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Over-the-counter drug - WikipediaAccess World Health Organization Bulletin Menu Sales of antibiotics in community and online pharmacies, ChinaYanhong Gong a, Nan Jiang a, Zhenyuan Chen a, Jing Wang a, Jia Zhang a, Jie Feng a, Zuxun Lu a " Xiaoxv Yin a a. Department of Social Medicine and Health Management, Faculty of Public Health, Tongji School of Medicine, Huazhong University of Science and Technology, Wuhan 430030, China. Correspondence to Xiaoxv Yin (email: ). (Presented: 05 August 2019 – Revised version received: 20 February 2020 – Accepted: 19 March 2020 – Published online: 21 April 2020.) World Health Organization Newsletter 2020;98:449-457. doi: Introduction The abuse and excessive use of antibiotics and resistance to antibiotics that these practices have caused are serious global public health problems. Pharmacies are one of the main sources of antibiotics worldwide; an average of 93% of the people reported to have obtained their most recent antibiotics from pharmacies. Although antibiotics are prescription drugs only in many countries, they are frequently supplied without a prescription worldwide. The global prevalence of dispensing prescription antibiotics in community pharmacies is 62.2%. This dispensation of antibiotics is particularly common in Saudi Arabia (97.9 per cent; 47/48 transactions), India (94.3 per cent; 248/263 transactions), Indonesia (90.9 per cent; 80/88 transactions) and the Syrian Arab Republic (87.0 per cent; 174/200 transactions). - With the development of the Internet, online sales of antibiotics have increased public access to these drugs, which is an additional challenge for the antibiotic administration., Research has shown that antibiotics were freely available for online purchase without a prescription for a buyer from Canada, the United Kingdom of Great Britain and Northern Ireland and the United States of America, which promotes self-medication and poor quality of care. Other research in the United Kingdom reported that 45.0% (9/20) of online pharmacies provided unprescription antibiotics. China has a serious problem of misuse and overuse of antibiotics, and retail pharmacies are the most common source of prescription antibiotics. Previous research has shown that about 70-84% of community pharmacies in China provide unprescription antibiotics for adults with acute high respiratory infections. The Chinese government has issued policies and regulations to improve the rational use of antibiotics in retail pharmacies, and a 2004 law stipulates that pharmacies are only allowed to dispense antibiotics with a prescription. In addition, retail pharmacies should have a separate counter to show antibiotics and a sign indicating "medicine only by prescription" published on the counter indicating that antibiotics are sold only with a prescription. In addition, pharmacies have to post a notice that asks customers to report any illegal medical prescription drug dispensation in a pharmacy or on a website calling a dedicated phone number and a reward will be given once verified. In addition, the 12th five-year plan on drug security in 2012 explicitly stated that by 2015, all community and hospital pharmacies should have pharmacists on duty for working hours to monitor the dispensation of drugs and ensure their rational use. However, at the end of 2017, there were 453 738 community pharmacies but only 408 431 authorized pharmacists in China. As a result of the shortage of authorized pharmacists and the lack of specific antibiotic training for pharmacists, improving the rational use of antibiotics in retail pharmacies is not easy. In 2018, the drug sales of community pharmacies amounted to 391,900 million Chinese yuan (YA; equivalent to 59.2 billion dollars; US$), which accounted for about one fifth of the total drug sales (US 1.71 billion; US$ 258.3 billion) in China. At the same time, with the development of e-commerce, Internet drug sales have increased considerably. Total drug sales on the Internet in China increased by 29%; from ¥ 7.7 billion (US$ 1.1 billion) in 2017 to ¥ 9.9 billion (US$ 1.500 million) in 2018. A 2017 study on online drug purchase in China reported that 46.9% (183/390) of the participants had purchased medicines on the Internet. In view of the considerable damage caused by the excessive use and misuse of antibiotics, it is important that the large amounts of medicines sold in retail pharmacies and the rapid increase of online pharmacies, transparency on the dispensation of antibiotics in online and community pharmacies. Therefore, with the overall objective of improving the understanding of the current state of antibiotic sales in China, this study was aimed at: (i) comparing the dispensation of antibiotics in online and community pharmacies; (ii) exploring factors associated with the dispensation of non-prescription