“Two-colour capsules”: Self-management of health and the commonly used non-prescribed antibiotics amongst pharmacy customers

Abstract

Background: Treating a variety of moderate and severe infections affecting human health is now possible thanks to the utilization of antibiotics. This explains why antibiotics are amongst the most commercialized, prescribed and utilized drugs in the world. Nevertheless, the persistent inappropriate use of these precious drugs is growing, with non-prescription sales and practices of self-medication with antibiotics (SMA) undermining the global efforts to rationalize the use and contain the antimicrobial resistance (AMR). This study aimed at identifying the commonly used antibiotics and the main health conditions leading to the practice of self-medication with antibiotics. Methods: Between October 2018 and March 2019 we conducted a qualitative study with 32 pharmacy customers and 17 pharmacists working in nine private pharmacies in Maputo city. In-depth interviews and focus group discussions (FGD) were conducted with customers while in-depth interviews were held with pharmacists. The interviews were audio-recorded, transcribed, coded and analysed using latent content analysis. The COREQ (Tong, 2007) checklist for interviews and FGD was performed. Results: The frequent use of non-prescribed antibiotics (NPA) was admitted by 30 of the 32 customers while 15 of the 17 pharmacists admitted NPA dispensing. The commonly used NPA were amoxicillin, cotrimoxazole, azithromycin, metronidazole, amoxicillin with clavulanic acid, tetracycline, doxycycline and erythromycin. Those were used after participants self-diagnosed or self-perceived health conditions related to sore throat, fever, cough, vaginal discharge, eye problem, common flu, urinary infection, respiratory infection, wounds and toothaches. Conclusion: The self-management of illness, the need to save time and the therapeutic itineraries customers adopt, together with the suboptimal dispensing practices of pharmacists, enabled the growing practices of SMA among pharmacies customers. These paves the way to the utilization of antibiotics as a daily basis as an approach to self-manage health problems. Contextual interventions are needed to involve public health stakeholders, pharmacists and healthcare professionals to enlighten customers regarding the inappropriate use of antibiotics at all levels.