TY - JOUR AU - Moura, Maria AU - Boszczowski, Icaro AU - Blaque, Manuela AU - Mussarelli, Rafael AU - Fossaluza, Victor AU - Pierrotti, Ligia AU - Campana, Gustavo AU - Brandileone, Maria AU - Zanella, Rosemeire AU - Almeida, Samanta C.G. AU - Levin, Anna T1 - Effect on Antimicrobial Resistance of a Policy Restricting Over-the-Counter Antimicrobial Sales in a Large Metropolitan Area, São Paulo, Brazil T2 - Emerging Infectious Disease journal PY - 2022 VL - 28 IS - 1 SP - 180 SN - 1080-6059 AB - Although restricting over-the-counter (OTC) antimicrobial drug sales is recommended globally, no data track its effect on antimicrobial resistance (AMR) in bacteria. We evaluated the effect of a national policy restricting OTC antimicrobial sales, put in place in November 2010, on AMR in a metropolitan region of São Paulo, Brazil. We reviewed associations between antimicrobial sales from private pharmacies and AMR in 404,558 Escherichia coli and 5,797 Streptococcus pneumoniae isolates using a dynamic regression model based on a Bayesian approach. After policy implementation, a substantial drop in AMR in both bacterial species followed decreased amoxicillin and trimethoprim/sulfamethoxazole sales. Conversely, increased ciprofloxacin sales were associated with increased ciprofloxacin resistance, and extended spectrum β-lactamases–positive E. coli isolates and azithromycin sales increases after 2013 were associated with increased erythromycin resistance in S. pneumoniae isolates. These findings suggest that restricting OTC antimicrobial sales may influence patterns of AMR, but multifaceted approaches are needed to avoid unintended consequences. KW - antimicrobial resistance KW - antimicrobial drugs KW - anti-infective agents KW - nonprescription drugs KW - over-the-counter drugs KW - bacteria KW - public policy KW - public health KW - government regulation KW - Brazil DO - 10.3201/eid2801.201928 UR - https://wwwnc.cdc.gov/eid/article/28/1/20-1928_article ER - End of Reference