Self-Medication and indiscriminate use of antibiotics without Prescription in Chennai, India: A Major Public Health Problem

ISSN No:2321 – 8630, V – 1, I – 1, 2014 Journal Club for Pharmaceutical Sciences (JCPS)

Manuscript No: JCPS/RES/2014/25, Received On: 18/09/2014 , Accepted On : 29/09/2014, Published On: 12/10/2014

RESEARCH ARTICLE

© All Rights Reserved by “Journals Club & Co.” 130

Self-Medication and Indiscriminate Use of Antibiotics Without Prescription in Chennai, India: A Major Public Health Problem

1*Nandakumar Ganesan, 2Siva Subramanian, 3Jaikumar, 4Harish Rawat, 5Senthil Kumar

1Department of Public Health, Supreme Council of Health Doha, Qatar. 2Pulla TKR College of Pharmacy, Hyderabad, AP

3Sree Lakshmi Narayana Institute of Medical Sciences, Pondicherry, Tamilnadu 4Tata consultancy services, Noida, New Delhi

5Dept of Pharmacology, R.V.S College of Pharmaceutical Sciences, Coimbatore, Tamilnadu

ABSTRACT To explore the use of self-medication with antibiotics among the general population in Chennai in the state of Tamilnadu. A total of 1021 adults aged 18 and above were approached and 781 subjects (76.4%) were participated in this study from the period of Jan - March 2014 in Chennai. Face to face interviews were conducted using a structured questionnaire to collect data on the socio-demographic details, use of antibiotics, and self-medication with antibiotics with or without prescription, source of antibiotics obtained and most common symptoms/Disease for which antibiotics were frequently used. The prevalence of self-medication with antibiotics in Chennai was 39.1%. Among the eligible representative sample 781, Males 424(54.3%) and females 357(45.7%) were reported the frequent use of self-medication with antibiotics. The use of self-medication with antibiotics was found to be statistically significantly associated with age, income. The major source of obtaining antibiotics without medical prescription was the Pharmacy (P<0.001). Self-medication with antibiotics is common and more prevalent among general population and it is recommended that further research study is needed in this area to know more about it and to understand it better. Doctor’s contribution and altitude is must for minimize or reduce the misuse of antibiotics in the city of Chennai.

KEYWORDS

Prevalence, Antibiotics, Self-medication, Chennai, Cefuroxime

INTRODUCTION

Alexander Fleming started the history of

antibiotics in the 1920s by discovery of

penicillin’s, When penicillin’s was first

introduced and used widely, and it was

spoken as wonder drug, then penicillin was

used for much more infections caused by

various organisms.1 In 1929, Alexander

Fleming said that, the time may come

when penicillin can be bought by anyone

from the medical shops, and when a man

Address for Correspondence: Nandakumar Ganesan, Department of Public Health, Supreme Council of Health Doha, Qatar Email: [email protected], [email protected]

http://www.slims.ac.in/

mailto:[email protected]

mailto:[email protected]



who may gets under dose himself by

exposing his microbes to non lethal action

of drugs which makes them more

resistance.1 According to Alexander

Fleming suggestions, Antibiotics need to

be prescribed in a judicious manner and

more than 100 millions outpatient

prescriptions are unnecessary.2 In early

stages, 70 & 80s study revealed that more

than 60% of the doctors/physician used

antibiotics to treat even common cold on

their patients. 3

Antibiotics can be defined as a

substance derived from living organisms,

usually bacteria or molds, and it is able to

kill microorganisms or inhibit their

growth. In fact, the word antibiotic means

life destroying. Whereas antibiotics were

originally grown from natural components

for the use of treatment of parasitic

diseases, today they are often synthetically

produced to help combat bacterial

infections.4 Self-medication can be

defined as the use of drugs to treat self

diagnosed symptoms or the intermittent or

continued use of prescribed medication for

chronic or recurrent disease or symptoms. 5

Data is not available from Chennai

regarding the level of self medication and

using antibiotics without prescription.

Although, pharmacies in Chennai are not

allowed to sell antibiotics without a valid

prescription by a licensed practitioner.

