Author

MARIE KASBAUM

Date of Award

Fall 12-2019

Degree Type

Dissertation/Thesis

Degree Name

Master of Public Health (MPH)

Advisor(s)

SUSAN TORTOLERO EMERY

Second Advisor

CESAR.A.ARIAS

Third Advisor

ERIC BROWN

Abstract

The misuse of antibiotics has been shown to exacerbate the global antibiotic resistance crisis, which could have major consequences on public health worldwide (Auta et al., 2018). In Bogotá, Colombia, the non-prescription sale of antibiotics still occurs in pharmacies despite national regulations requiring a prescription from a physician or health agency before dispensing antibiotics to a patient (Vacca et al., 2011). The purpose of this study was to investigate the non-prescription sale of antibiotics in community pharmacies to foreign travelers and Colombian citizens in Bogotá, Colombia. Trained Simulated Clients (SCs) gathered experimental data in pharmacies distributed throughout 20 geographic districts within Bogotá to investigate an association between a pharmacy customer’s Colombian citizenship status and their likelihood of being offered antibiotics without a prescription. Two groups of simulated clients (SCs) separately conducted trials at each pharmacy included in the study sample (N=94); one SC group was made up of foreign U.S. travelers, and the other SC group was a comparison group of Colombian citizens who are native to Bogotá. In these trials, the SCs followed a standardized script and acted as though they were seeking medication from pharmacy vendors for a friend with traveler’s diarrhea (TD). Antibiotics were offered to US travelers and to the Colombian group in 62 (68.13%) and 60 (65.96%) pharmacies, respectively. The traveler group was significantly more likely than the Colombian comparator group to be offered antibiotics without any prompting (p < 0.05). When pharmacy employees refused to sell antibiotics, the traveler group was significantly more likely to be given a clinical reason not to receive antibiotics. Refusal to Colombian citizens was more frequently due legal reasons (p < 0.05). This study provides insight on the non-prescription sale of antibiotics in Colombian pharmacies. The data can be used for future policy and antimicrobial stewardship interventions in Latin American countries to combat the misuse of antibiotics.

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