Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales.

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  • Additional Information
    • Subject Terms:
    • Author-Supplied Keywords:
      Academic skills
      Antibiotic resistance
      Antibiotics
      Antimicrobial resistance
      Antimicrobials
      Biology and life sciences
      Brazil
      Cognitive psychology
      Cognitive science
      Drugs
      Economic analysis
      Economics
      Geographical locations
      Health care
      Infectious diseases
      Literacy
      Medicine and health sciences
      Microbial control
      Microbiology
      Neuroscience
      People and places
      Pharmacology
      Population biology
      Population density
      Population metrics
      Psychology
      Public and occupational health
      Research Article
      Social sciences
      Socioeconomic aspects of health
      South America
    • NAICS/Industry Codes:
      325410 Pharmaceutical and medicine manufacturing
      424210 Drugs and Druggists' Sundries Merchant Wholesalers
      414510 Pharmaceuticals and pharmacy supplies merchant wholesalers
      325411 Medicinal and Botanical Manufacturing
    • Abstract:
      Background: Improper antibiotic use is one of the main drivers of bacterial resistance to antibiotics, increasing infectious diseases morbidity and mortality and raising costs of healthcare. The level of antibiotic consumption has been shown to vary according to socioeconomic determinants (SED) such as income and access to education. In many Latin American countries, antibiotics could be easily purchased without a medical prescription in private pharmacies before enforcement of restrictions on over-the-counter (OTC) sales in recent years. Brazil issued a law abolishing OTC sales in October 2010. This study seeks to find SED of antibiotic consumption in the Brazilian state of São Paulo (SSP) and to estimate the impact of the 2010 law. Methods: Data on all oral antibiotic sales having occurred in the private sector in SSP from 2008 to 2012 were pooled into the 645 municipalities of SSP. Linear regression was performed to estimate consumption levels that would have occurred in 2011 and 2012 if no law regulating OTC sales had been issued in 2010. These values were compared to actual observed levels, estimating the effect of this law. Linear regression was performed to find association of antibiotic consumption levels and of a greater effect of the law with municipality level data on SED obtained from a nationwide census. Results: Oral antibiotic consumption in SSP rose from 8.44 defined daily doses per 1,000 inhabitants per day (DID) in 2008 to 9.95 in 2010, and fell to 8.06 DID in 2012. Determinants of a higher consumption were higher human development index, percentage of urban population, density of private health establishments, life expectancy and percentage of females; lower illiteracy levels and lower percentage of population between 5 and 15 years old. A higher percentage of females was associated with a stronger effect of the law. Conclusions: SSP had similar antibiotic consumption levels as the whole country of Brazil, and they were effectively reduced by the policy. [ABSTRACT FROM AUTHOR]
    • Abstract:
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    • Author Affiliations:
      1Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
      2Course of Medicine, Health Sciences Sector, Federal University of Paraná, Curitiba, Brazil
      3Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
      4Department of Infectious Diseases and LIM54, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
      5MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
    • ISSN:
      1932-6203
    • Accession Number:
      10.1371/journal.pone.0167885
    • Accession Number:
      120153976
  • Citations
    • ABNT:
      KLIEMANN, B. S. et al. Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales. PLoS ONE, [s. l.], v. 11, n. 12, p. 1–14, 2016. DOI 10.1371/journal.pone.0167885. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=aph&AN=120153976. Acesso em: 31 mar. 2020.
    • AMA:
      Kliemann BS, Levin AS, Moura ML, Boszczowski I, Lewis JJ. Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales. PLoS ONE. 2016;11(12):1-14. doi:10.1371/journal.pone.0167885.
    • APA:
      Kliemann, B. S., Levin, A. S., Moura, M. L., Boszczowski, I., & Lewis, J. J. (2016). Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales. PLoS ONE, 11(12), 1–14. https://doi.org/10.1371/journal.pone.0167885
    • Chicago/Turabian: Author-Date:
      Kliemann, Breno S., Anna S. Levin, M. Luísa Moura, Icaro Boszczowski, and James J. Lewis. 2016. “Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales.” PLoS ONE 11 (12): 1–14. doi:10.1371/journal.pone.0167885.
    • Harvard:
      Kliemann, B. S. et al. (2016) ‘Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales’, PLoS ONE, 11(12), pp. 1–14. doi: 10.1371/journal.pone.0167885.
    • Harvard: Australian:
      Kliemann, BS, Levin, AS, Moura, ML, Boszczowski, I & Lewis, JJ 2016, ‘Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales’, PLoS ONE, vol. 11, no. 12, pp. 1–14, viewed 31 March 2020, .
    • MLA:
      Kliemann, Breno S., et al. “Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales.” PLoS ONE, vol. 11, no. 12, Dec. 2016, pp. 1–14. EBSCOhost, doi:10.1371/journal.pone.0167885.
    • Chicago/Turabian: Humanities:
      Kliemann, Breno S., Anna S. Levin, M. Luísa Moura, Icaro Boszczowski, and James J. Lewis. “Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales.” PLoS ONE 11, no. 12 (December 12, 2016): 1–14. doi:10.1371/journal.pone.0167885.
    • Vancouver/ICMJE:
      Kliemann BS, Levin AS, Moura ML, Boszczowski I, Lewis JJ. Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales. PLoS ONE [Internet]. 2016 Dec 12 [cited 2020 Mar 31];11(12):1–14. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=aph&AN=120153976