Thus, this study will provide an important

data regarding the self medication and use

of antibiotics without prescription among

population. The result can be useful for

developing policies and regulations

regarding the indiscriminate use of

antibiotics and other medications in

Chennai.

The prevalence of self-medication with

antibiotics was high in Chennai because,

this is the fact that not only Chennai, all

over India most of the drugs easily

available or obtained from the community

pharmacies and retail drug store without

valid medical prescription. As a result of

this, minor ailments are often treated with

most powerful antibiotics. Despite the

introduction of essential drug list by world

health organization (WHO) with concept

of limited number of drugs supply for

betterment of prescriptions and to reduces

the cost of healthcare.5

METHODS

This is prospective cross-sectional survey

based study on general population which

included subjects aged between 18 -55

years old. Participants who refused to

provide consent will be excluded from the

study and subjects were selected randomly

by using simple random sampling

technique. Data collection took place from

the period of three month between Jan -

March 2014. The questionnaires with a



letter of explanation, structured, validated

questionnaire were distributed to the

subjects studying in college and university

and general population. College and

university students and general population

completed the questionnaires and returned

them to the interviewer. A total of 1021

populations were approached and 781

subjects participated in the study giving a

response rate of 76.4%.The questionnaire

had three parts. The first part included the

socio-demographic details of the studied

subjects; the second part included the type

of antibiotics used; Source of Obtaining

Antibiotics and Common

Symptoms/Disease for which antibiotics

were self used. There is no ethical

clearance for the study was obtained

because of this survey based study.

Informed consent was obtained from

individual subject before each interview

starts. The statistical analysis was

performed by using the Statistical Package

for Social Sciences (IBM SPSS version

19.0, SPSS Inc, Chicago, Illinois).The data

were collected and computed into SPSS

statistical software. Frequency with

percentage will be calculated for all

categorical variables and mean with

standard deviation for continuous scale

data. The Chi-square and Fisher’s exact

tests (two-tailed) were performed to test

for differences in proportions of

categorical variables between two or more

groups. Student-t test was used to ascertain

the significance of differences between

mean values of two continuous variables.

The level P<0.05 was considered as cut-off

value for significance.

RESULTS

Table 1 shows the socio-demographic

characteristics of the studied subjects with

and without self-medication. Overall mean

age was 32.8± 9.5 years old with 27.1±9.3

years old among self-medication group

and 36.4±7.7 years old among non Self

medication group, Among the studied

subjects 424(54.3%) were males while

357(45.7%) were females. Males were

more 271(88.0%) vs. 37(12.0%) in self-

medication group while females were

more 320(67.7%) Vs 153(32.3%) in non

self- medication group (P<0.001). Most of

the respondents were in the age group 26-

34 years (30.6%). The majority of them

were College/University education

(28.6%), with middle level of income

(42.9%) and the difference in educational

level, and occupation status was not

statistically significant between self-

medication and non self medication group

(P=0.583; P=0.139 respectively).

Table 2 shows the Prevalence of Self-

Medication with antibiotics according to

gender of the studied subjects. Prevalence

of Ciprofloxacin, Azithromycin and

efaclor self-medication was higher among



studied male subjects as compared to

females (5.7%Vs1.7); 23.1%Vs16.5%) and

21.7%Vs15.1%) respectively) with Values

0.004, 0.022, and 0.019 respectively. In

addition, prevalence of erythromycin,

Norfloxacin and Cefuroxime was higher

among females as compare to males

(P<0.001; 0.045 and 0.002).

Table 3 and figure 1 shows the source of

obtaining antibiotics and common

symptoms/Disease for which antibiotics

were self-used. Difference between males

and females in terms of obtaining

antibiotics and common medical

symptoms/Disease were higher significant

with P<0.001 for each. Higher proportions

among males are obtaining antibiotics

from Doctor/ dentist while more

proportions among females are obtaining

antibiotics from community pharmacies

and friends. The commonest symptoms

among males for self-medication are cold

while on other hand toothache is the most

common symptoms among females.

