For a country that consumes the most antibiotics in the world, a pattern largely fuelled by the ready availability of even prescription drugs over the counter, Indian pharmacies have shown restraint in dispensing anti-tuberculosis drugs, a new study has found. However, drugs that can delay tuberculosis diagnosis are still available over the counter.
The study published in journal Lancet states that none of the pharmacies mapped in Mumbai, Delhi and Patna dispensed first-line anti-tuberculosis drugs, and the use of stronger fluoroquinolone antibiotics and heavily-restricted drug classes was low. The study says: “Furthermore, the use of all antibiotics decreased sharply when the patient’s diagnosis was made available to the pharmacists.”
It goes on to state that “concerns regarding the use of anti-tuberculosis drugs by pharmacies seem to be unfounded, at least in major cities, and pharmacies are unlikely sources of irrational drug use that contributes to multidrug-resistant tuberculosis. The study, which sampled 622 pharmacies between April 1, 2014, and November 29, 2015, in Delhi, Mumbai, and Patna, has praised measures of the Indian National Tuberculosis Control Program to reduce drug abuse. However, not all is well.
“Our findings showed that 38% of the pharmacies dispensed antibiotics or steroids to people with tuberculosis symptoms but no test results. The use of fluoroquinolones in 7% and steroids in 5% of interactions is especially worrying because these drugs delay tuberculosis diagnosis. Additionally, fluoroquinolones are also an essential part of multi-drug resistant tuberculosis treatment regimens and emerging regimens, so quinolone abuse is a concern.”
Decrease in use
The study notes that most pharmacies surveyed had managed the confirmed tuberculosis cases correctly and the use of all antibiotics decreased sharply when the patient’s diagnosis was revealed to the pharmacists.