{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:31:56Z","timestamp":1787027516543,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T00:00:00Z","timestamp":1684195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Programa Universitario de Investigaci\u00f3n en Salud (PUIS)","award":["IN218220"],"award-info":[{"award-number":["IN218220"]}]},{"name":"Programa de Apoyo a Proyectos de Investigaci\u00f3n e Innovaci\u00f3n Tecnol\u00f3gica (PAPIIT), Universidad Nacional Aut\u00f3noma de M\u00e9xico (UNAM)","award":["IN218220"],"award-info":[{"award-number":["IN218220"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>The first level of medical care provides the largest number of consultations for the most frequent diseases at the community level, including acute pharyngitis (AP), acute diarrhoea (AD) and uncomplicated acute urinary tract infections (UAUTIs). The inappropriate use of antibiotics in these diseases represents a high risk for the generation of antimicrobial resistance (AMR) in bacteria causing community infections. To evaluate the patterns of medical prescription for these diseases in medical offices adjacent to pharmacies, we used an adult simulated patient (SP) method representing the three diseases, AP, AD and UAUTI. Each person played a role in one of the three diseases, with the signs and symptoms described in the national clinical practice guidelines (CPGs). Diagnostic accuracy and therapeutic management were assessed. Information from 280 consultations in the Mexico City area was obtained. For the 101 AP consultations, in 90 cases (89.1%), one or more antibiotics or antivirals were prescribed; for the 127 AD, in 104 cases (81.8%), one or more antiparasitic drugs or intestinal antiseptics were prescribed; for the scenarios involving UAUTIs in adult women, in 51 of 52 cases (98.1%) one antibiotic was prescribed. The antibiotic group with the highest prescription pattern for AP, AD and UAUTIs was aminopenicillins and benzylpenicillins [27\/90 (30%)], co-trimoxazole [35\/104 (27.6%)] and quinolones [38\/51 (73.1%)], respectively. Our findings reveal the highly inappropriate use of antibiotics for AP and AD in a sector of the first level of health care, which could be a widespread phenomenon at the regional and national level and highlights the urgent need to update antibiotic prescriptions for UAUTIs according to local resistance patterns. Supervision of adherence to the CPGs is needed, as well as raising awareness about the rational use of antibiotics and the threat posed by AMR at the first level of care.<\/jats:p>","DOI":"10.3390\/antibiotics12050915","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T02:04:05Z","timestamp":1684289045000},"page":"915","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Real Practice Prescribing Antibiotics in Outpatients: A Failed Control Case Assessed through the Simulated Patient Method"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3262-2608","authenticated-orcid":false,"given":"Mar\u00eda Guadalupe","family":"Miranda-Novales","sequence":"first","affiliation":[{"name":"Unidad de Investigaci\u00f3n en An\u00e1lisis y S\u00edntesis de la Evidencia, Instituto Mexicano del Seguro Social, Centro M\u00e9dico Nacional Siglo XXI, Mexico City 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Flores-Moreno","sequence":"additional","affiliation":[{"name":"Laboratorio de Microbioma, Facultad de Medicina, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Mexico City 04510, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio","family":"Rodr\u00edguez-\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Departamento de Microbiolog\u00eda y Parasitolog\u00eda, Facultad de Medicina, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Mexico City 04510, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7111-8813","authenticated-orcid":false,"given":"Yolanda","family":"L\u00f3pez-Vidal","sequence":"additional","affiliation":[{"name":"Departamento de Microbiolog\u00eda