antibiotics; and (iii) comparing the quality of the services of online and community pharmacies in terms of the information requested and given to antibiotics. Methods We perform a cross-sectional analysis of a nationally representative sample of online and community pharmacies in China from July 2017 to December 2018. Online pharmacies The online pharmacy business in China works in two ways. One form consists of pharmaceutical companies that provide drug transaction services to customers directly through commercial websites. All these websites are displayed on the official website of the National Medical Products Administration (before the Chinese Food and Drug Administration). The other way is to establish online pharmacies on third-party trading platforms, with Taobao, Jingdong, Wechat, Amazon and Yihaodian being the five most popular platforms in China. On November 1, 2018, we extracted all domain names 693 shown by the National Medical Products Administration to buy antibiotics through the websites. Of these domains, 364 could not access because their domain names had expired, 109 only had medical devices or dietary supplements for sale, and the remaining 220 domains had drugs for sale. Of these 220 with drugs for sale, only 37 sold antibiotics. For online pharmacies on third-party trading platforms (Amazon, Jingdong, Taobao, WeChat and Yihaodian), we search for amoxicillin or cephalosporine on platforms directly to identify online pharmacies with antibiotics for sale. These two antibiotics are commonly distributed by retail pharmacies and are the best known antibiotics among the Chinese., Antibiotics were for sale in 88 (of 472) online pharmacies in WeChat, 72 (of 72) in Taobao, 23 (of 114) in Jingdong and none in Amazon or Yihaodian. We checked 220 online pharmacies that had antibiotics for sale in November and December 2018. Community pharmacies Community pharmacies were selected for multi-stage sampling across the Chinese peninsula and researched from July 2017 to September 2018. We calculate the minimum number of pharmacies required within a province surveyed to estimate the proportions of non-prescription antibiotic dispensation in community pharmacies. We use the formula: n = z2p(1-p)/d2, where n is the sample size, p is the proportion of pharmacies that dispense antibiotics without prescription, z is the normal deviation (1.96) and d is the margin of error (0.15p). The previous research on the dispensing of prescription antibiotics in community pharmacies in China had reported a prevalence of 67-84%. Therefore, we assumed that 70% of pharmacies dispensed unprescription antibiotics (P = 0.7) and set the confidence interval (CI) at 95%. The minimum size of the calculated sample was 73 pharmacies for each province, which increased to 75. The specific sampling process was the following. First, on the basis of the geographical area (according to China ' s statistical health and family planning yearbook), we divided China into three regions: eastern (11 provinces), central (8 provinces) and western (12 provinces). We select three provinces from each random region by drawing lots. Second, within each province, we include the provincial capital (the main city), and then randomly selected, drawing lots, a prefecture-level city (smaller, less developed city than the provincial capital) and a county (rural area). Third, starting in a general hospital in the central area of each city, simulated clients visited a sample of convenience of 25 community pharmacies, a total of 75 pharmacies in each province. In total, simulated clients investigated 675 community pharmacies. The sampling process of community pharmacies is shown in Fig. 1. simulated client We hired two graduate students in public health as simulated clients. These students navigated online pharmacies and requested customer service staff for two oral amoxicillin boxes or cephalosporine. If none of the medications were on sale, they would ask for other types of antibiotics, such as azithromycin. If the online pharmacy declares that antibiotics are not sold or that they do not dispens prescription antibiotics, the investigation was concluded. When the customer service staff asked for a prescription before the sale of antibiotics, the simulated client raised a expired recipe that had been written 6 months earlier by a licensed doctor. If the pharmacy provided antibiotics with this recipe, the investigation was completed. If the pharmacy refused to dispens the antibiotic with this recipe, the simulated client asked online pharmacists to prescribe a valid prescription for the purchase of antibiotics. The purchase process is shown in Fig. 2. If you are wondering about your reasons for buying antibiotics, the simulated client would answer, "I want to take some antibiotic boxes for a trip," which meant there was no medical need to take antibiotics. Therefore, we