Poompruek, Panoopat; Perris, Anna; Whanpuch, Phakha; Chandler, Clare IR; Sringernyuang, Luechai; (2022) Mystifying medicines and maximising profit: Antibiotic distribution in community pharmacies in Thailand. Global Public Health, 17 (12). pp. 3931-3943. ISSN 1744-1692 DOI: https://doi.org/10.1080/17441692.2022.2049843
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Abstract
Thailand's antimicrobial stewardship strategy has focussed on promoting 'rational drug use' in the public sector, to reduce the threat of drug resistance and control healthcare expenditure. The strategy's next ambition is to attend to the private sector, where antibiotics are widely available over the counter without prescription. Using ethnographic and survey data, this paper follows antibiotics through community pharmacies, to explore drug distribution and access, and identify potential challenges for stewardship. We extend the analytical frame beyond 'irrational' dispenser-customer transactions, to explore the logics of practice of a multiplicity of actors in the context of a highly competitive pharmaceutical market. Highlighting the role of the pharmaceutical industry in mystifying medicines, we show how antibiotics are collapsed into a category of 'strong medicines' and requested by customers using 'prescriptions by proxy'. We further examine how Thailand's drug regulation and classificatory systems, historically orientated around access to medicines, enable the proliferation of antibiotics in the context of contemporary efforts to control distribution. Recognising the negotiations involved in dispensing antibiotics in a pluralistic health system, we attempt to reconfigure allocations of responsibility, advocating for stewardship approaches that take into account local ecologies of care, as well as implications for access, equity, and accountability.
Item Type | Article |
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Faculty and Department | Faculty of Public Health and Policy > Dept of Global Health and Development |
Research Centre | Antimicrobial Resistance Centre (AMR) |
PubMed ID | 35282798 |
Elements ID | 172796 |
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Filename: Poompruek_etal_2022_Mystifying-medicines-and-maximising-profit.pdf
Description: This is an author accepted manuscript version of an article accepted for publication, and following peer review. Please be aware that minor differences may exist between this version and the final version if you wish to cite from it.
Licence: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
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