Journal of Antimicrobial Chemotherapy (1999) 44, 163-177
© 1999 The British Society for Antimicrobial Chemotherapy
Working Party Report |
Self-medication of antibacterials without prescription (also called `over-the-counter' use)
A report of a Working Party of the British Society for Antimicrobial Chemotherapy
,*
a Southmead Hospital, Bristol b The City Hospital, Nottingham c SmithKline Beecham Pharmaceuticals, Harlow d Ninewells Hospital, Dundee e Aston University, Birmingham f Glaxo Wellcome R&D,Uxbridge g Johnson & Johnson MSD, High Wycombe h The Medical School, Nottingham, UK
Abstract
The availability of antimicrobial agents for self-medication may increase and could include antibacterial agents for oral or topical use. Wholesale deregulation of antibacterials would be undesirable and likely to encourage misuse of classes of agents currently important in the management of serious infections. Changed regulation from Prescription-Only Medicine (POM) to Pharmacy (P) medicine of selected agents with indications for short-term use in specific minor infections and illness is likely to have advantages to the user. However, safeguards to their use would need to be included in the Patient Information Leaflet (PIL). Agents and indications for self-medication are discussed. Any alteration in licensed status from POM to P will require careful risk–benefit assessment, including the likely impact on bacterial resistance. Safety issues also include concerns relating to age of the user, pregnancy, underlying disease and the potential for drug interactions. The importance of appropriate information with the PIL is emphasized, as is the role of the pharmacist, while ways of improving adverse event notification and monitoring are discussed. The paucity of good denominator-controlled data on the prevalence of in-vitro resistance is highlighted, and recommendations for improving the situation are made. There are currently no levels of resistance accepted by regulatory bodies on which to base a licensing decision, be it for granting a product licence, renewal of a licence or a change in licensed status from POM to P. Due consideration should be given to: the validation of user-defined indications in comparison with those medically defined; the enhancement of pharmacy advice in the purchase of such agents; improved safety monitoring; the establishment of systematic surveillance of susceptibility data.
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