y Parasitolog\u00eda, Facultad de Medicina, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Mexico City 04510, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Luis","family":"Soto-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda Manuel Velasco Su\u00e1rez, Mexico City 14269, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fortino","family":"Sol\u00f3rzano Santos","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n en Enfermedades Infecciosas, Hospital Infantil de M\u00e9xico Federico G\u00f3mez, Secretar\u00eda de Salud, Mexico City 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Ponce-de-Le\u00f3n-Rosales","sequence":"additional","affiliation":[{"name":"Programa Universitario de Investigaci\u00f3n Sobre Riesgos Epidemiol\u00f3gicos y Emergentes, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Mexico City 04510, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,16]]},"reference":[{"key":"ref_1","first-page":"S220","article-title":"Sistema de salud de M\u00e9xico","volume":"53","author":"Sesma","year":"2011","journal-title":"Salud P\u00fablica M\u00e9x."},{"key":"ref_2","unstructured":"Valdespino, J.L., Olaiz, G., L\u00f3pez-Barajas, M.P., Mendoza, L., Palma, O., Vel\u00e1zquez, O., Tapia, R., and Sep\u00falveda, J. (2022, January 03). Encuesta Nacional de Salud 2000. Tomo I. Vivienda, Poblaci\u00f3n y Utilizaci\u00f3n de Servicios de Salud. Instituto Nacional de Salud P\u00fablica. Available online: https:\/\/ensanut.insp.mx\/informes\/ENSA_tomo1.pdf."},{"key":"ref_3","unstructured":"Olaiz-Fern\u00e1ndez, G., Rivera-Dommarco, J., Shamah-Levy, T., Rojas, R., Villalpando-Hern\u00e1ndez, S., Hern\u00e1ndez-Avila, M., and Sep\u00falveda-Amor, J. (2022, January 03). Encuesta Nacional de Salud y Nutrici\u00f3n 2006. Instituto Nacional de Salud P\u00fablica. Available online: https:\/\/ensanut.insp.mx\/informes\/ensanut2006.pdf."},{"key":"ref_4","unstructured":"Guti\u00e9rrez, J.P., Rivera-Dommarco, J., Shamah-Levy, T., Villalpando-Hern\u00e1ndez, S., Franco, A., Cuevas-Nasu, L., Romero-Mart\u00ednez, M., and Hern\u00e1ndez-\u00c1vila, M. (2022, January 03). Encuesta Nacional de Salud y Nutrici\u00f3n 2012. Resultados Nacionales. Instituto Nacional de Salud P\u00fablica. Available online: https:\/\/ensanut.insp.mx\/informes\/ENSANUT2012ResultadosNacionales.pdf."},{"key":"ref_5","unstructured":"Chu, M., and Garcia-Cuellar, R. (2022, January 03). Farmacias Similares: Private and Public Health Care for the Base of the Pyramid in Mexico. Harvard Business School Case 307-092, January 2007. (Revised April 2011). Harvard Business School. Available online: https:\/\/hbsp.harvard.edu\/product\/307092-PDF-ENG."},{"key":"ref_6","unstructured":"Comisi\u00f3n Federal Para la Protecci\u00f3n Contra Riesgos Sanitarios (COFEPRIS), and Secretar\u00eda de Salud (2022, January 03). Avanza la Estrategia Para Regular Consultorios en Farmacias (Comunicado de Prensa, 29\/Ene\/2014). Available online: https:\/\/www.gob.mx\/cofepris\/prensa\/avanza-la-estrategia-para-regular-consultorios-en-farmacias-62847."},{"key":"ref_7","unstructured":"Secretar\u00eda de Salud (Diario Oficial de la Federaci\u00f3n, 2010). Acuerdo por el que determinan los lineamientos a los que estar\u00e1 sujeta a la venta y dispensaci\u00f3n de antibi\u00f3ticos, Diario Oficial de la Federaci\u00f3n."},{"key":"ref_8","unstructured":"Fundaci\u00f3n Mexicana Para la Salud (FUNSALUD) (2022, January 03). Estudio Sobre la Pr\u00e1ctica de la Atenci\u00f3n M\u00e9dica en Consultorios M\u00e9dicos Adyacentes a Farmacias Privadas. FUNSALUD. Available online: http:\/\/funsalud.org.mx\/portal\/wp-content\/uploads\/2015\/07\/Informe-final-CAF-v300615-e-book.pdf."},{"key":"ref_9","first-page":"3","article-title":"Consultorios adyacentes a farmacias privadas: Calidad de los servicios de salud y calidad de vida laboral (CAF)","volume":"21","year":"2016","journal-title":"Rev. Conamed"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"320","DOI":"10.21149\/spm.v57i4.7575","article-title":"Consultorios adyacentes a farmacias privadas en M\u00e9xico: Infraestructura y caracter\u00edsticas del personal m\u00e9dico y su remuneraci\u00f3n","volume":"57","author":"Idrovo","year":"2015","journal-title":"Salud P\u00fablica M\u00e9x."