define the customer service staff agreement to sell antibiotics as illegal. We hired three degree medical students to visit community pharmacies as simulated clients. The simulated client showed no symptoms that required antibiotic use. If he was asked for his reasons for buying antibiotics, the simulated client gave the same reason that he gave to online pharmacies. The process of purchasing in community pharmacies (Fig. 2) was similar to that of online pharmacies, except that antibiotics were not attempted using a expired prescription because we did not have enough expired prescriptions. After each investigation, the simulated client completed a standard questionnaire on whether or not the pharmacy had done the following: he reminded the customer about the illegal sale of prescription medications only; he asked the customer about their symptoms, allergies to medicines and history of taking the antibiotic dispensed; and he dispensed the antibiotic. If the pharmacy dispenses the antibiotic, the simulated client also documents the prescription requirements, if the pharmacist provides a prescription to dispens the antibiotic, and if information is provided on the dose of the antibiotic, duration of the course and possible adverse reactions to the medications. If the pharmacy did not have the antibiotic, the simulated client recorded the reasons for not dispensing them. Statistical analysis We use version 9.4 for Windows (SAS Institute Inc., Cary, NC, USA) for data analysis. We report descriptive statistical analysis as percentages. We use Fisher's exact tests to compare the prevalence of unprescription antibiotic sales between online and community pharmacies, and between location and features of community pharmacies. We did invalid and multivariate logistic regression analysis to evaluate the factors associated with community pharmacies dispensing valid prescription antibiotics. We believe that differences are statistically significant if P was less than 0.05. Declaration of ethics The Committee on Ethics and Human Mathematics of Tongji Medical University, Wuhan, China approved research (no. 2014IEC(S078)). Given the minimum risk of the study to pharmacies and for realistic results, we do not disclose information about the research to pharmacies. Since our goal was to determine whether prescription antibiotics were being dispensed, rather than informing pharmacies of any illegal behavior, all data were kept anonymous and confidential. Results We found 878 online pharmacies that had drugs for sale, but only 220 (25.1%) sold antibiotics. We studied the 220 online pharmacies and 675 community pharmacies from nine provinces in China. Of the 220 online pharmacies, 111 (50.4%) had a notice for customers on their website that it was illegal to sell prescription antibiotics (Table 1), but none of the community pharmacists had such notice. Of the 675 community pharmacies, 651 (96.4%) had a separate counter to dispense antibiotics (Table 1). In the online pharmacy survey, we find three types of illegal antibiotic sales: (i) unprescription antibiotic sales; (ii) sale of antibiotics with a expired prescription; and (iii) sale of antibiotics using a prescription provided by the pharmacy itself. Of the 220 online pharmacies that had antibiotics for sale, 174 (79.1%) agreed to dispens valid prescription antibiotics. Of the pharmacies that gave antibiotics, 118 (67.8%) sold these prescription drugs without a prescription, 44 (25.3%) sold them after a expired prescription was lifted and 12 (6.9%) dispensed them after the online pharmacy itself provided a prescription (Table 1). Online pharmacies without notice on the illegal sale of prescription drugs were more likely to sell antibiotics illegally than pharmacies with this notice (P There were two types of illegal sale of antibiotics by community pharmacies: dispensing prescription antibiotics and dispensing antibiotics using a prescription from the pharmacy. Most of the community pharmacies (86.8%; 586/675) provided antibiotics without a valid prescription: 568 (96.9%) dispensed the prescription antibiotics and 18 (3.1%) gave them a prescription provided by the pharmacy itself (Table 1). The prevalence of unprescription antibiotic sales in provincial capital pharmacies (71.6%; 161/225) was significantly lower than that of prefectural-level cities (95.1%; 214/225) and counties (93.8%; 211/225; Table 1). Community pharmacy personnel in prefectural-level cities (proportion of adjusted probability, OR: 8.05; 95% CI: 4.08–15.89) or counties (ordinated: 6.09; 95% CI: 3.27–11.36) were considerably more likely to dispense antibiotics with no valid prescription than those of provincial capitals. In addition, pharmacy staff in the western region were more likely to dispense antibiotics without a valid prescription than staff in the eastern region (ordered: 2.35; 95% CI: 