Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : August | Volume : 6 | Issue : 6 | Page : 951 - 954

A Study on the Sale of Antimicrobial Agents without Prescriptions in Pharmacies in an Urban Area in South India

Rathnakar U.P., Nitish Kumar Sharma, Raina Garg , Unnikrishnan B, Gopalakrishna HN

1. Associate Professor, Department of Pharmacology, 2. MBBS student, 8th semester, 3. MBBS student, 8th semester, 4. Professor, Department of Community Medicine, 5. Associate Professor, Department of Pharmacology Manipal University, Kasturba Medical College, Mangalore, India.

Correspondence Address :
Dr. Rathnakar U.P,
Kasturba Medical College
Manipal University
L.H.H.Road, Mangalore
Pin-575001, Karnataka, India.
Phone: 919448983292
E-mail: ratnakar.uncle@gmail.com

Abstract

Introduction: Antimicrobial drug resistance is a fast emerging problem worldwide. It is a consequence of the use, particularly of the misuse of drugs. In most of the developing countries, antibiotics can be purchased without prescriptions, even when the practice is not legal. Presently, in India, Schedule H, under the Drug and Cosmetics Act and Rules, provides a list of over 536 drugs which include Antimicrobial Agents [AMAs], which are required to be sold on the prescription of a registered medical practitioner.

Objectives: To evaluate the Over the Counter (OTC) sales of antimicrobial agents in allopathic pharmacies [community] within the city corporation limits. To describe the degree of difficulty which is faced in obtaining antibiotics without a prescription. To find out as to what advice, if any, was given by the pharmacists with regards to the administration of the medicines which had been sold.

Methods: Three diseases were simulated by two medical students who presented as patients in randomly selected pharmacies at an Urban location. They then requested the pharmacists for medications for their illnesses. AMAs were requested for, if they were not issued at the first instance.

Results and Discussion: Nearly 50% of the pharmacists declined to issue AMAs. Amoxicillin was the most common of the AMAs which were dispensed by the pharmacists. The duration and the frequency of the treatment which was advised by the pharmacists were mostly wrong.

Conclusion: This study showed that the practice of dispensing AMAs without prescriptions was widely prevalent among the dispensaries which were located even in urban areas. Not only were the AMAs dispensed, but also they were dispensed without taking any history of hypersensitivity. What makes the practice worse is that the duration and the frequency of administration of these drugs are wrongly advised more often than not.

Keywords

Heart rate Variability, Time domain method, Frequency domain method, Mobile phone users and non-users

How to cite this article :

Rathnakar U.P., Nitish Kumar Sharma, Raina Garg , Unnikrishnan B, Gopalakrishna HN. A STUDY ON THE SALE OF ANTIMICROBIAL AGENTS WITHOUT PRESCRIPTIONS IN PHARMACIES IN AN URBAN AREA IN SOUTH INDIA. Journal of Clinical and Diagnostic Research [serial online] 2012 August [cited: 2018 Oct 18 ]; 6:951-954. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=August&volume=6&issue=6&page=951-954&id=2308

Introduction
Antimicrobial drug resistance is a worldwide problem. It is the result of the use, particularly of the misuse of antimicrobial agents. The advent of antimicrobial resistance can be attributed to a number of causes such as the inappropriate use of antimicrobials by health care providers (1) or the easy availability of AMAs without a physician’s prescription. In most of the developing countries, antibiotics can be purchased without prescriptions, even when the practice is not legal. In many African, Asian and Latin American countries, antibiotics are readily available on demand from pharmacies, drug stores, roadside stalls and hawkers (2). Presently in India, Schedule H, under the Drug and Cosmetics Act and Rules, has provided a list of over 536 drugs, including antibiotics, which are required to be sold on the prescription of a registered medical practitioner and the manufacturer is required to label the drug with the symbol Rx and with the following words: “Schedule H drug - warning: To be sold by retail on the prescription of a Registered Medical Practitioner only” (3).

