Abstract

Tuberculosis (TB) is a major cause of morbidity and mortality in developing countries, and heavily impacts 22 high burden countries; Thailand included. Drug-sensitive TB, if diagnosed and treated in a timely manner, is curable in part due to use of an anti-TB medication called rifampicin (RMP). Though RMP requires a prescription to purchase it, unregulated markets exist that work outside these legal frameworks. The sale of RMP without a prescription can lead to TB resistance, transmission of nearly untreatable strains of TB and an enormous burden on local health care systems. The purpose of this study was to assess the ability to purchase RMP without a prescription in Bangkok. In four distinctly different districts in Bangkok, pharmacies were asked if they would sell RMP without a prescription and at what price. Informed consent was a pre-requisite to completing the study, and all potential participants were aware that they had a right to refuse. No personal information was collected from the pharmacies, other than a signature for informed consent and no pharmaceuticals were purchased during the study. There were 111 total numbers of pharmacies visited, and with 22 refusals, data analysis was completed on 89 consented samples. Out of the 89 pharmacies, 33 (37%) sell RMP without a prescription. The four districts average cost per sheet of ten tablets of RMP was $14.96 USD, with prices ranging from a low of $8.06 USD to $25.81 USD. This study revealed that RMP is available, at varying costs, in four districts without a prescription in unregulated markets. Findings suggest that enforcement, education and accreditation of unregulated pharmacies needs to be improved in partnership with National TB networks, along with mandatory reporting systems for substandard or counterfeit drugs in the market. Further research into the extent, size and impact of the unregulated market is needed to better understand the scope of the problem.