Self-medication can be very dangerous to anyone who does not understand a drug’s side-effects and the consequence of its overuse. In most countries, a regulatory agency selects OTC drugs to ensure that they are safe and effective when used without a physician’s input. For example, paracetamol can be bought over-the-counter worldwide. However, since an overdose of paracetamol can be lethal, some countries limit the number of tablets sold.

In many parts of the world, antibiotics are sold over the counter, with few or no restrictions on quantities sold. OTC antibiotics are often misused, for example being taken for a non-bacterial disease – and therefore ineffective.[1]  Also, the drugs are dispensed without knowledge of a patient’s allergies. An OTC drug provider may give a short course or lower doses of antibiotics than recommended. Thus, OTC further worsens the problem of drug-resistant infections.

This easy access to the OTC antibiotics combined with misconceptions about when it’s appropriate to use them has created a vicious cycle of overconsumption that has driven growing drug-resistant infections. Studies have shown that drug-resistant bacterial infections are common in communities with frequent use of OTC antibiotics.[1]

OTC antibiotics are still widely available in most developing countries because it is felt that making them readily available to the sick is more important than the consequences of over-use. In addition, public opinion, attitudes, and misconceptions about antibiotics hinder changing the current over-the-counter system.

For example, Malaysia, an upper-middle-income country, prohibits OTC sales of antibiotics.[2] Under the Malaysian Poisons Act, the purchase of antibiotics requires a prescription from physicians. Even though OTC antibiotic sales are controlled, antibiotic prescribing rates are still high in public and private primary care settings.[2] This finding suggests that the next step to reduce antibiotic misuse must include regulating antibiotic prescriptions by physicians, and the sale of OTC antibiotics.

References

1 Morgan, D. J., Okeke, I. N., Laxminarayan, R., Perencevich, E. N., & Weisenberg, S. (2011). Non-prescription antimicrobial use worldwide: A systematic review. The Lancet Infectious Diseases,11(9), 692-701. doi:10.1016/s1473-3099(11)70054-8

2 Rahman, N. A., Teng, C. L., & Sivasampu, S. (2016). Antibiotic prescribing in public and private practice: A cross-sectional study in primary care clinics in Malaysia. BMC Infectious Diseases,16(1). doi:10.1186/s12879-016-1530-2