1.27-4.34; table 2). Of the 89 community pharmacies that refused to dispense antibiotics, 84 did so because of the absence of a prescription. The other five considered it unnecessary for the client to have an antibiotic reservation for a trip. In general, 23 (10.4%) of the 220 online pharmacy employees and 104 (15.4%) of the 675 community pharmacy staff asked about allergies after simulated customers asked to buy antibiotics. Of the 174 online pharmacies that agreed to dispense antibiotics, only one pharmacy explained the dose, and two explained the possible adverse reactions. No online pharmacy explained the duration of the antibiotic course. For community pharmacies, 20.1 per cent (118/586) and 5.3 per cent (31/586) of pharmacy staff explained the dose and duration of the course, respectively. No staff explained about adverse reactions (Table 3). Discussion This study compares the differences in antibiotic dispensation practices between online and community pharmacies using simulated clients. Simulated customers had no symptoms that required antibiotics and therefore selling antibiotics to these customers was illegal. The sale of antibiotics with a valid prescription was common both in online pharmacies and in communities, particularly in community pharmacies in small cities and counties. Similar studies have shown that the dispensing of prescription antibiotics is predominant in community pharmacies in China. The prevalence of dispensing prescription antibiotics in our study is similar to that reported in another Chinese study (83.6%; 925/1106), but higher than that reported in 2017 studies (77.7%; 199/256) and 2019 (70.1%; 1690/2411). However, all these results indicate that Chinese can get antibiotics easily without a valid prescription and this problem requires urgent attention. We found three types of illegal antibiotics dispensing at online pharmacies. While most of the pharmacies that sold the antibiotics did not require a prescription at all, 12 provided prescriptions and sold antibiotics after obtaining the names of the clients and the identity card numbers and 44 pharmacies accepted a expired prescription. Although the prevalence of these recipes is low, forged and invalid, it increases the difficulty of applying antibiotic rules. Therefore, the government should pay attention not only to whether antibiotics are sold with prescriptions, but also to the validity of these recipes through specific management strategies. We show that compliance with the requirement to show a notice about the illegality of selling prescription drugs only without a prescription was associated with less prescription antibiotic sales in online pharmacies. However, despite the positive influence of this notice, online pharmacies still use invalid recipes to avoid the requirement of prescription. In the future, notification should be strengthened to emphasize that recipes should be valid and legitimate. Although most of the community pharmacies had a separate antibiotic counter, they still sold unprescription antibiotics. In addition, none of the community pharmacies in the study showed a public notice. These findings suggest that labeling medicines as a unique recipe without empowering the public to actively monitor the practice of the pharmacy does not reduce the sale of prescription antibiotics in community pharmacies. In addition to providing unprescription antibiotics, the quality of pharmacy services was poor, especially in online pharmacies. Most pharmacy staff did not ask for important customer information before dispensing the medication or providing the customer with necessary information about the antibiotic. The lack of a skilled pharmaceutical workforce for the staff of all retail pharmacies is an important reason for this problem. Pharmaceutical staff play an important role in public advice on medicines, promoting the prudent use of antibiotics and reducing antimicrobial resistance. However, the poor practice of pharmacy is a common problem in developing countries. In 2012, the International Pharmaceutical Federation and the World Health Organization published good guidelines for the practice of pharmacy, which describe ways to improve access for pharmaceuticals to health care, health promotion and the use of medicines for service providers. Since pharmacists are often the first contact people have with the health care system, some countries now provide national guidelines for pharmacists to deal with the sale of prescription drugs and increase pharmacy skills. National standards for the good practice of the drugstore in China have not yet been developed. However, our findings of the dispensation of antibiotics without a valid prescription and bad pharmacy practices suggest that such standards are necessary, especially in the retail pharmacy. Pharmacy staff needs training on the information they should ask and give