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

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  • Breno S Kliemann
  • Anna S Levin
  • M Luísa Moura
  • Icaro Boszczowski
  • James J Lewis

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.

Suggested Citation

  • Breno S Kliemann & Anna S Levin & M Luísa Moura & Icaro Boszczowski & 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, Public Library of Science, vol. 11(12), pages 1-14, December.
    • Handle: RePEc:plo:pone00:0167885
    DOI: 10.1371/journal.pone.0167885
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    References listed on IDEAS

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    1. Filippini, Massimo & Masiero, Giuliano & Moschetti, Karine, 2006. "Socioeconomic determinants of regional differences in outpatient antibiotic consumption: Evidence from Switzerland," Health Policy, Elsevier, vol. 78(1), pages 77-92, August.
    2. Radyowijati, Aryanti & Haak, Hilbrand, 2003. "Improving antibiotic use in low-income countries: an overview of evidence on determinants," Social Science & Medicine, Elsevier, vol. 57(4), pages 733-744, August.
    3. Giuliano Masiero & Massimo Filippini & Matus Ferech & Herman Goossens, 2010. "Socioeconomic determinants of outpatient antibiotic use in Europe," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 55(5), pages 469-478, October.
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    2. Silvia Portero de la Cruz & Jesús Cebrino, 2020. "Prevalence and Determinants of Antibiotic Consumption in the Elderly during 2006–2017," IJERPH, MDPI, vol. 17(9), pages 1-16, May.

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