Multicenter study on self-medication and self-prescription in six Latin American countries

Objective: To evaluate the patterns of self-medication in Latin-American countries. Methods: This cross-sectional drug utilization study took place at 242 pharmacies in 11 study areas in six countries. Unselected samples of customers were interviewed with a structured questionnaire after they had purchased a medicinal product without any medical prescription and without seeking or accepting the advice of the pharmacist or pharmacy counter assistant. Results: We interviewed 8597 consumers. They had purchased 10,569 pharmaceutical products. Ten percent of the products were intended for family use, 14.1% were for children, 68.2% were for adults, and 7.9% were for elderly people. Thirty-nine percent of the products were fixed-dose combinations, and 19% contained three or more active ingredients. Analgesics (16.8%) were the leading group of drugs, followed by antibiotics (7.4%), antiinflammatory and antirheumatic products (5.9%), and vitamins (5.1%). Consumers interviewed purchased relatively high numbers of cardiovascular drugs (494, 5%) and drugs that act on the central nervous system (256, 2.4%). Only 34% of dispensed drugs had an approved over-the-counter status; less restrictive criteria suggest that 24% should have been dispensed on a medical prescription. Conclusions: The high proportion of fixed-dose combinations reflects poorly regulated pharmaceutical markets. The relatively high proportion of drugs dispensed without a medical prescription that nevertheless need medical follow-up is probably attributable to difficult access to medical care. The potential effectiveness of these treatments is therefore jeopardized by lack of medical follow-up. There is a need for implementation of a comprehensive pharmaceutical and health care policy in the participating countries.