Multidrug resistance (MDR) is already occurring among some equids in India. Donkeys and mules are a mobile species moving between regions and international borders, often populating areas of India where private community pharmacies, or medical stores, are the primary healthcare provider for both humans and animals. This article highlights how the capacities of drug retail outlet workers might affect their antibiotic dispensing practices, particularly in relation to donkeys and mules, in order to consider how this might impact the development of antimicrobial resistance (AMR) on a wider scale. A mixed-methods approach was implemented using patient simulation method (n = 28), semi-structured interviews (SSIs) (n = 23), focus group discussions (FGDs) with veterinary practitioners and non-governmental organisation animal health workers (n = 2 FGDs), and participant observation. Fewer than 48 per cent of drug retail outlet workers admitted to having had any formal training in pharmaceuticals at all, while 78 per cent reported having no formal training in animal-related pharmaceuticals. Moreover, 35 per cent of all participants sold antibiotics without a prescription, unprompted and without specifically being asked for antibiotics. Of the antibiotics dispensed, only 21 per cent were correctly dispensed for the symptoms presented, and all dosages dispensed were incorrect (underdosed). Furthermore, 43 per cent of drug retail outlet workers interviewed believe that some antibiotics can be legally dispensed without a prescription. Equine owners in northern India are frequently being sold antibiotics without a prescription and, in most cases, with incorrect diagnoses, treatment choice, and dosage. A substantial gap in capacities exists amongst Drug Retail Outlet (DRO) workers, with few being sufficiently qualified or trained to dispense antibiotics to animal owners. The study highlights the need for further training of private DRO workers as well as knowledge extension and awareness training for both DRO workers and animal owners regarding antimicrobial resistance and its potential impact upon livelihoods. It also illustrates the need to identify a balance whereby greater enforcement of regulation at all levels is implemented, while at the same time maintaining sufficient access to medicine for rural populations.

中文翻译：

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没有处方，没有问题！印度北部药品零售商店中与工作马有关的抗菌素管理的混合方法研究。

印度的一些医疗机构中已经出现了多药耐药性（MDR）。驴和mu子是在区域和国际边界之间移动的流动物种，通常居住在印度的私人社区药房或医疗店是人类和动物的主要医疗保健提供者的地区。本文重点介绍了药品零售业人员的能力如何影响他们的抗生素分配做法，尤其是在驴和mu子方面，以便考虑这可能如何在更大范围内影响抗菌素耐药性（AMR）的发展。使用患者模拟方法（n = 28），半结构化访谈（SSI）（n= 23），与兽医和非政府组织动物卫生工作者进行焦点小组讨论（n= 2 FGDs），并观察参与者。只有不到48％的药品零售业工人承认完全接受过药物正规培训，而78％的人报告说没有接受过动物相关药物的正规培训。此外，在所有参与者中，有35％的人在没有处方的情况下出售抗生素，没有提示，也没有明确要求使用抗生素。在分配的抗生素中，只有21％正确分配了所出现的症状，并且分配的所有剂量都不正确（剂量不足）。此外，接受采访的43％的药品零售商店工作人员认为，某些抗生素无需处方即可合法分发。印度北部的马主经常被出售未经处方的抗生素，并且在大多数情况下，他们的诊断，治疗选择不正确，和剂量。药品零售商店（DRO）工人之间的能力差距很大，很少有足够的资格或受过训练可以向动物所有者分配抗生素。这项研究强调了需要对DRO私营工人进行进一步培训，以及对DRO工人和动物所有者进行有关抗菌素耐药性及其对生计的潜在影响的知识扩展和意识培训。它还表明有必要找出一种平衡点，以便在各级加强执法力度，同时保持农村人口获得充足药物的机会。这项研究强调了需要对DRO私营工人进行进一步培训，以及对DRO工人和动物所有者进行有关抗菌素耐药性及其对生计的潜在影响的知识扩展和意识培训。它还表明有必要找出一种平衡点，以便在各级加强执法力度，同时保持农村人口获得充足药物的机会。该研究强调，需要对DRO私营工人进行进一步培训，并为DRO工人和动物所有者提供有关抗菌素耐药性及其对生计的潜在影响的知识扩展和意识培训。它还表明有必要找出一种平衡点，以便在各级加强执法力度，同时保持农村人口获得充足药物的机会。