چکیده (انگلیسی):

Objective: The present survey was conducted to investigate the price and availability of a basket of 24 essential
antibiotics and eight high-end antibiotics at various levels of health care in public and private sector in National
Capital Territory of Delhi, India using standardized WHO/HAI methodology.
Methods: Data on procurement price and availability was collected from three public healthcare providers in the
state: the federal (central) government, state government and Municipal Corporation of Delhi (MCD). Overall a total
of 83 public facilities, 68 primary care, 10 secondary cares and 5 tertiary care facilities were surveyed. Data was also
collected from private retail (n = 40) and chain pharmacies (n = 40) of a leading corporate house. Prices were
compared to an international reference price (expressed as median price ratio-MPR).
Results: Public sector: Delhi state government has its essential medicine list (Delhi state EML) and was using Delhi
state EML 2007 for procurement; the other two agencies had their own procurement list. All the antibiotics
procured including second and third generation antibiotics except for injections were available at primary care
facilities. Antibiotic available were on the basis of supply rather than rationality or the Delhi state EML and none
was 100% available. There was sub-optimal availability of some essential antibiotics while other non-essential ones
were freely available. Availability of antibiotics at tertiary care facilities was also sub-optimal. Private sector:
Availability of antibiotics was good. For most of the antibiotics the most expensive and popular trade names were
often available. High-end antibiotics, meropenam, gemifloxacin, and moxifloxacin were commonly available. In retail
pharmacies some newer generation non-essential antibiotics like gemifloxacin were priced lower than the
highest-priced generic of amoxicillin + clavulanic acid, azithromycin, and cefuroxime aexitl.
Conclusions: Inappropriate availability and pricing of newer generation antibiotics, which may currently be bought
without prescription, is likely to lead to their over-use and increased resistance. All providers should follow the EML
of whichever of the three concerned Delhi public sector agencies that it is under and these EMLs should follow the
essential medicine concept. The Indian regulatory authorities need to consider urgently, drug schedules and pricing
policies that will curtail inappropriate access to new generation antibiotics.