Medicosnext
Dr. Sinda Karkee
She is a practicing pediatrician in KIOCH. She graduated MBBS from Patan Academy of Health Sciences, and MD, Pediatrics from Manipal College of Medical Sciences.
Outside the hospital, she enjoys gardening keenly and loves winding the day down with coffee and a suspense thriller book.
The TakeAway Message
Is the “quick fix” from the corner pharmacy worth risking a child’s future?
In Nepal, local pharmacies are more ubiquitous than temples, serving as the first line of defense for worried parents seeking immediate relief for their sick children. While these local shops provide essential access to basic care in remote areas, they are increasingly fueling a silent crisis: the rampant and unregulated use of Over-The-Counter (OTC) medicines.
Pediatricians frequently encounter children who have been treated with a “cocktail” of unprescribed drugs—ranging from unnecessary antibiotics and painkillers to sugary drinks falsely marketed as life-saving Oral Rehydration Solutions (ORS)—before a diagnosis is even made. This practice is often driven by untrained shopkeepers rather than qualified pharmacists.
While convenient, this haphazard approach has a severe long-term consequence: Antimicrobial Resistance. By misusing antibiotics for simple viral infections, we are breeding “superbugs” that standard medicines can no longer kill. To combat this, the healthcare system must enforce stricter prescription laws and ensure pharmacy staff are trained to recognize red flags rather than just selling products.
Ultimately, doctors must prioritize “Antibiotic Stewardship”—prescribing only when necessary—and educate parents that a little patience today is far safer than facing a future where there is no cure.
In my practice as a pediatrician, the one thing that bothers me most is the rampant use of Over-The-Counter (OTC) medications amongst children. The first thing that comes to the mind of most of our Nepalese parents when dealing with a child’s sickness is to visit their trusted local pharmacy or “medical” for basic treatment. Nepal is a country rich in temples, but probably more widespread than temples are “pharmacies and medical halls” which are seen in every nook and cranny. They are armed with a range of medications from the basic, to ones that ideally should be sold only with a prescription.
When a child comes to the OPD with an upset stomach, you are almost always bound to discover that the child has already been prescribed a painkiller, an antibiotic (or sometimes two antibiotics), some probiotics, Pantoprazole or Ranitidine and maybe also a plastic bottle that looks like an orange soda but “claims” to be an electrolyte drink. Note that a Hyderabad pediatrician Dr. Sivaranjani Santosh won a major legal battle after an eight-year fight, leading to India’s food regulator (FSSAI) banning the term “ORS” on sugary drinks that don’t meet World Health Organization (WHO) standards, protecting children from harmful, misleading products that worsened dehydration, and establishing ORS as a life-saving medicine, not a beverage. What is even more surprising is that the prescription generation and dispensing is done by the same person; the one from their nearest local pharmacy, who in most cases is not even a pharmacist. In our setting, children are often prescribed medicines first even before they are diagnosed with an illness.
On the bright side, local medical shops have extended the reach of our healthcare system, and made precious medicines available to even remote parts of Nepal. A febrile and irritable child can quickly get better with a basic Paracetamol and a child on the verge of getting dehydrated benefits really well from a simple Oral Rehydration Solution (ORS) from the local pharmacy. It is relatively a very convenient way to find quick relief for children and their parents compared to going the extra mile which is, visiting a hospital.
However, it is the haphazard use of OTC medicines which is most concerning. Many studies have shown that prevalence of OTC medication is strikingly high, especially in developing nations. In these situations, an overprescribed cocktail of pills and syrups, is partly to be blamed for the advent of multi-drug-resistant microbes. This is because a big chunk of this cocktail includes multiple antibiotics prescribed and taken without any evidence of bacterial infection.
While this issue may not seem significant to parents at that moment, it definitely will create mishaps in the long run. The most troublesome of the lot being ‘Antimicrobial Resistance (AMR)’. The haste in search of fast miracle cures through local pharmacies have led to surfacing of superbugs in the community, resistant to the broadest spectrum antimicrobials.
Antimicrobial resistance as a global health peril has been an emerging topic of interest for many years. But has the issue actually gained enough attention and graveness that it should? Definitely not. At least not in our country with local medical shops dispensing antibiotics to any willing buyer and without any proper prescription.
Therefore, the first and the most crucial step is to be aware of “Antibiotic Stewardship” i.e, prescribing appropriate antibiotics only when indicated in its proper dose, frequency and duration. It becomes our responsibility as clinicians to counsel parents and patients about this issue. If we are to play our part in minimizing the prevalence of AMR, it is our role as doctors to focus and emphasize this to each and every patient/ caregiver. We tend to underestimate the power of communication with our patients. A simple but concerned explanation of why Antibiotic stewardship is so critical, makes a marked difference than we might have expected.
Undeniably, a proper and thorough monitoring and supervision of dispensing OTC medicines is also pivotal. Enforcing prescription only laws, especially for antibiotics is another constructive step. Likewise, provision of only registered pharmacists in the local medical shop and making them aware about AMR should also be a priority. Maybe training them about differentiating viral vs bacterial illness and recognizing red flags in children would be some useful approaches to reducing the risk of rampant use of OTC medicines.
Hence, let’s wonder: Is NO CURE for tomorrow better than a little patience today?