The Lancet, in a recently published article about the ‘Superbug’, has insinuated that the large scale antibiotic misuse in India has resulted in many strains of bacteria becoming resistant to many antibiotics (4). In response, the Government of India has created a committee to frame a new antibiotic policy for the country. The antibiotic policy which has been written by this committee isSectionSchedule HX which is currently under review by the Union Law Ministry, after which it will be reviewed by the Drugs Technical Advisory Board (5).

The increasing resistance of microorganisms calls for serious interventions to prevent the emergence of new resistant strains and the spread of the existing ones. One approach is to control the inappropriate use of antibiotics in both the hospital and the community settings (6) and their sale without prescription. Studies which have been conducted across various parts of the world have shown that AMAs could be obtained easily from local pharmacies despite the regulations (7),(8),(9),(10). A study which was conducted in Spain, found that antibiotics were obtained from 79.7% pharmacies when a urinary tract infection was simulated, from 34.8% pharmacies when a sore throat was simulated and from 16.9% of 59 pharmacies when acute bronchitis was simulated. A similar study which was conducted in Brazil, found that antibiotics were offered in 58% of the pharmacies, and that this offer was increased to 74% after the investigator insisted on having them (7).

An interview based study was conducted in Nagpur, India, where it was found that drugs were dispensed without prescriptions, despite the prohibition by the Indian Pharmaceutical Act. Salesof antimicrobial drugs, which had accounted for 17.5% of the purchases. The most common indications were upper respiratory, gastrointestinal and nonspecific complaints. The dispenser rarely offered advice or instructions on the use of the prescribed antimicrobials (11). It is widely believed that antimicrobial agents are available over the counter in most of the parts of India. This study was planned to evaluate the availability of antimicrobial agents without prescriptions in allopathic dispensaries in a city of south India. This study was inspired by a similar study which was carried out in Spain in 2008. We hope to provide data about the availability and the ease/difficulty which is faced in the availability of AMAs without prescriptions. Our study results may strengthen the legal process which is underway in restricting the use of antimicrobial agents.

Objectives
1. To evaluate the Over The Counter (OTC) sale of AMAs in the allopathic pharmacies [community] which are within a city corporation limits. 2. To describe the degree of difficulty which is faced in obtaining antibiotics without a prescription. 3. To find out what advice, if any, is given by the pharmacist with regards to the administration of the medicines which are sold.

Material and Methods

A prospective study was carried out from October to December 2011 among the dispensaries in a corporation area in south India. A complete list of all the pharmacies in this area was obtained from various sources. Only community based dispensaries were included in the study. All the homeopathic pharmacies, ayurvedic pharmacies and the pharmacies in hospitals and nursing homes were excluded from the study. These pharmacies were grouped into the wards [administrative units] of the city corporation to which they belonged. One pharmacy from each of the 60 wards in the city was randomly selected. These 60 pharmacies formed the sample for the study. two medical students [1 boy and 1 girl] visited these pharmacies and play acted as patients. Any one of three different well rehearsed clinical scenarios was presented in a pharmacy. The clinical conditions which had to be presented in each of the pharmacies were randomly allocated. One scenario was presented in 20 pharmacies. The three clinical conditions which were presented were (1) Upper Respiratory Tract Infection [URTI] (2) Acute bronchitis and (3) Diarrhoea. Symptoms to be presented were:

1. URTI: Running nose, severe headache, body ache and fever. 2. Acute bronchitis: Cough with expectoration and fever. 3. Diarrhoea: Loose stools 5-6 times, pain in the abdomen and fever. These symptoms were rehearsed with the aid of senior members of the department of pharmacology to obtain the standardization of the simulation of these diseases. The male student always presented the symptoms of URTI or diarrhoea and the female student presented the symptoms of acute bronchitis. The investigators used two levels of demand. First, the investigator asked for some medicine to alleviate the symptoms. If this initial request did not yield antibiotics, then the investigator used the second level of demand, which was to directly ask for AMAs. A note was made as to whether the pharmacist demanded a prescription, asked any952leading questions about the illness, and gave any instructions as to how often and how long the medicines had to be taken. If no such instructions were offered, the investigator asked for the frequency and the durations of use of the AMAs. In all the cases, the investigators were very polite and they did not get into any sort of arguments. The data was collected in a semi-structured proforma. The details were recorded soon after the encounter. Prior approval was obtained from the institutional ethics committee and the names of the dispensaries and the city limits where the study was carried out were not revealed in this study, as was suggested by the ethics committee. We performed descriptive statistical analyses of the results and used Chi square tests to compare the qualitative variables. The differences were considered to be significant if p was <0.05.

Results

The three diseases, namely, upper respiratory infections, acute bronchitis and diarrhoea were simulated by the investigators in 20 pharmacies for each disease, among 60 randomly selected pharmacies in an urban administrative location, as was described in the methodology.

Ease of obtaining the AMAs:
Among the 60 pharmacies, 29 [48.3%], declined to issue antimicrobial agents even when they were asked for by the investigator. However, the investigators could get AMAs from 16[26.7%] pharmacies when they were requested for. The rest [25%] issued AMAs as soon as the symptoms were presented. In case of diarrhoea, 70% of the dispensaries did not dispense AMAs, whereas 75% of the dispensaries issued AMAs when URTI was presented. The breakdown of the ease in obtaining AMAs from the dispensaries for each of the simulated diseases has been shown in (Table/Fig 1).

The type of AMAs which were dispensed: (Table/Fig 2) shows the type of AMAs which were dispensed against the various simulated diseases. Amoxicillin was the most common AMA which was dispensed by the pharmacies.

Details of the illnesses:
The details of the illnesses were not enquired by 47[79%] of the dispensing persons. The others asked for a few details but none asked for a history of the drug allergy.

Advice by the pharmacists about the duration/ frequency of dosing: The number of pharmacies where the duration and the frequency of the AMAs were advised either on their own or after asking has been shown in (Table/Fig 3). If the duration / frequency of the administration of the AMAs was advised after asking for, it was mostly wrong. A higher frequency of wrong advices were given after asking for them as compared to the frequency of the advices which were given without asking for them and this wasfound to be statistically significant [p<0.05].

Discussion

Many studies from various parts of the world have revealed that antibiotics could be obtained from almost 70%- 97% of the local pharmacies despite the regulations (7). However, in the present study, nearly 50% of the dispensaries refused to issue AMAs. Almost half of the pharmacies, who dispensed AMAs, dispensed them as soon as the symptoms were presented and AMAs could be obtained from the rest only after specifically asking for the AMAs to be issued. Details of the illness and a history of allergy are particularly important to be asked about before dispensing AMAs to patients. A history of hypersensitivity is very important if betalactam antibiotics are dispensed. The details of the illnesses were not enquired for by 79% of the pharmacists. Some details of the symptoms were enquired about by the rest, but none asked about drug hypersensitivity. This could be dangerous, as anaphylaxis is a possibility even when betalactums are administered orally.

Amoxicillin was the commonest AMA which was dispensed when the symptoms of URTI and acute bronchitis were presented. When diarrhoea was presented as a symptom, 70% of the dispensaries refused to issue AMAs. Fluroquinolones alone, or in combination with tiinidazole, were dispensed by other dispensaries for diarrhoea. Among the 31 pharmacies that sold AMAs, only 18 pharmacists advised on the frequency of taking AMAs and 19 advised about the duration of the treatment, without the investigators asking for them. Other pharmacists gave the advice only after they were asked for by the investigators. In a similar study which was done in Spain among pharmacies that sold antibiotics, 84.3% of the pharmacists explained the number of times per day that the drug had to be taken and 68.7% explained the duration of the treatment (7). In our study, more than 60% of the dispensaries gave wrong advice. Another interesting finding in this study was that if the person who dispensed the AMAs gave out the advice on his/her own without asking, he/she was likely to be right and if the information was given only after it was asked for, it was more likely to be wrong [p<0.05]. In other words, if the dispensing person was sure of the frequency and the duration of the treatment of AMAs, he/she would advice routinely as the drug was dispensed.

