Respondents viewed OTC antibiotic as a convenient alternative to formal healthcare, the access to which was influenced by distance, time and money. Inappropriately short regimens (2–3 days) were also offered without follow-up. Dispensing included the empirical use of broad-spectrum antibiotics, often combining multiple antibiotics, without laboratory diagnostic and drug susceptibility testing. Clinicians described antibiotics as easily available OTC at drug shops. There were economic incentives for clients and drug stores: patients were able to save money by bypassing the formal healthcare services. Interactions were brief and transactional: symptoms were described or explicit requests for specific medicine made, and money was exchanged. Results Drug shops were the primary location where patients engaged with health services.
7 Australian Federation of AIDS Organisations, Bangkok, Thailand.6 Country Coordinating Mechanism, The Global Fund, Ministry of Health and Population, Kathmandu, Nepal.5 Patan Academy of Health Sciences, Patan, Nepal.4 BP Koirala Institute of Health Sciences, Dharan, Nepal.3 Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal.2 Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.1 Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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