Nye Caroline, Watson Tamlin, Kubasiewicz Laura, Raw Zoe, Burden Faith
Centre for Rural Policy Research (CRPR), The University of Exeter, EX4 4PJ Devon, UK.
The Donkey Sanctuary, Sidmouth, EX10 0NU Devon, UK.
Antibiotics (Basel). 2020 Jun 2;9(6):295. doi: 10.3390/antibiotics9060295.
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 ( = 28), semi-structured interviews (SSIs) ( = 23), focus group discussions (FGDs) with veterinary practitioners and non-governmental organisation animal health workers ( = 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.
多重耐药性（MDR）在印度的一些马科动物中已经出现。驴和骡是一种流动性物种，在不同地区和国际边界之间移动，常常出现在印度一些地区，在这些地区，私人社区药房或药店是人类和动物的主要医疗服务提供者。本文强调药品零售店员的能力可能如何影响他们的抗生素配药行为，特别是与驴和骡相关的行为，以便思考这可能如何在更广泛的范围内影响抗菌药物耐药性（AMR）的发展。采用了混合方法，包括患者模拟法（n = 28）、半结构化访谈（SSIs）（n = 23）、与兽医从业者和非政府组织动物卫生工作者进行的焦点小组讨论（FGDs）（2个FGDs）以及参与观察。不到48%的药品零售店员承认接受过任何正规的药学培训，而78%的人报告没有接受过与动物相关药品的正规培训。此外，35%的所有参与者在没有处方的情况下主动出售抗生素，且没有被专门要求提供抗生素。在所配出的抗生素中，只有21%是根据所呈现的症状正确配出的，并且所有配出的剂量都是错误的（剂量不足）。此外，接受采访的43%的药品零售店员认为有些抗生素可以在没有处方的情况下合法配出。印度北部的马科动物主人经常在没有处方的情况下被出售抗生素，而且在大多数情况下，诊断、治疗选择和剂量都是错误的。药品零售店员（DRO）之间存在很大的能力差距，很少有人具备足够的资质或培训来向动物主人配出抗生素。该研究强调需要对私人DRO工作人员进行进一步培训，以及对DRO工作人员和动物主人进行关于抗菌药物耐药性及其对生计潜在影响的知识扩展和意识培训。它还表明需要找到一种平衡，即在加强各级监管力度的同时，保持农村人口有足够的药品可及性。
