Antibiotic use in a periurban community in Mexico: A household and drugstore survey

In developing countries, antibiotics are the most common drugs sold, and some data suggest that they are frequently misused. In order to describe the pattern of antibiotic use in a periurban community in Mexico City, 1659 randomly-selected households were visited and an interview with the housewife was carried out. Six local drugstores also were selected at random. A social worker made six visits to each pharmacy, observed the events during the purchase of the drug and applied a structured questionnaire to the customer immediately after the transaction. Of 8279 individuals, 425 (5%) said that they had used at least one antimicrobial in the preceding 2 weeks and antibiotics were the majority (29%) of the drug sales. The main perceived reasons for drug use were acute respiratory tract ailments and gastroenteritis. Interviewees reported that antibiotic therapy was given in 27% of respiratory diseases and in 37% of all diarrheal episodes. The drugs most commonly reported were: penicillins, erythromycin, metronidazole, neomycin, cotrimoxazole and tetracyclines. While self-medication and drug purchases without medical prescription were common, the majority of antibiotics were prescribed by a physician. Approximately two thirds of individuals using an antibiotic said they had used it for less than 5 days and 72% of the purchases were for insufficient quantities of drugs. Our data suggest that antibiotics are frequently misused and they support the need to assess the determinants of self-medication, health-seeking behavior and physician prescribing practices. The need for effective educational programs to improve prescribers' decisions is stressed.