DISCUSSION

Use of self-medication with antibiotics

without valid medical prescription is a

serious health problem which may leads to

increases bacterial resistance and several

side effects. Antibiotics are the most

powerful agents used for various bacterial

infections and acts as bacteriostatic and

bactericidal action. Inappropriate use of

antibiotics may drug cause resistance,

adverse effects and may lift up the cost of

the treatment.6

In present study 39.1% of the subjects

practiced self-medication with antibiotics

without medical prescription within the

period of three month before the study

starts. The excessive use of inappropriate

and insufficient doses of antibiotics in

developing countries is a major public

concern because it can lead to numerous

complications to the society. 7 In Malta, the

public perception towards antibiotics use

in the general population around 19.2 % of

the cases took without medical

prescription. 8 A similar study revealed in

Philippines, 66.2% of the cases were

purchased antibiotics without

prescriptions, mainly penicillin V was used

among Filipino population.9 In another

study reported from Vietnam ,cough

(34.1%),sore throat (32.0%)and diaherroea

(8.8%) were treated by antibiotics without

prescriptions ,even though patient does not

know what does it mean.10 In similar to

results of the study in Turkey11 with 45.8%

of self medication with antibiotics and also

in Jordan12 (40.7%) and other studies in

Sudan13 (48%), Lithuania14 (39.9) and

USA15 (43%), Mexico16 (5%), Finland17

(28.1%) and finally Palestine18 (19.9%).



Table 1. Socio-demographics characteristics of the studied population according to the Self-Medication and Non-Self Medication (N=781)

Variable Total N=781 n(%

Self-Medication N=308 n(%)

Non-Self Medication N=473 n(%)

P-Value

Age (Mean±SD) 32.8±9.5 27.1±9.3 36.4±7.7 <0.001 Age Group 18-25 Years 242(31.0) 105(34.1) 137(29.0) 26-34 Years 206(26.4) 84(27.3) 122(25.8) 35-44 Years 204(26.1) 83(26.9) 121(25.6) 0.048 45-54 Years 68(8.7) 21(6.8) 47(9.9) >55 Years 61(7.8) 15(4.9) 46(9.7) Sex Male 424(54.3) 271(88.0) 153(32.3) Female 357(45.7) 37(12.0) 320(67.7) <0.001 Education Level Illiterate 62(7.9) 22(7.1) 40(8.5) Primary 220(28.2) 89(28.9) 131(27.7) Secondary 81(10.4) 38(12.3) 43(9.1) 0.583 Diploma 191(24.5) 71(23.1) 120(25.4) College/university 88(28.6) 229(29.0) Occupation Not working 263(33.7) 103(33.4) 160(33.8) College student 138(17.7) 42(13.6) 96(20.3) Private officer 221(28.3) 92(29.9) 129(27.3) 0.139 Govt officer 101(12.9) 45(14.6) 56(11.80) Business 58(7.4) 26(8.4) 32(6.8) Income/month*INR <5000 131(16.8) 50(16.2) 81(17.1) 5000-14,999 294(37.6) 132(42.9) 162(34.2) <0.001 15000-19,999 208(26.6) 90(29.2) 118(24.9) >20000 148(19.0) 36(11.7) 112(23.2)

*INR=Indian Rupees

Table 2. Prevalence of Self-Medication with antibiotics according to gender wise (N=781)

Antibiotics* Male N=424 n(%) Female N=357 n(%) P-Value Amoxicillin 295(69.6%) 209(58.5) 0.001

Augmentin 92(21.7) 54(15.1) 0.019 Ciprofloxacin 24(5.7) 6(1.7) 0.004

Doxycyline 34(8.0) 15(4.2) 0.028 Erythromycin 190(44.8) 247(69.2) <0.001 Azithromycin 98(23.1) 59(16.5) 0.022 Norfloxacin 109(25.7) 115(32.2) 0.045 Cefuroxime 89(21.0) 109(30.5) 0.002

Cefixime 137(32.3) 101(28.3) 0.224



* Multivariable don’t add to100%

Table 3. Source of Obtaining Antibiotics and Common Symptoms for which antibiotics were self –Medicated (N=781)

