India has one of the highest rates of antimicrobial resistance (AMR) worldwide. Despite being prescription drugs, antibiotics are commonly available over-the-counter (OTC) at retail pharmacies. We aimed to gain insight into the OTC sale of antibiotics at retail pharmacies and to elucidate its underlying drivers. We conducted face-to-face, in-depth interviews using convenience sampling with 22 pharmacists and 14 informal dispensers from 36 retail pharmacies across two Indian states (Haryana and Telangana). Thematic analysis revealed that antibiotics were often dispensed OTC for conditions e.g., fever, cough and cold, and acute diarrhea, which are typically viral and self-limiting. Both Access and Watch groups of antibiotics were dispensed for 1–2 days. Respondents had poor knowledge regarding AMR and shifted the blame for OTC practices for antibiotics onto the government, prescribers, informal providers, cross practice by alternative medicine practitioners, and consumer demand. Pharmacists suggested the main drivers for underlying OTC dispensing were commercial interests, poor access to public healthcare, economic and time constraints among consumers, lack of stringent regulations, and scanty inspections. Therefore, a comprehensive strategy which is well aligned with activities under the National Action Plan-AMR, including stewardship efforts targeting pharmacists and evidence-based targeted awareness campaigns for all stakeholders, is required to curb the inappropriate use of antibiotics.

中文翻译：

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印度抗生素的非处方销售：对两个州供应商观点的定性研究

印度是全球抗菌素耐药性 (AMR) 率最高的国家之一。尽管是处方药，但抗生素通常可以在零售药店的非处方药 (OTC) 中买到。我们旨在深入了解零售药店中抗生素的 OTC 销售并阐明其潜在驱动因素。我们使用便利抽样对来自印度两个邦（哈里亚纳邦和特兰加纳邦）的 36 家零售药店的 22 名药剂师和 14 名非正式配药员进行了面对面的深入访谈。专题分析显示，抗生素经常在非处方药中用于治疗发烧、咳嗽和感冒以及急性腹泻等疾病，这些疾病通常是病毒性的和自限性的。Access 和 Watch 组抗生素均使用 1-2 天。受访者对 AMR 知之甚少，并将抗生素 OTC 实践的责任推给了政府、处方者、非正式提供者、替代医学从业者的交叉实践以及消费者需求。药剂师认为，潜在的非处方药配药的主要驱动因素是商业利益、公共医疗保健的渠道不畅、消费者的经济和时间限制、缺乏严格的法规以及缺乏检查。因此，需要制定与国家行动计划-AMR 下的活动密切相关的综合战略，包括针对药剂师的管理工作和针对所有利益相关者的基于证据的有针对性的宣传活动，以遏制抗生素的不当使用。替代医学从业者的交叉实践和消费者需求。药剂师认为，潜在的非处方药配药的主要驱动因素是商业利益、公共医疗保健的渠道不畅、消费者的经济和时间限制、缺乏严格的法规以及缺乏检查。因此，需要制定与国家行动计划-AMR 下的活动密切相关的综合战略，包括针对药剂师的管理工作和针对所有利益相关者的基于证据的有针对性的宣传活动，以遏制抗生素的不当使用。替代医学从业者的交叉实践和消费者需求。药剂师认为，潜在的非处方药配药的主要驱动因素是商业利益、公共医疗保健的渠道不畅、消费者的经济和时间限制、缺乏严格的法规以及缺乏检查。因此，需要制定与国家行动计划-AMR 下的活动密切相关的综合战略，包括针对药剂师的管理工作和针对所有利益相关者的基于证据的有针对性的宣传活动，以遏制抗生素的不当使用。