Regulation of antibiotic sales in Mexico: an analysis of printed media coverage stakeholder participation

Abstract

Background: Restricting antibiotics sales to those with medical prescriptions only is a central strategy for promoting appropriate use containing antibiotic resistance; however, many low middle income countries have not enforced policies that prevent widespread self medication with antibiotics. In 2010, the Mexican government announced the enforcement of antibiotic sales regulations, a policy that gained media prominence. This study analyzes media coverage of issues, stakeholder representation, positions taken during policy agenda setting, drafting, implementation to shed light on policy making to promote appropriate antibiotic utilization. Methods: We carried out a quantitative content analysis of 322 newspaper articles published between January 2009 December 2010 in 18 national regional newspapers. Additionally, we conducted a qualitative content analysis to underst the positions adopted strategies developed by nine key stakeholders. Framing theory guided the analysis. Results: The Ministry of Health dominated media coverage, justifying the enforcement policy by focusing on risks of self medication, to a lesser degree dangers of increasing antibiotic resistance. Pharmacy associations appeared to be the leading opponents, arguing that the policy created logistical difficulties corruption, and had negative economic impact for pharmacies their clients. The associations developed strategies against the regulation such as attempting to delay implementation installing physicians’ consultation offices within pharmacies. While medical associations academic institutions called for a comprehensive strategy to combat antibiotic resistance, improve prescription quality, create public awareness, these issues had little impact on media coverage. Consumer groups legislators received very little media coverage. Conclusions: The narrowly focused polarized media coverage ─centred on problems of self medication and economic impact ─ was a missed opportunity to publicly discuss to develop a comprehensive national strategy on antibiotic use in Mexico. It highlights the need for discussing developing interventions within the framework of a pharmaceutical policy.