Mexico cracks down on self-prescribed antibiotics

The instructions aren’t on any box of medicine, but Mexicans know them all the same: At the first sign of sore throat or fever, race to the pharmacy for antibiotics. Take as you see fit.

Even though the law requires a prescription for antibiotics, pharmacists in Mexico seldom ask for one before handing them over. And they hand them over by the boatload: nearly 2 billion doses of antibiotics a year, enough for two full courses of treatment for almost each of the nation’s 110 million people.

Such handy access is easier than schlepping to the doctor or a crowded public clinic. But Mexican health officials fear so much self-medication poses a threat to public health by discouraging real medical care and promoting the development of bacteria that resist treatment by antibiotics.

So, in a big shift, authorities here have announced a crackdown on all the self-prescribed penicillin-popping. Under rules that take effect in August, pharmacies will face tighter oversight and stricter disclosure requirements to make sure they sell antibiotics only to patients with prescriptions. Violators face fines of up to $15,000 and possible closure.

“This is a culture we have to eradicate,” said Miguel Angel Toscano, who runs COFEPRIS, Mexico’s equivalent of the Food and Drug Administration. “People need to learn that antibiotics are for urgent medical uses, only for serious cases.”

By law, prescriptions were already needed to buy antibiotics. But as with many legal requirements in Mexico, enforcement is lax and the rule usually flouted. Antibiotics such as penicillin and ciprofloxacin are essentially sold over the counter — just place your order and pay at the register.

Compliance is also a big question mark for the newly announced measures, which reflect growing worry worldwide over excessive antibiotics use.

The issue took on added urgency in Mexico after the country’s unnerving bout last year with the H1N1 virus, which authorities say was needlessly deadly here because of rampant self-medication.

Many people infected with the flu virus first treated themselves with antibiotics, then went to the doctor only after it was too late. Nearly 1,000 people died.

Officials spent months negotiating an agreement with pharmacy associations, drug makers and distributors on the prescription requirement and other rules governing antibiotics.

Mexico’s health secretary, Jose Angel Cordova, said the drug companies resisted at first, but signed on after officials simplified proposed rules. “We reached a very amicable, very reasonable agreement,” Cordova said when the accord was announced last month.

Some people are already grumbling at the prospect of having to fight traffic and endure hours-long waits at health clinics to consult a doctor. (Some pharmacies keep a physician on duty.)

“A lot of times we don’t have time to go to the doctor and leave work and it’s easier to come to the pharmacy,” said Francisco Garcia, a 62-year-old government worker shopping at a Mexico City pharmacy. “Of course if it’s serious, you go to the doctor.”

Some pharmacy owners worry the prescription requirement will crimp earnings from antibiotics, the second-biggest-selling item among Mexico’s approximately 25,000 pharmacies.

At Santa Rosa Pharmacy in south Mexico City, for example, antibiotics account for 40% of sales. Most are sold without a prescription.

“I don’t want to imagine when we start refusing people medicine,” owner Alfonso Diaz said.

Diaz said buyers might instead shop for antibiotics on Mexico’s black market, already bursting with pirated clothing, DVDs and computer software, and little bothered by law enforcement.

The new rules could also hurt the scores of pharmacies that saturate Tijuana and other spots on the U.S. border, catering to Americans who troop over to buy cut-rate medications.

“This is going to cause some pharmacies to fail. It’s going to be unsustainable, unless they’re pharmacies that sell on the illegal market,” said Toscano of COFEPRIS.

Enforcement will fall mainly to local health inspectors in Mexico’s 31 states and Mexico City, which is officially a federal district. Success could hinge on whether policing efforts fall prey to graft.

But Toscano said his agency had been granted extra clout to keep pharmacies in line. And having the agreement of pharmacy groups and companies should help boost compliance, he said.

In addition, doctors will receive new training on using antibiotics. A study this year by Mexico’s National Public Health Institute found that in 9 of 10 cases, antibiotics sold were not needed, suggesting that physicians often prescribe them improperly.

The prescription rule sounded reasonable to Cristina Romero, a 21-year-old student. But she wondered about negative side effects — and not the upset stomach kind.

“People should understand that they shouldn’t self-medicate, that it’s for their own health,” Romero said. “I only hope it works and doesn’t lend itself to more corruption.”

Sanchez is a news assistant in The Times’ Mexico City Bureau.