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

Abstract

c During 2010, Mexico and Brazil implemented policies to enforce existing laws of restricting over-the-counter sales of antibiotics. We determined if the enforcement led to more appropriate antibiotic use by measuring changes in seasonal variation of penicillin use. We used retail quarterly sales data in defined daily doses per 1,000 inhabitant-days (DDD/TID) from IMS Health from the private sector in Mexico and Brazil from the first quarter of 2007 to the first quarter of 2013. This database contains information on volume of antibiotics sold in retail pharmacies using information from wholesalers. We used interrupted time-series models controlling for external factors with the use of antihypertensives with interaction terms to assess changes in trend, level, and variation in use between quarters for total penicillin use and by active substance. The most used penicillin was amoxicillin, followed by amoxicillin-clavulanic acid and ampicillin (minimal use in Brazil). Before the restrictions, the seasonal variation in penicillin use was 1.1 DDD/TID in Mexico and 0.8 DDD/TID in Brazil. In Mexico, we estimated a significant decrease in the seasonal variation of 0.4 DDD/TID after the restriction, mainly due to changes in seasonal variation of amoxicillin and ampicillin. In Brazil, the seasonal variation did not change significantly, overall and in the breakdown by individual active substances. For Mexico, inappropriate penicillin use may have diminished after the restrictions were enforced. For Brazil, increasing use and no change in seasonal variation suggest that further efforts are needed to reduce inappropriate penicillin use.

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…There was a reduction in penicillin use among private pharmacies in Mexico after this initiative, with a more limited reduction in Brazil 298,299 . Further details about the impact of these initiatives are contained in Table 4.…”

Decrease in Penicillin Sales in Brazil after Over-the-Counter Restrictions

“…; Faculty of Health Sciences, University of Brasília, Brasília, DF, Brazil b W e read with great interest the recently published paper by Santa-Ana-Tellez et al (1). In that work, the authors measured the changes in the seasonal variation in penicillin use before and after the restrictions on over-the-counter (OTC) antibiotic sales went into effect in Mexico and Brazil in 2010.…”

“…Santa-Ana-Tellez et al (1) found that following the implementation of policies to restrict OTC sales of antibiotics, the seasonal variation in antibiotic usage decreased in Mexico but not in Brazil. On the basis of these findings, the authors concluded that in Mexico, the inappropriate use of penicillin may have diminished after the restrictions were enforced.…”

Drug Resistance in Bacteria, Fungi, Malaria, and Cancer

“…Among many Latin American countries, including Brazil and Mexico, restrictions on OTC sales of antibiotics were implemented in 2010 (Santa- Ana-Tellez et al 2015). This included the requirement for a prescription for antibiotics to be dispensed even in private pharmacies.…”

“…Brazil (private sector), Mexico and Serbia, and this will grow (Godman et al 2014;Moura et al 2015;Santa-Ana-Tellez et al 2015). We are already seeing a number of countries tighten illegal self-purchasing of antibiotics, e.g.…”