Have you ever wondered how many of us carry the prescription to the pharmacy store? Or do you let the pharmacist decide the drug of choice, brand, etc for you. Have you thought about the OTC drugs sales and its impact?

1.   What are OTC drugs?

Over-the-counter drugs aimed to mostly treat mild symptoms and diseases without intervention of doctors, and therefore provide easy accessibility to the patient. This evidently helped the patients in early stages, and controlled symptoms of mild diseases.

These OTC drugs do not require prescription specifically when sold at the pharmacy stores, this promotes sales of several drugs without consultation. And allowing OTC drugs sales without proper regulation or consultation poses increase threats for:

1. Drug abuse
2. Increase risk of adverse drug reaction
3. Delayed access to healthcare
4. RESISTANCE to medications

People are so unaware of the consequences, that occur with just the change in the brand of a particular medicine, example: PHEYNYTOIN, WARFARIN, etc. They aren’t compliant and do not propose BIOEQUIVALENCE.

2.   Is BIOEQUIVALENCE actually a threat?

The property of two dosage forms of active ingredients with similar blood concentrations levels that produce the same effect at the site of a physiologic activity it is basically a COMPARISON of the bioavailability of two identical products.

Though repeated consumption of even different companies (brands) medicines, leads to dependence and ultimately cause RESISTANCE.

Therefore the biggest threat is imposed towards the sales of antibiotics without prescription, if you notice the easy availability of antibiotics at the pharmacies these days which is slowly resulting in resistance to drugs when it is actually needed by the body to treat the disease.

3. Anti Microbial Resistance (AMR)

As the population is resistant to drugs, it simply forces the doctors to increase the dose required, or change the regime normally used for the treatment. These habits have made the patient so dependent, that even smallest procedures these days have to be performed with higher dosage.

A significant increase in the sales of antibiotics has been noticed in India, that is the biggest exporter of antibiotic formulation in 2019, while China dominated the export of antibiotic ingredients.

The WHO’s Global Action Plan on Antimicrobial Resistance (WHO GAP) recognizes the need for regulation to optimize the use of antibiotics. Despite being illegal, OTC sales of antibiotics by pharmacies without a valid prescription form a registered medical practitioner, appear widespread in India.

Pharmacies are mere subject of commercial pressures, after all its their businesses. But the desire to maximize profits and the concerns about losing a sale or customer to a rival pharmacy motivate the dispensing of antibiotics without a valid prescription. As a result, antibiotics are often dispensed by staff who lack medical qualifications and have inadequate knowledge of drug safety and efficacy.

4.   Action that has to be taken

The initiatives set out within India’s National Action Plan on Antimicrobial Resistance (NAP-AMR) conceptualizes regulation more generally. Yet on the contrary, compliance with existing or revised laws is contingent, among other factors on the awareness and education of pharmacists about the rational use of antibiotics and Antimicrobial Resistance.

But to start on small scale, education and training of pharmacist on the use of antibiotics and resistance changes in the behavior of consumers regarding antibiotics consumption.

We can also prioritize ‘Improve awareness and understanding of Antimicrobial Resistance through effective Communication, Education and Training.’ There is need of interventions designed to suit the Indian context will therefore also be necessary to optimize the use of antimicrobial agents in health, animals, and food.

Strengthening the legislation regarding various facets of antimicrobials. Misuse of antibiotics is one of the primary reasons for the emergence of antimicrobial resistance in India, which is the largest consumers of antibiotics.

This misuse could result from the actions or inactions of different actors including pharmacists as dispensers of antibiotics, medical practitioners as prescribers of antibiotics, consumers of antibiotics, as well as manufacturers, sellers, and distributors of antibiotics who also seek to influence the practices and behavior of the above-mentioned actors. To look at the positive side, it is found that the Indian government is currently working to close a gap in the regulatory framework for sales of antibiotics relating to e-pharmacies. Outside these specific areas, formal rules require a prescription from a registered medical professional for sales of antibiotics and specify the regulatory actors charged with enforcement. I hope that these acts get implemented, and help the future generations to come.

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