced, we need to reclassify and restrict access to certain antibiotics and to develop systems to audit the dispensing of antibiotics in the retail sector and track the movements of active ingredients.

Antibiotics utilization and farmers’ knowledge of its effects on soil ecosystem in the coastal drylands of Ghana

“…Practices of farmers on antibiotics utilization, showed that the purchase of antibiotics overthe-counter and without prescription was prevalent amongst farmers in the study area. This was consistent with assertions that antibiotics can easily be bought without prescription in some developing countries [29]. Even if there is prescription, it is usually invalid or issued by unlicensed veterinarians [29].…”

Antimicrobial Use in Extensive Smallholder Livestock Farming Systems in Ethiopia: Knowledge, Attitudes, and Practices of Livestock Keepers

“…The inappropriate antimicrobial use by pastoralists might be linked with this ease of access and inadequate advice for farmers (35). Restricting access to antimicrobials by removing over-the-counter sales has been identified as a potential route to better antimicrobial use in animals (6,36).…”

The Costs, Benefits and Human Behaviours for Antimicrobial Use in Small Commercial Broiler Chicken Systems in Indonesia

“…Poor awareness of AMR has been identified as a hurdle to changing antimicrobial practices in many low-and middle-income countries [38,39]. Overall, study respondents had a poor knowledge of what defined AMR and expressed few concerns over the impact of AMR on either human or animal health.…”

“…At present, there are many questions over the capacity and economic feasibility of enforcing antimicrobial use policy in Indonesia; it is useful to draw on the experiences of neighbouring countries. For example, despite Thailand having a more extensive infrastructure and tighter control over antimicrobials, researchers have identified that the illegal use of antimicrobials in livestock may be widespread [39,50]. In order to minimise the risks of antimicrobials becoming a black-market commodity, a stepwise approach to regulation would be best taken in Indonesia.…”

“…The study results identified a need for a stepwise approach to restrict antimicrobial use, which would be best achieved with better regulation of drug sellers and pharmacies as the initial stage with the ultimate goal of making antimicrobials a prescription-only drug. There is a risk that implementing major changes to policy may encourage farmers to source antimicrobials from black-market sources [39].…”