953But if the advice was obtained only after asking for it, after the dispensing person had failed to provide the advice on his/her own, it was more likely to be a wrong advice.

Conclusion

Many studies which had been carried out in different parts of the world have shown that AMAs could be obtained in 70%-97% of the pharmacies, without prescriptions. But the present study has shown that almost 50% of the pharmacists declined to dispense AMAs. But this figure is no reason for any solace, as AMAs should not be dispensed at all without a physician’s advice, for the fear of the organisms developing resistance. It is quite possible that instead of simulating the disease, if AMAs are directly asked for, the results could be different. This study showed that the practice of dispensing AMAs without prescriptions was widely prevalent among the dispensaries which were located even in the urban areas. Not only were the AMAs dispensed, they are dispensed without taking any history of the subject’s hypersensitivity. What made the practice worse was that the duration and the frequency of the administration of these drugs were wrongly advised more often than not.

References

1.
National Institute of Allergy and Infectious Diseases [Internet]. Understanding Antimicrobial (Drug) Resistance [Updated on 2011 December 21; cited 2011 nov 15]. Available from: http://www.niaid.nih.gov/topics/antimicrobialResistance/Understanding/Pages/causes.aspx.
2.
Okeke IN, Lamikanra A, Edelman R. Socioeconomic and behavioral factors which lead to an acquired bacterial resistance to antibiotics in the developing countries. Emerg Infect Dis 1999; 5: 18-27.
3.
Srivastava RK. A review on the current situation regarding the manufacture, use and the misuse of antibiotics in the country. In: National Policy for the Containment of Antimicrobial Resistance. New Delhi. Published by Directorate General of Health Services; 2011; 14-7 .
4.
Kumarasamy KK. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis.2010; 109: 597-602.
5.
CDDEP [Internet]. Regulating Over-the-Counter Antibiotic Sales: What Will “Schedule HX” Mean for India? [updated 2011 Aug 2; cited 2011 Sep 2011]. Available from: http://www.cddep.org/blog/posts/regulating_over_the_counter_antibiotic_sales_what_will_schedule_hx_mean_india.
6.
Aranda CMA, Mazzotti LR. Teaching the appropriate antibiotic use in the developing countries. In: Anibal de J Sosa, editor. Antimicrobial resistance in the developing countries, 1st edn. New York: Springer; 2010; 491-504.
7.
Llor C, Cots JM. The sale of antibiotics without prescriptions in pharmacies in Catalonia, Spain. Clin Infect Dis .2009; 48: 1345-9.
8.
Volpato DE, De Souza BV, Dalla Rosa LG, Melo LH, Daudt CA, Deboni L. The use of antibiotics without medical prescriptions. Braz J Infect Dis. 2005; 9: 288-91.
9.
Al-Faham Z, Habboub G, Takriti F. The sale of antibiotics without prescriptions in pharmacies in Damascus, Syria. J Infect Dev Ctries. 2011; 5: 396-9.
10.
Lansang MA, Lucas-Aquino R, Tupasi TE, Mina VS, Salazar LS, Juban N, et al. The purchase of antibiotics without prescriptions in Manila, the Philippines. Inappropriate choices and doses. J Clin Epidemiol .1990; 43: 61-7.
11.
Dua V, Kunin CM, White LV. The use of antimicrobial drugs in Nagpur, India. A window on the medical care in a developing country. Soc Sci Med .1994; 38: 717-24.

DOI and Others

D: JCDR/2012/4511:2308

Financial OR OTHER COMPETING INTERESTS:
None.


Date of Submission: May 10, 2012
Date of Peer Review: Jun 22, 2012
Date of Acceptance: Jul 05, 2012
Date of Publishing: Aug 10, 2012

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