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Article

No Prescription, No Problem! A Mixed-Methods Study of Antimicrobial Stewardship Relating to Working Equines in Drug Retail Outlets of Northern India

1
Centre for Rural Policy Research (CRPR), The University of Exeter, EX4 4PJ Devon, UK
2
The Donkey Sanctuary, Sidmouth, EX10 0NU Devon, UK
*
Author to whom correspondence should be addressed.
Antibiotics 2020, 9(6), 295; https://doi.org/10.3390/antibiotics9060295
Received: 20 April 2020 / Revised: 27 May 2020 / Accepted: 29 May 2020 / Published: 2 June 2020
(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)
Multidrug resistance (MDR) is already occurring among some equids in India. Donkeys and mules are a mobile species moving between regions and international borders, often populating areas of India where private community pharmacies, or medical stores, are the primary healthcare provider for both humans and animals. This article highlights how the capacities of drug retail outlet workers might affect their antibiotic dispensing practices, particularly in relation to donkeys and mules, in order to consider how this might impact the development of antimicrobial resistance (AMR) on a wider scale. A mixed-methods approach was implemented using patient simulation method (n = 28), semi-structured interviews (SSIs) (n = 23), focus group discussions (FGDs) with veterinary practitioners and non-governmental organisation animal health workers (n = 2 FGDs), and participant observation. Fewer than 48 per cent of drug retail outlet workers admitted to having had any formal training in pharmaceuticals at all, while 78 per cent reported having no formal training in animal-related pharmaceuticals. Moreover, 35 per cent of all participants sold antibiotics without a prescription, unprompted and without specifically being asked for antibiotics. Of the antibiotics dispensed, only 21 per cent were correctly dispensed for the symptoms presented, and all dosages dispensed were incorrect (underdosed). Furthermore, 43 per cent of drug retail outlet workers interviewed believe that some antibiotics can be legally dispensed without a prescription. Equine owners in northern India are frequently being sold antibiotics without a prescription and, in most cases, with incorrect diagnoses, treatment choice, and dosage. A substantial gap in capacities exists amongst Drug Retail Outlet (DRO) workers, with few being sufficiently qualified or trained to dispense antibiotics to animal owners. The study highlights the need for further training of private DRO workers as well as knowledge extension and awareness training for both DRO workers and animal owners regarding antimicrobial resistance and its potential impact upon livelihoods. It also illustrates the need to identify a balance whereby greater enforcement of regulation at all levels is implemented, while at the same time maintaining sufficient access to medicine for rural populations. View Full-Text
Keywords: antimicrobial resistance; social drivers; LMICs; antimicrobial stewardship; India; community pharmacy; antibiotic dispensing antimicrobial resistance; social drivers; LMICs; antimicrobial stewardship; India; community pharmacy; antibiotic dispensing
MDPI and ACS Style

Nye, C.; Watson, T.; Kubasiewicz, L.; Raw, Z.; Burden, F. No Prescription, No Problem! A Mixed-Methods Study of Antimicrobial Stewardship Relating to Working Equines in Drug Retail Outlets of Northern India. Antibiotics 2020, 9, 295. https://doi.org/10.3390/antibiotics9060295

AMA Style

Nye C, Watson T, Kubasiewicz L, Raw Z, Burden F. No Prescription, No Problem! A Mixed-Methods Study of Antimicrobial Stewardship Relating to Working Equines in Drug Retail Outlets of Northern India. Antibiotics. 2020; 9(6):295. https://doi.org/10.3390/antibiotics9060295

Chicago/Turabian Style

Nye, Caroline, Tamlin Watson, Laura Kubasiewicz, Zoe Raw, and Faith Burden. 2020. "No Prescription, No Problem! A Mixed-Methods Study of Antimicrobial Stewardship Relating to Working Equines in Drug Retail Outlets of Northern India" Antibiotics 9, no. 6: 295. https://doi.org/10.3390/antibiotics9060295

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