Variable Male N=424 n(%)

Female N=357 n(%)

P-Value

Source of Antibiotics Prescription Prescription from Doctor/Physician

107(25.2) 75(21.0)

Prescription from Dentist 86(20.3) 38(10.6) From Community Pharmacy 190(44.8) 181(50.7) <0.001 Friends 41(9.7) 63(17.6) Common Symptoms Coughs and sore throat 51(12.0) 29(8.1) Cold and fever 202(47.6) 131(36.7) Ear Infections 52(12.3) 48(13.4) <0.001 Flu conditions 68(16.0) 71(19.9) Toothache 51(12.0) 78(21.8)

Figure 1. The most common medical symptoms or conditions for which antibiotics were self-medicated (N=781)

Excessive use of antibiotics may increase

antimicrobial resistance and the burden of

chronic disease and several side effects

and also lift up the cost of healthcare

services. Without prescription, antibiotics

use will not be effective against infectious

disease. Most of the surgical methods and

chemo therapies are not possible without

antibiotics to fight against infection. These

are consequences please bear in mind

when use of antibiotics without valid

medical prescription. However, no studies

47.6

1612.3 12.1 12

36.7

19.9

13.4

8.2

21.8

05

101520253035404550

Cold andfever

Fluconditions

EarInfections

Coughsand sore

throat

Toothache

Common Symptoms

%

MaleFemale



have been reported regarding misuse of

antibiotics along with self-medication in

the state of Tamilnadu, Chennai.

Therefore, the objective of the present

study was to determine the prevalence of

self-medication with antibiotics and its

possible impact on misuse of antibiotics

and other possible socio-demographic

factors.

Antibiotics meant for bacterial infection

and mostly antibiotics misuse is caused by

lack of education or awareness campaign

etc. Improper use of antibiotics may

increase the bacterial resistance and

antibiotics are best medication for

bacterial infection and doctors/physician,

who knew that antibiotics are not effective

against viral infections. Most of the

antibiotics do not cure the common cold

because it is caused by virus not bacteria.

Most of doctors prescribing powerful

antibiotics when patients comes with mild

or moderate or severe cold with infections

,many antibiotics are misused because of

the patients does not adhere to doctors

/physician introductions and some of

patients going to pharmacies or retail drug

store asking antibiotics for common cold

or sore throat from pharmacist as a OTC

drugs. These kind of pharmacy

practices/physician or Doctor Practice may

result in the misuse of antibiotics and it

will leads to development of bacterial

resistance.6 Improper use of antibiotics

may increase the cost of treatment which

leads to prolongation of infections and, use

of antibiotics become ineffective for future

use on the certain bacterial disease. 7

There is several documented method to

prevent the inappropriate use of powerful

antibiotics, such as health education,

Doctor-patients communication and

changing or implementing the antibiotics

policy.

Health education is important contributing

factors for misuse of antibiotics. Health

education would be good measurement for

reducing the excessive use of

antibiotics19,20 and clinic and community

based health education method could be

more efficient in delivering messages to

public about inappropriate of use of self-

medication with antibiotics.21 Doctor-

patients communication is also very good

effective method to reduce the antibiotics

misuse21 and some developing

organizational policies or implementing of

exist one, to support cautious use of

antibiotics21,22, even though; some

organization and institution believes that a

computerized antibiotics therapy program

would improve the quality of the patient

care23 Although implementing the

antibiotics policy may decrease the misuse

of antibiotics as well as increase the

patient satisfaction.



Misuse of antibiotics may be caused by

several causative factors, such as socio-

economic, cultural, cognitive and

educational.23 In USA, Most of the

pediatrician reported that, parental

pressure to prescribe non indicated use of

antibiotics.24 Another study done in

Kuwait city, half of the physicians are

forced to prescribe the antibiotics by their

parents.25 Socio-economic status must be

considered as an important factor for

influencing the rise of antibiotics misuse.