to the customer, and the importance of showing notices in their pharmacies. Although China has issued a number of policies and regulations to improve the rational use of antibiotics over the past decade, these regulations often go to hospitals and overlook retail pharmacies. Easy access to antibiotics in retail pharmacies can encourage people to go to retail pharmacies instead of health care institutions for antibiotics and suggest the application of the prescription drug rule. This situation could pose a threat to the administration of antibiotics in the health care institutions introduced by the Chinese government in 2011. The Chinese Government should recognize that the promotion of the rational use of antibiotics is complex and needs a systematic approach, and that the reduction in the use of antibiotics only in health care institutions is insufficient. Strengthening the implementation of regulations, establishing a public oversight system and pharmacy staff to improve the quality of their pharmaceutical services should be a priority for the antibiotic administration of the Chinese government. Although only 220 online pharmacies sell antibiotics, they provide services for people across the country. Therefore, the monitoring and supervision of online pharmacies needs a lot of attention. Due to restrictions on internet domain names, we do not collect data to determine whether online pharmacies sell antibiotics outside of China. A previous study showed that British citizens could get valid prescription antibiotics from online pharmacies outside the UK. In the context of globalization, China should also introduce regulations to control the sale of unprescription antibiotics valid for people living outside China through online Chinese pharmacies. Our study has some limitations. First, we evaluate the requests for a product (antibiotics), which represents only a small number of pharmacy sales and may underestimate the prevalence of dispensing prescription antibiotics in online and community pharmacies. Second, our sample was recruited from nine provinces, but we do not apply proportional probability to sampling size. This sampling led to an overrepresentation of prefectural city and county pharmacies in the general sample, which may overestimate the prevalence of unprescription antibiotics in community pharmacies. Third, we have selected community pharmacies based on sampling of convenience, which could have led to the selection of biases and an underestimation of the prevalence of antibiotics not prescribed in community pharmacies. This study was funded by the National Natural Sciences Foundation of China: No. 71403091 and No. 71874060. None declared. References You are here:

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But sometimes TBT medicines can cause unpleasant effects Oct 09, 2019 · In most cases, the pharmacist will recommend certain over-the-counter (common) medicines and this is what other pharmacists can prescribe. Step 1 Tell your doctor about the vitamins you are taking What are some of the counter-restricted/vitamin medications that have helped you? The use of excessive cough and cold medicines in young children can result in serious and potentially fatal side effects. Since the discovery of antibiotics in the 1920s and the development that some are about the antibiotics of new products throughout the 1980s, it has become much more difficult for scientists to find new and effective antimicrobial products In the United States, oral antibiotics cannot be sold at the counter. Oregano, thyme and basil oils have also shown strong antimicrobial properties. 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It is paid to keep in mind that a urinary tract urinary tract infection is an infection caused by bacteria, and that means that the best UTI medication should be an antibiotic; however, because the antibiotics for UTI cannot be purchased at the counter, is the second best option to buy a product that promotes the health of the urinary tract to combat infection In some cases, the tooth cannot be stored and the dentist will remove the infected tooth and drain the abscess to remove the infection. The three topical antibis of free sale are underway to minimize the rate at which bacterial resistance can be developed. Some avoid what's on antibiotics or cure diseases, such as dental decay and athlete's foot. Both medicines may have severe side effects if taken at high doses or for a long time open 16, 2019 · Unfortunately, there is only oral antibiotics. what are some about the counter antibiotics It must be to post a comment. Google We prefer a man... Google Here's a good Bl... 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You can buy antibiotics for super cheap and over the counter by just buying fish Amoxicillin. It's literally just 500mg capsules of Amoxicillin. : mildlyinteresting