Kotwani Anita, Holloway Kathleen
Department of Pharmacology, V. P. Chest Institute, University of Delhi, Delhi, India.
Essential Drugs and Other Medicines, World Health Organization, Regional Office of South East Asia, New Delhi, India.
J Pharm Policy Pract. 2013 Aug 12;6:6. doi: 10.1186/2052-3211-6-6. eCollection 2013.
The present survey was conducted to investigate the price and availability of a basket of 24 essential antibiotics and eight high-end antibiotics at various levels of health care in public and private sector in National Capital Territory of Delhi, India using standardized WHO/HAI methodology.
DATA ON PROCUREMENT PRICE AND AVAILABILITY WAS COLLECTED FROM THREE PUBLIC HEALTHCARE PROVIDERS IN THE STATE: the federal (central) government, state government and Municipal Corporation of Delhi (MCD). Overall a total of 83 public facilities, 68 primary care, 10 secondary cares and 5 tertiary care facilities were surveyed. Data was also collected from private retail (n = 40) and chain pharmacies (n = 40) of a leading corporate house. Prices were compared to an international reference price (expressed as median price ratio-MPR).
PUBLIC SECTOR: Delhi state government has its essential medicine list (Delhi state EML) and was using Delhi state EML 2007 for procurement; the other two agencies had their own procurement list. All the antibiotics procured including second and third generation antibiotics except for injections were available at primary care facilities. Antibiotic available were on the basis of supply rather than rationality or the Delhi state EML and none was 100% available. There was sub-optimal availability of some essential antibiotics while other non-essential ones were freely available. Availability of antibiotics at tertiary care facilities was also sub-optimal. Private sector: Availability of antibiotics was good. For most of the antibiotics the most expensive and popular trade names were often available. High-end antibiotics, meropenam, gemifloxacin, and moxifloxacin were commonly available. In retail pharmacies some newer generation non-essential antibiotics like gemifloxacin were priced lower than the highest-priced generic of amoxicillin + clavulanic acid, azithromycin, and cefuroxime aexitl.
Inappropriate availability and pricing of newer generation antibiotics, which may currently be bought without prescription, is likely to lead to their over-use and increased resistance. All providers should follow the EML of whichever of the three concerned Delhi public sector agencies that it is under and these EMLs should follow the essential medicine concept. The Indian regulatory authorities need to consider urgently, drug schedules and pricing policies that will curtail inappropriate access to new generation antibiotics.
采用世界卫生组织/医疗机构抗生素使用调查（WHO/HAI）的标准化方法，对印度德里国家首都辖区公共和私营部门不同医疗保健层面的24种基本抗生素和8种高端抗生素的价格及可获得性进行调查。
从该邦的三家公共医疗服务提供者处收集采购价格和可获得性数据：联邦（中央）政府、邦政府和德里市政公司（MCD）。总共对83家公共机构进行了调查，其中包括68家初级保健机构、10家中级保健机构和5家三级保健机构。还从一家大型企业的私人零售药店（n = 40）和连锁药店（n = 40）收集了数据。将价格与国际参考价格（以中位数价格比-MPR表示）进行比较。
公共部门：德里邦政府有其基本药物清单（德里邦EML），并使用2007年德里邦EML进行采购；其他两个机构有各自的采购清单。除注射剂外，所有采购的抗生素包括第二代和第三代抗生素在初级保健机构均有供应。抗生素的供应是基于供应情况而非合理性或德里邦EML，且没有一种抗生素的供应率达到100%。一些基本抗生素的可获得性欠佳，而其他非基本抗生素却可随意获得。三级保健机构的抗生素可获得性也不理想。私营部门：抗生素的可获得性良好。对于大多数抗生素，通常都有最昂贵且最受欢迎的商品名药物。高端抗生素美罗培南、吉米沙星和莫西沙星普遍有售。在零售药店，一些新一代非基本抗生素如吉米沙星的价格低于阿莫西林+克拉维酸、阿奇霉素和头孢呋辛酯最高价格的仿制药。
新一代抗生素目前无需处方即可购买，其供应和定价不当可能导致过度使用并增加耐药性。所有提供者均应遵循其所属的德里三个相关公共部门机构中任何一个的EML，并且这些EML应遵循基本药物概念。印度监管当局需要紧急考虑药物目录和定价政策，以减少对新一代抗生素的不当获取。