25 Use of self-medication with antibiotics

without prescription from pharmacies or

other sources are common practice

throughout world, especially in developed

and developing countries,27 Availability of

antibiotics without prescription, lack of

regulation, unrestricted access to

antibiotics from pharmacies and

pharmacist are dispensing antibiotics

without known to the cause of infection,

27,28 these factors common for self-

medication with antibiotics. Moreover,

Self- medication is a significantly growing

public health problem in developed and

developing countries.27 Improper use of

antibiotics is presently one of the major

public health issues worldwide. 29,30,31

Besides, misuse of antibiotics was found

to be significantly common in children,

mainly when present with upper

respiratory tract infection (URTIs).27

In present study shows that patients are

likely to follow this pattern from low

income population. The risks of buying

antibiotics without doctor prescription

were associated with age, income, etc. The

public perception of buying antibiotics

without prescription, it is more expensive

to see or consult the doctor or physician

and very poor satisfaction with the

medical practitioners in the Chennai city.

The most common medical symptoms

treated by antibiotics were upper

respiratory tract infections (URTI)

particularly coughs and cold, sore throat

with pharmacies about 47.5% of the cases.

This present study clearly state that need

for unlimited health education Campaigns

on proper use of antibiotics among the

general population in Chennai city.

Powerful antibiotics like cefadroxyl,

cefatoxine, cefdinor, cefetamet, and

cefuroxyne, which are used for post

operative medication to treat the infections

in the body, which are being used

indiscriminately, resulting in severe health

problem to public who use the powerful

antibiotics. Retail pharmacist or

community pharmacist are supposed to

dispense scheduled drugs only with valid

medical prescriptions which has been

prescribed by qualified doctor or

physician or consultant and pharmacist

who violate the such pharmacy law must



be punished on the spot. Self-medication

with antibiotics has the potential hazard to

individual patient’s health as well as

public at huge level. This will create an

impact on antibiotics resistance health

related problem, our present study

revealed that immediate implementation

for public health education and the

enforcement of regulations regarding the

use of antibiotics without prescription in

Chennai.

Limitations in This Study:

The main limitation of this study is, it’s

cross sectional nature which have inherent

weakness in inferring causality. Also,

cross sectional survey are unable to

provide conclusive temporal association.

Therefore, results of this study should be

generalized with caution and failure to

evaluate all the risk factors and interview

all the population involved due to time

constraints.

Although, this study only estimates the

prevalence of self-medication with

antibiotics with the patterns of utilization

of non-prescribed antibiotics. No such

studies have been documented regarding

misuse of antibiotics along with self-

medication in the Chennai. Therefore, the

objective of the present study was to

determine the prevalence of self-

medication with antibiotics and its possible

impact on misuse of antibiotics and other

possible socio-demographic factors.

However, present study was not a

population-based survey and as a result

was neither representative nor could

exclude sample bias. In addition, that study

did not discover the reasons of self

medication using antibiotics, which are

important for understanding such behavior.

The present study is the first population-

based survey in an urban area in Chennai

to estimate the prevalence, source of

obtaining antibiotics and common

symptoms for which antibiotics were self –

Medicated.

CONCLUSION

Chennai has a considerably high prevalence of

self-medication with antibiotics. A strong

educational activity for the general public must

be initiated and doctors and physicians should

teach their patients not to use powerful

antibiotics without valid medical prescriptions

for any conditions. Even though, the concern

pharmaceutical regulatory authorities in the state

pharmacy council must focus on the selling

antibiotics without prescription from pharmacy

store, as a result of public health problem owing

to the increase of misuse and bacterial

resistance. In such circumstances, penalties and

imprisonment should be imposed on the retail or

community pharmacists who violate such

pharmacy laws.



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HOW TO CITE THIS ARTICLE

Ganesan, N., Subramanian, S., Jaikumar, Rawat, H., Kumar S. (2014). Self-Medication and Indiscriminate Use of Antibiotics Without Prescription in Chennai, India: A Major Public

Health Problem. Journal Club for Pharmaceutical Sciences (JCPS), 1(I), 130-141.

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Self-Medication and indiscriminate use of antibiotics without Prescription in Chennai, India: A Major Public Health Problem