ArticleBMJ global health2021
Why do people purchase antibiotics over-the-counter? A qualitative study with patients, clinicians and dispensers in central, eastern and western Nepal.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers.
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Who cites it
45 citing papers in PubMed.
- Trial
- Antimicrobial Consumption and Resistance Dynamics Across Healthcare Level: Global Evidence and Stewardship Implications.Pathogens (Basel, Switzerland) · 2026Review
- Informal over-the-counter supply of antibiotics in Ghana: A qualitative analysis of practices in community pharmacies.Exploratory research in clinical and social pharmacy · 2026Article
- Improving AMR reporting in low- and middle-income countries: a public health priority.Annals of medicine and surgery (2012) · 2026Article
- "Treating myself first": Healthcare-seeking experiences among migrant workers in Thailand's fisheries sector.PLOS global public health · 2026Article
- Knowledge, attitudes, and practices regarding antimicrobial use and resistance among smallholder dairy farmers in Zambia: a cross-sectional study.Frontiers in veterinary science · 2026Article
- Community engagement strategies for antimicrobial resistance control and interventions.BMJ public health · 2026Review
- Co-creating community-driven solutions and policy priorities to address antimicrobial resistance through Responsive Dialogues: A qualitative evaluation from Malawi.PLOS global public health · 2026Article
- Prevalence and Associated Factors for Purchasing Antibiotics Without a Prescription Among Patients in Rural South Africa: Implications for Addressing Antimicrobial Resistance.Antibiotics (Basel, Switzerland) · 2025Article
- Stakeholder analysis for 'One Health' approach to tackle antimicrobial resistance.BMJ global health · 2025Review
- Antimicrobial use for influenza-like illnesses in Nha Trang, Vietnam: a cross-sectional study.BMJ open · 2025Observational
- Gender-specific antibiotic-resistance patterns and characterization of bacterial flora of undergraduate students' mobile phones and associated factors at a Nigerian university.BMC microbiology · 2025Article
- Increasing childhood illnesses (diarrhea and fever) and decreasing care-seeking practices in Nepal: Insights from three most recent Demographic and Health Surveys (2011, 2016 and 2022).PLOS global public health · 2025Article
- Knowledge, attitude, and practices of self-medication with antibiotics among senior undergraduate pharmacy students: A cross-sectional study in Jordan.SAGE open medicine · 2025Article
- Antimicrobial resistance at a turning point: microbial drivers, one health, and global futures.Frontiers in microbiology · 2025Review
- Over the counter use of topical corticosteroid for skin conditions among patients before attending skin specialist clinic in Nepal: A qualitative study.PLOS global public health · 2025Article
- A qualitative study on factors influencing health workers' uptake of a pilot surgical antibiotic prophylaxis stewardship programme in selected Georgian hospitals.PLOS global public health · 2025Article
- Dilemmas of care: Healthcare seeking behaviours and antibiotic use among women in rural communities in Nam Dinh Province, Vietnam.Social science & medicine (1982) · 2024Article
- Influences on use of antibiotics without prescription by the public in low- and middle-income countries: a systematic review and synthesis of qualitative evidence.JAC-antimicrobial resistance · 2024Review
- An Overview of the Recent Advances in Antimicrobial Resistance.Microorganisms · 2024Review
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Authors and funding
15 authors.
Funding
Abstract
introductionOver-the-counter (OTC) use of antibiotics contributes to the burgeoning rise in antimicrobial resistance (AMR). Drawing on qualitative research methods, this article explores the characteristics of OTC sales of antibiotic in Nepal, its drivers and implications for policy.
methodsData were collected in and around three tertiary hospitals in eastern, western and central Nepal. Using pre-defined guides, a mix of semi-structured interviews and focus group discussions were conducted with dispensers at drug stores, patients attending a hospital and clinicians. Interviews were audio-recorded, translated and transcribed into English and coded using a combination of an inductive and deductive approach.
resultsDrug shops were the primary location where patients engaged with health services. Interactions were brief and transactional: symptoms were described or explicit requests for specific medicine made, and money was exchanged. There were economic incentives for clients and drug stores: patients were able to save money by bypassing the formal healthcare services. Clinicians described antibiotics as easily available OTC at drug shops. Dispensing included the empirical use of broad-spectrum antibiotics, often combining multiple antibiotics, without laboratory diagnostic and drug susceptibility testing. Inappropriately short regimens (2-3 days) were also offered without follow-up. Respondents viewed OTC antibiotic as a convenient alternative to formal healthcare, the access to which was influenced by distance, time and money. Respondents also described the complexities of navigating various departments in hospitals and little confidence in the quality of formal healthcare. Clinicians and a few dispensers expressed concerns about AMR and referred to evadable policies around antibiotics use and poor enforcement of regulation.
conclusionsThe findings point to the need for clear policy guidance and rigorous implementation of prescription-only antibiotics.
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