Impact of Over-the-Counter Restrictions on Antibiotic Consumption in Brazil and Mexico

Abstract

BackgroundIn Latin American countries over-the-counter (OTC) dispensing of antibiotics is common. In 2010, both Mexico and Brazil implemented policies to enforce existing laws of restricting consumption of antibiotics only to patients presenting a prescription. The objective of the present study is therefore to evaluate the impact of OTC restrictions (2010) on antibiotics consumption in Brazil and Mexico.Methods and FindingsRetail quarterly sales data in kilograms of oral and injectable antibiotics between January 2007 and June 2012 for Brazil and Mexico were obtained from IMS Health. The unit of analysis for antibiotics consumption was the defined daily dose per 1,000 inhabitants per day (DDD/TID) according to the WHO ATC classification system. Interrupted time series analysis was conducted using antihypertensives as reference group to account for changes occurring independently of the OTC restrictions directed at antibiotics. To reduce the effect of (a) seasonality and (b) autocorrelation, dummy variables and Prais-Winsten regression were used respectively.Between 2007 and 2012 total antibiotic usage increased in Brazil (from 5.7 to 8.5 DDD/TID, +49.3%) and decreased in Mexico (10.5 to 7.5 DDD/TID, −29.2%). Interrupted time series analysis showed a change in level of consumption of −1.35 DDD/TID (p<0.01) for Brazil and −1.17 DDD/TID (p<0.00) for Mexico. In Brazil the penicillins, sulfonamides and macrolides consumption had a decrease in level after the intervention of 0.64 DDD/TID (p = 0.02), 0.41 (p = 0.02) and 0.47 (p = 0.01) respectively. While in Mexico it was found that only penicillins and sulfonamides had significant changes in level of −0.86 DDD/TID (p<0.00) and −0.17 DDD/TID (p = 0.07).ConclusionsDespite different overall usage patterns of antibiotics in Brazil and Mexico, the effect of the OTC restrictions on antibiotics usage was similar. In Brazil the trend of increased usage of antibiotics was tempered after the OTC restrictions; in Mexico the trend of decreased usage was boosted.

Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales

“…SSP had similar levels of consumption to those yielded by literature for the whole country of Brazil. [15,20] SED of a higher oral antibiotic consumption in municipalities of SSP were: HDI, percentage of urban population, density of private health establishments, lower percentage of population between 5 and 15 years old, lower illiteracy levels, higher life expectancy and percentage of females in the population. The policy effect was stronger in municipalities with a higher percentage of females.…”

“…Santa-Ana-Tellez et al . (2013) [15] analysed the impact of this same policy countrywide in Brazil, controlling for the use of anti-hypertensives, and found a significant reduction of 1.35 DID in the level of consumption immediately after the law enforcement—however, no significant change in slope was seen. In the same way, Moura et al .…”

“…Santa-Ana-Tellez et al . (2013) [15] noticed an increase in the private sector antibiotic use from 5.7 in 2007 to 8.5 DID in 2012. It is noticeable that, from 2010 to 2012, consumption has decreased more considerably in those meso-regions of SSP which had a larger consumption in 2010 –no meso-regions had consumption levels greater than 10 DID in 2012, and the distribution of antibiotic sales was more even in 2012 than in 2008.…”

Seasonal Variation in Penicillin Use in Mexico and Brazil: Analysis of the Impact of Over-the-Counter Restrictions

“…In Mexico, penicillin use decreased by 0.86 DDD/TID and sulfonamide use decreased by 0.17 DDD/TID. In Brazil, penicillin use decreased by 0.64 DDD/TID, sulfonamide use by 0.41 DDD/TID, and macrolide use by 0.47 DDD/TID (6). In both countries, no shift toward use of other classes of antibiotics, such as quinolones, macrolides, and tetracyclines, was observed.…”

“…We focused on the consumption of penicillins because they are the most frequently used class of antibiotics in the selected countries. Additionally, seasonal variation in their use and high rates of self-medication have been reported previously (5,6,12,13). We converted the kilograms of each antibiotic and antihypertensive sold into a daily defined dose per 1,000 inhabitant-days (DDD/TID) according to the anatomical therapeutic chemical (ATC) classification system proposed by the World Health Organization (14).…”