Antibiotic Resistance: The Impact of OTC Availability

Antibiotic resistance has emerged as a significant global public health challenge. As bacteria develop immunity to antibiotics, the effectiveness of these essential medications diminishes, leading to treatment failures and increased health care costs. This phenomenon is exacerbated by the OTC availability of antibiotics in several countries, where regulations may not be as stringent as in others, such as the US.

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Many countries allow individuals to purchase antibiotics without a prescription, making this a widespread practice. Individuals in these regions often purchase antibiotics directly from pharmacies without consulting a physician. This easy access encourages misuse, such as taking antibiotics for viral infections or stopping treatment too early, which contributes to the rise of antibiotic-resistant strains. For example, in Saudi Arabia, a study found that 15.8% of community pharmacies sold antibiotics without prescriptions during the COVID-19 pandemic, despite regulations against it.¹

The US enforces strict regulations that require a prescription for most antibiotics, ensuring the appropriate and necessary use of antibiotics. The CDC runs campaigns to raise awareness about responsible antibiotic use and to reduce over-prescription by health care providers. Despite these efforts, antibiotic resistance continues to be a major concern in the US, driven by inappropriate prescribing, patient demand for antibiotics, and the use of antibiotics in livestock.¹

Antibiotic resistance leads to serious consequences. Resistant infections, such as those caused by methicillin-resistant Staphylococcus aureus (MRSA), cause severe health complications and raise mortality rates. Moreover, the economic burden on health care systems also increases as hospitals handle more patient admissions and rely on costly second-line antibiotics.¹

To combat the antibiotic resistance, experts have proposed several therapeutic strategies. First, educating the public about the dangers of self-medication and the importance of finishing prescribed antibiotic courses plays a crucial role. Public health campaigns that promote responsible antibiotic use can raise awareness and encourage better practices among patients and health care providers. Additionally, improving diagnostic tools ensures that antibiotics are prescribed only when needed. Rapid diagnostic tests that differentiate between bacterial and viral infections help guide proper treatment decisions, reducing unnecessary antibiotic use.¹

Furthermore, various health care settings have implemented antibiotic stewardship programs to optimize antibiotic use. These programs involve multidisciplinary teams working together to promote the appropriate selection, dosage, and duration of antibiotic therapy. By ensuring that antibiotics are used judiciously, health care providers can help slow the development of resistance.

Researchers are also exploring alternative therapies, such as antimicrobial peptides (AMPs) and bacteriophage therapy, to combat resistant infections. AMPs are naturally occurring molecules involved in the innate immune response across many species that disrupt bacterial membranes and offer broad-spectrum antimicrobial effects. Bacteriophages, viruses that specifically infect and kill bacteria, provide another promising solution. Phage therapy targets bacterial cells without harming human cells, and phages can evolve alongside bacteria, offering a potentially sustainable way to combat resistant strains.²

As we move forward, we must recognize that no single approach can solve antibiotic resistance. Combining various therapeutic strategies will likely produce the best outcomes. Implementing antibiotic stewardship programs that promote responsible use of current antibiotics and raise public awareness about resistance will also play a valuable role in addressing this issue.^1,2

The OTC availability of antibiotics in some countries significantly contributes to the global challenge of antibiotic resistance. The contrast across global regions highlights the need for a coordinated response to this public health threat. Collaborative efforts are essential to preserve the efficacy of antibiotics for future generations and to ensure that these lifesaving medications remain effective in treating bacterial infections.

REFERENCES

1. Khojah HMJ, Khojah B. Over-the-counter sale of antibiotics during COVID-19 outbreak by community pharmacies in Saudi Arabia: a simulated client study. BMC Health Serv Res. 2022;22:123. doi:10.1186/s12913-022-07553-x

2. MacNair CR, Rutherford ST, Tan MW. Alternative therapeutic strategies to treat antibiotic-resistant pathogens. Nat Rev Microbiol. 2024;22:262-275. doi:10.1038/s41579-023-00993-0