Selling antibiotics individually improves adherence to treatment. By reducing self-medication, it is possible to fight antibiotic resistance.
The sale of antibiotics by the unit would fight against antibiotic resistance, according to a French experiment described in Plos One. Commissioned by the Ministry of Health, this study also shows that this mode of distribution would improve treatment adherence. These interesting results offer a new angle of attack against the emergence of numerous multiresistant bacterial strains.
This phenomenon “constitutes a major public health issue in many European countries”, note the authors. France, one of the biggest consumers of antibiotics in Europe, is also one of the most affected by this threat. Each year, 12,000 deaths are linked to these resistant infections.
This massacre is largely linked to the consumption of antibiotics in town medicine. More than 90% of these precious drugs are prescribed by liberal doctors. However, about a third of these prescriptions would be unnecessary, according to the scientific literature.
Ration antibiotics
But antibiotic resistance is not just the result of overloaded prescriptions. The mode of distribution of these drugs is also questioned because the boxed sale does not always correspond to the prescriptions. The French pharmacy kits are proof of this: they are overflowing with unused drugs. This promotes self-medication but also contamination of the environment when patients throw away their pills in the traditional trash.
It is for this reason that the ministry wished to test the unit sale for 14 antibiotics. The experiment took place for a year between November 2014 and November 2015 in around a hundred volunteer pharmacies across France (Ile-de-France, Limousin, Lorraine, Provence-Alpes-Côte d’Azur). Among these pharmacies, 25 continued to dispense antibiotics by box. They were the control group. The others distributed the exact amount of tablets needed for treatment.
At the same time, pharmacists asked more than 1,200 patients to give their opinion on this new method of distribution. They were also questioned about their drug recycling habits, self-medication and their knowledge of antimicrobial resistance.
Better treatment compliance
During the experiment, more than 80% of the patients agreed to receive antibiotics by the unit instead of a conventional box. In 60% of cases, pharmacists gave patients fewer tablets compared to what they would usually have delivered with the boxes (20 single drugs on average against 23 with the boxes).
This made it possible to reduce the number of drugs dispensed by around 10%, and indirectly reduce costs for Social Security. The patients were also more inclined to follow their treatment until the end (91% of the patients who received their medication by the unit against 65% in the other group).
Among the patients who went to the control pharmacies, nearly two in ten admitted that they would keep the extra pills present in the boxes, and one in ten confided that they would surely reuse them without medical prescription. “Thanks to unit sales, it would be possible to reduce self-medication by 1.9%,” the study noted.
A promise from Emmanuel Macron
For the authors, these good results demonstrate that the medical prescriptions do not correspond to the packaging of antibiotics, “despite what the pharmaceutical industry can affirm”. The laboratories argue in particular that the boxes of drugs ensure traceability and better information for patients, we can read in the study.
During the presidential campaign, Emmanuel Macron spoke in favor of the unit sale of the drug. Asked about its application, the Minister of Health, Agnès Buzyn, explained to wait for the return of the experiments in progress. Taking up the arguments of the drug industry, the minister added that unit sales are a “complex” process that could present “risks for patients.
In 2015, Dr. Jean Carlet’s report on antibiotic resistance also denounced the packaging of antibiotics and proposed to modify it to adapt it to prescriptions. He also recommended limiting the initial antibiotic prescription to 7 days, indicating that the patient should return to his doctor if the infection was not treated. A measure which undoubtedly aimed to ration the number of antibiotics delivered to the French.
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