Regulation of antibiotic sales in Mexico: an analysis of printed media coverage and stakeholder participation

Abstract

BackgroundRestricting antibiotics sales to those with medical prescriptions only is a central strategy for promoting appropriate use and containing antibiotic resistance; however, many low and middle income countries have not enforced policies that prevent widespread self-medication with antibiotics. In 2010, the Mexican government announced the enforcement of antibiotic sales regulations, a policy that gained media prominence. This study analyzes media coverage of issues, stakeholder representation, and positions taken during policy agenda setting, drafting, and implementation to shed light on policy making to promote appropriate antibiotic utilization.MethodsWe carried out a quantitative content analysis of 322 newspaper articles published between January 2009 and December 2010 in 18 national and regional newspapers. Additionally, we conducted a qualitative content analysis to understand the positions adopted and strategies developed by nine key stakeholders. Framing theory guided the analysis.ResultsThe Ministry of Health dominated media coverage, justifying the enforcement policy by focusing on risks of self-medication, and to a lesser degree dangers of increasing antibiotic resistance. Pharmacy associations appeared to be the leading opponents, arguing that the policy created logistical difficulties and corruption, and had negative economic impact for pharmacies and their clients. The associations developed strategies against the regulation such as attempting to delay implementation and installing physicians’ consultation offices within pharmacies. While medical associations and academic institutions called for a comprehensive strategy to combat antibiotic resistance, improve prescription quality, and create public awareness, these issues had little impact on media coverage. Consumer groups and legislators received very little media coverage.ConclusionsThe narrowly-focused and polarized media coverage ─centred on problems of self- medication and economic impact ─ was a missed opportunity to publicly discuss and to develop a comprehensive national strategy on antibiotic use in Mexico. It highlights the need for discussing and developing interventions within the framework of a pharmaceutical policy.

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

“…In addition, in Mexico physician offices were installed within or right next to pharmacies only separated by a wall; pharmacies' customers demanding antibiotics OTC are referred to these physicians' offices to get a prescription. There is not yet evidence about antibiotics prescribing patterns by these offices; but, since their installment was explicitly recommended by market consultancy groups in Mexico as a way “to avoid losses from antibiotics sales” [9], it is probable that prescriptions for antibiotics issued in these offices partly compensated for OTC sales of antibiotics. Although in Brazil a copy of the prescription for an antibiotic is required to be retained; however, there are anecdotal reports of problems in the verification of the prescription retention, and thus the policy might not be fully implemented.…”

“…The antibiotics as therapeutic group have occupied the second place in retail sales (40% without a prescription), but the first place with regards to reports on adverse reactions [8] [9]. The consequences of self-prescription were highlighted during the epidemic of influenza A (H1N1) in 2009.…”

“…The consequences of self-prescription were highlighted during the epidemic of influenza A (H1N1) in 2009. Indeed, the Mexican government justified the antibiotic regulation in 2010 [10] arguing that it would prevent harmful self-medication with antibiotics that had led to delayed medical diagnosis of life-threatening complications during the influenza epidemic [9]. This regulation requires prescriptions for antibiotics to be retained and registered in pharmacies, and imposes fines to the owners of the pharmacies for non-compliance.…”

“…Approximately 40% of the medicines consumed in Brazil are antibiotics and they are commonly self-medicated; in 2008 alone, the sale of these medicines had a revenue of 377 million USD, with over 70 million units sold [12]. The National Health Surveillance Agency in Brazil (ANVISA) has discussed the need to improve the control of sales of antibiotics since 2009; however, it was the spread of the multi-resistant KPC bacteria ( Klebsiella Pneumoniae Carbapenemase ) and related deaths from hospital infections during 2010 that speeded up the process of carrying out the regulation [9], which was implemented in November of 2010 [13]. After that, the regulation had some modifications detailing that the pharmacies should keep a copy of the prescriptions; from April 2013, the antibiotics were included into the National Controlled Substances Management System (SNGPC) to improve the supervision of their consumption [14].…”

Self medication: a potentially avoidable cause of antibiotic misuse and resistance

“…Restricting sales of antibiotic with medical prescriptions only. 9 2. Effective use of mass media like television, newspaper and internet for improving awareness about adverse consequences of antimicrobial usage.…”