ArticleThe Lancet. Infectious diseases2016
Use of standardised patients to assess antibiotic dispensing for tuberculosis by pharmacies in urban India: a cross-sectional study.
Article in The Lancet. Infectious diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 69 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
69 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies.PLoS medicine · 2024Pooled it
- Evaluation of andrographolide from Andrographis paniculata against drug-resistant and HFolia microbiologica · 2026Article
- "Fragmented care pathway in a layered TB care system": a grounded theory approach to understand care pathways and delays in TB care in Odisha.BMC health services research · 2026Article
- Engaging community pharmacy in tuberculosis case detection (ENHANCE): a study protocol for an implementation study in Indonesia.Archives of public health = Archives belges de sante publique · 2025Article
- Using Unannounced Standardized Patients to Assess the Quality of Tuberculosis Care and Antibiotic Prescribing: A Cross-Sectional Study on a Low/Middle-Income Country, Pakistan.Antibiotics (Basel, Switzerland) · 2025Article
- The impact of a multi-faceted intervention on non-prescription dispensing of antibiotics by urban community pharmacies in Indonesia: a mixed methods evaluation.BMJ global health · 2024Article
- Pharmacists' Role in Global TB Elimination: Practices, Pitfalls, and Potential.Healthcare (Basel, Switzerland) · 2024Review
- Exploring private sector perspectives on barriers and facilitators in availing tuberculosis care cascade services: a qualitative study from the Indian state.BMC primary care · 2024Article
- Global restriction of the over-the-counter sale of antimicrobials: does it make sense?Frontiers in public health · 2024Article
- Article
- Article
- Private pharmacies as healthcare providers in Odisha, India: analysis and implications for universal health coverage.BMJ global health · 2023Article
- Pharmacy engagement in TB prevention and care: not if, but how?BMJ global health · 2023Article
- Do private providers initiate anti-tuberculosis therapy on the basis of chest radiographs? A standardised patient study in urban India.The Lancet regional health. Southeast Asia · 2023Article
- The Real Practice Prescribing Antibiotics in Outpatients: A Failed Control Case Assessed through the Simulated Patient Method.Antibiotics (Basel, Switzerland) · 2023Article
- Dispensing of antibiotics for tuberculosis patients using standardized patient approach at community pharmacies: results from a cross-sectional study in Pakistan.Frontiers in public health · 2023Article
- Development and Validation of the Knowledge, Attitude, and Practice Questionnaire for Community Pharmacy Personnel in Tuberculosis Case Detection, Drug Monitoring, and Education: A Study from Indonesia.Infection and drug resistance · 2023Article
- Use of standardised patients to assess tuberculosis case management by private pharmacies in Patna, India: A repeat cross-sectional study.PLOS global public health · 2023Article
- Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India.BMJ global health · 2022Article
- Article
9 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
10 authors.
Funding
Abstract
backgroundIndia's total antibiotic use is the highest of any country. Patients often receive prescription-only drugs directly from pharmacies. Here we aimed to assess the medical advice and drug dispensing practices of pharmacies for standardised patients with presumed and confirmed tuberculosis in India.
methodsIn this cross-sectional study in the three Indian cities Delhi, Mumbai, and Patna, we developed two standardised patient cases: first, a patient presenting with 2-3 weeks of pulmonary tuberculosis symptoms (Case 1); and second, a patient with microbiologically confirmed pulmonary tuberculosis (Case 2). Standardised patients were scheduled to present each case once to sampled pharmacies. We defined ideal management for both cases a priori as referral to a health-care provider without dispensing antibiotics or steroids or both.
findingsBetween April 1, 2014, and Nov 29, 2015, we sampled 622 pharmacies in Delhi, Mumbai, and Patna. Standardised patients completed 1200 (96%) of 1244 interactions. We recorded ideal management (defined as referrals without the use of antibiotics or steroids) in 80 (13%) of 599 Case 1 interactions (95% CI 11-16) and 372 (62%) of 601 Case 2 interactions (95% CI 58-66). Antibiotic use was significantly lower in Case 2 interactions (98 [16%] of 601, 95% CI 13-19) than in Case 1 (221 [37%] of 599, 95% CI 33-41). First-line anti-tuberculosis drugs were not dispensed in any city. The differences in antibiotic or steroid use and number of medicines dispensed between Case 1 and Case 2 were almost entirely attributable to the difference in referral behaviour.
interpretationOnly some urban Indian pharmacies correctly managed patients with presumed tuberculosis, but most correctly managed a case of confirmed tuberculosis. No pharmacy dispensed anti-tuberculosis drugs for either case. Absence of a confirmed diagnosis is a key driver of antibiotic misuse and could inform antimicrobial stewardship interventions.
fundingGrand Challenges Canada, Bill & Melinda Gates Foundation, Knowledge for Change Program, and World Bank Development Research Group.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.