The number of antibiotics sold without a prescription to donkey owners in India has been described as staggering by researchers, and the lack of knowledge of pharmacists about the regulations surrounding the sale of the drugs as “astonishing”.
Researchers have highlighted the consequences of erroneously prescribed medicines by untrained pharmacists to working equines in northern India in a study by the world’s largest equine welfare charity, The Donkey Sanctuary.
The paper published in the journal Antibiotics, titled No Prescription, No Problem! A Mixed-Methods Study of Antimicrobial Stewardship Relating to Working Equines in Drug Retail Outlets of Northern India, specifically focuses on working equines and their owners, and examines the role of local medical stores in regards to antimicrobial stewardship in northern India.
It demonstrates how antibiotics are often sold without a prescription, illegally and indiscriminately by insufficiently trained pharmacists to owners of working equines. The report also highlights that where animal knowledge does exist, it rarely includes knowledge of equines, let alone diagnosing and dispensing antibiotics to animal owners.
This lack of formal training, qualifications, and knowledge is not only likely to impact upon the welfare of equines in the short term, but is also likely to contribute to antimicrobial resistance in equines and the wider environment in the longer term.
Complacency, misuse, and overuse of antibiotics, are recognised as significant contributing factors to the growing global issue of antimicrobial resistance. Home to a population of more than half a million donkeys and mules, India is no different, with multidrug resistance already occurring among equids across the country.
Working equids are essential to millions of people across the world, and are the lifeblood to many in India. Any adverse effect on their welfare and subsequent deterioration in their health can lead to a potentially devastating impact upon livelihoods, human health and wellbeing.
“It is astonishing how few local pharmacists had any knowledge of the regulations surrounding the sale of antibiotics, and even more surprising how few were sufficiently trained to be dispensing pharmaceuticals at all, let alone to owners of working equines,” said Caroline Nye, the author of the study and former social science researcher at The Donkey Sanctuary.
“It is important that future interventions take into account the risks involved in the immediate medical treatment of mules and donkeys with regards to antibiotic use. This might take the form of knowledge extension to both local pharmacists and working equine owners in regards to the importance of good antimicrobial stewardship.”
Nye is now with the Centre for Rural Policy Research (CRPR) at the University of Exeter.
Tamlin Watson, Senior Researcher Global at the international animal welfare charity and contributor to the article said: “The highly mobile nature of working equids is of great concern regarding the potential for dissemination of antimicrobial resistance.
“Not only does this have serious implications for working equids but also for people, particularly those already vulnerable in isolated communities, without the economic capability to access adequate health care.”
Laura Kubasiewicz, Senior Researcher Global at The Donkey Sanctuary, who also contributed to the paper, added: “The fact that over a third of drug retail outlet workers sold antibiotics without a prescription is quite staggering, and could have huge implications for equid welfare in both the short and long term.
“Owners often rely on their equids as their main source of income, so these findings highlight the delicate balance required for dispensing regulations to be enforced, with the need for equid owners to have access to medical care.”
The study highlights the need for greater regulation, further training, and a better understanding of the importance of antimicrobial stewardship across the board. It also illustrates the need to identify a balance whereby greater enforcement of regulation at all levels is implemented, while at the same time maintaining sufficient access to medicine for rural populations.
No Prescription, No Problem! A Mixed-Methods Study of Antimicrobial Stewardship Relating to Working Equines in Drug Retail Outlets of Northern India.Caroline Nye, Tamlin Watson, Laura Kubasiewicz, Zoe Raw, and Faith Burden; Antibiotics 2020, 9(6), 295; https://doi.org/10.3390/antibiotics9060295