Social and Economic Factors Significantly Influence Supply of OTC Antibiotics

Social and economic factors, including financial incentives, education, social networks, and the weak enforcement of antibiotic regulations, all contribute to the supply and demand of OTC antibiotics, according to a study published in Exploratory Research in Clinical and Social Pharmacy.¹

“Unlike in some countries where antibiotics can be purchased without a prescription, the FDA requires that antibiotics be prescribed by a licensed health care provider,” according to TotalCare Health Services.² “This strict regulation is in place to prevent misuse, which can contribute to the rise of antibiotic-resistant bacteria—one of the most pressing global health concerns today.”

Antibiotics are a prominent medication class reserved for helping patients fight bacterial infections.³ Bacterial infections are significantly common and show up in many forms, from respiratory and skin infections to sexually transmitted diseases and food poisoning.⁴ With these conditions impacting patients of all ages across all locations, patients and experts alike are making a case for antibiotics to move toward OTC sales.

READ MORE: Proactive Warning Is Crucial in Preventing OTC Drug Abuse

Self-Care and Antibiotic Misuse

According to the University of Minnesota, antibiotic prescribing increased by 20% after the COVID-19 pandemic from the years 2021 to 2023.⁵ Much to the dismay of health care providers, ideas surrounding self-care were further jump-started after the pandemic, leading patients to focus less on pharmacists’ expertise and more on retrieving medications themselves.¹

However, even prior to the pandemic, antibiotics were prescribed unnecessarily in over 20% of all medications dispensed. According to several experts, the misuse of and self-medicating with antibiotics is gradually leading toward antimicrobial resistance (AMR), one of the greatest public health threats in the history of health care.⁶

“To effectively combat AMR, it is essential to address both global and industry-wide strategies as well as the specific practices contributing to the problem,” wrote the authors.¹ “Although the emergence of AMR is multifactorial and a natural phenomenon, the misuse and overuse of antibiotics play significant roles in accelerating this process of resistance.”

Exploring Pharmacies’ OTC Supply of Antibiotics

Amid the phenomena surrounding AMR, antibiotic misuse, and self-care, researchers of the current study wanted to further elucidate the reasons behind why patients seek OTC antibiotics and why pharmacies choose to dispense them across various settings in Ghana.

They conducted an exploratory qualitative study to investigate the leading factors associated with OTC antibiotics in Ghana through interviews spanning December 2022 to February 2023. Through these interviews, researchers assessed community pharmacists’ attitudes and beliefs, subjective norms, perceived behavioral control, and knowledge of OTC antibiotics.

“The interview questions were structured to elicit the salient behavioral, normative, and control beliefs within the framework of the Theory of Planned Behavior in the context of non-prescription antibiotic dispensing,” they wrote.¹ “Salient beliefs are the immediate thoughts that readily come to mind when the interviewees are posed with specific open-ended questions, and the modal salient beliefs are the thoughts common to the sample population.”

Common Factors Influencing Antibiotic Dispensing

The final analysis included 23 pharmacy practitioners (39.13% men; 52% aged 31-40). However, most of them were considered medicine counter assistants (52%), while the remaining 10 participants (43%) were pharmacists.

According to interview responses, Ghanaian pharmacies were more likely to dispense OTC antibiotics due to economic incentives, general sales targets, and customers’ perceived social status. These factors were furthermore prominent in pharmacies where regulatory oversight for OTC dispensing was weak or nonexistent.

One of the more obvious factors leading to OTC antibiotic supply is that pharmacies rely on the sale of medications to keep their businesses sustainable. Although pharmacy practitioners are well aware of the dangers behind OTC misuse, they are also conscious of the increased demand for OTC drugs and antibiotics, which could translate to greater pharmacy revenue.

Amid other social and economic themes uncovered in interviews, patients’ perceptions of both themselves and pharmacy employees contributed to OTC antibiotic supply. First, patients’ purchase of OTC products gave them confidence and preference in caring for themselves rather than a provider, leading to a greater demand for the supply of OTC antibiotics. Furthermore, when certified providers were willing to dispense OTC antibiotics to patients, the patients were instilled with more confidence in their purchase because it was supported by an educated practitioner.¹

FDA Regulations Needed for OTC Antibiotics

Although the results of this study highlight ongoing trends in OTC antibiotics, issues regarding AMR and misuse of these medications highlight the current need for more oversight. With a lack of oversight linked with greater use of OTC antibiotics, experts believe bodies like the FDA can alleviate potential issues from antibiotics, whether through prescriptions or OTC.

“Since current regulations allow for pharmacist discretion in antibiotic supply, it may be necessary for the FDA to adopt a guidance framework for the OTC supply of antibiotics in pharmacies to encourage rational antibiotic prescribing by pharmacists,” they concluded.¹ “Finally, the Ministry of Health must ensure that essential policies, such as the National Antimicrobial Policy and the National Antimicrobial Plan, are widely disseminated among pharmacy practitioners to facilitate a more inclusive implementation process.”

READ MORE: OTC Resource Center

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REFERENCES

1. Nortey RA, Kretchy IA, Opare-Addo MNA. Informal over-the-counter supply of antibiotics in Ghana: a qualitative analysis of practices in community pharmacies. Explor Res Clin Soc Pharm. December 10, 2025:100696. https://doi.org/10.1016/j.rcsop.2025.100696

2. Understanding over the counter antibiotics and where to find them. TotalCare Health Services. March 3, 2025. Accessed December 11, 2025. https://totalcare.us/blog/how-can-i-get-over-the-counter-antibiotics

3. Antibiotics. Cleveland Clinic. May 24, 2023. Accessed December 11, 2025. https://my.clevelandclinic.org/health/treatments/16386-antibiotics

4. Common bacterial diseases. University of Queensland. Accessed December 11, 2025. https://imb.uq.edu.au/common-bacterial-diseases

5. Dall C. Study shows rise in US outpatient antibiotic prescribing in late COVID period. University of Minnesota. August 4, 2025. Accessed December 11, 2025. https://www.cidrap.umn.edu/antimicrobial-stewardship/study-shows-rise-us-outpatient-antibiotic-prescribing-late-covid-period

6. Mostafavi B. Nearly a quarter of antibiotic prescriptions for children and adults may be unnecessary. University of Michigan. January 16, 2019. Accessed December 11, 2025. https://www.michiganmedicine.org/health-lab/nearly-quarter-antibiotic-prescriptions-may-be-unnecessary