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e004669","DOI":"10.1136\/bmjopen-2013-004669","article-title":"Effects of the expansion of doctors\u2019 offices adjacent to private pharmacies in Mexico: Secondary data analysis of a national survey","volume":"4","author":"Doubova","year":"2014","journal-title":"BMJ Open"},{"key":"ref_12","unstructured":"World Health Organization (WHO) (2022, January 03). The World Health Report 2006: Working Together for Health. WHO. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/43432."},{"key":"ref_13","unstructured":"Comisi\u00f3n Federal Para la Protecci\u00f3n Contra Riesgos Sanitarios (COFEPRIS), and Secretar\u00eda de Salud (2022, January 03). Informe de Rendici\u00f3n de Cuentas de Conclusi\u00f3n de la Administraci\u00f3n 2012\u20132018. Available online: http:\/\/sipot.cofepris.gob.mx\/Archivos\/juridico\/COFE\/Informe_Consolidado.pdf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e363","DOI":"10.1016\/j.ecns.2011.04.008","article-title":"Standardized Patients Versus Simulated Patients: Is There a Difference?","volume":"8","author":"Churchouse","year":"2012","journal-title":"Clin. Simul. Nurs."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"119","DOI":"10.5688\/aj7005119","article-title":"Simulated patients vs. standardized patients in objective structured clinical examinations","volume":"70","author":"Austin","year":"2006","journal-title":"Am. J. Pharm. Educ."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1093\/heapol\/czu014","article-title":"Survey using incognito standardized patients shows poor quality care in China\u2019s rural clinics","volume":"30","author":"Sylvia","year":"2015","journal-title":"Health Policy Plan"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.ambp.2007.11.004","article-title":"Using unannounced standardized patients to assess residents\u2019 competency in asthma severity classification","volume":"8","author":"Ozuah","year":"2008","journal-title":"Ambul. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2774","DOI":"10.1377\/hlthaff.2011.1356","article-title":"In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps","volume":"31","author":"Das","year":"2012","journal-title":"Health Aff. (Millwood)"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1016\/S1473-3099(16)30215-8","article-title":"Use of standardised patients to assess antibiotic dispensing for tuberculosis by pharmacies in urban India: A cross-sectional study","volume":"16","author":"Satyanarayana","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e000457","DOI":"10.1136\/bmjgh-2017-000457","article-title":"Do chain pharmacies perform better than independent pharmacies? Evidence from a standardised patient study of the management of childhood diarrhoea and suspected tuberculosis in urban India","volume":"2","author":"Miller","year":"2017","journal-title":"BMJ Glob. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/j.1365-2923.2007.02999.x","article-title":"Quality of standardised patient research reports in the medical education literature: Review and recommendations","volume":"42","author":"Howley","year":"2008","journal-title":"Med. Educ."},{"key":"ref_22","unstructured":"Centro Nacional de Excelencia Tecnol\u00f3gica en Salud (CENETEC), and Secretar\u00eda de Salud (2022, January 03). Atenci\u00f3n, Diagn\u00f3stico y Tratamiento de Diarrea Aguda en Adultos en el Primer Nivel de Atenci\u00f3n (Gu\u00eda de Referencia R\u00e1pida) (05 de octubre de 2015). Available online: https:\/\/www.gob.mx\/salud\/documentos\/atencion-diagnostico-y-tratamiento-de-diarrea-aguda-en-adultos-en-el-primer-nivel-de-atencion-guia-de-referencia-rapida."},{"key":"ref_23","unstructured":"Centro Nacional de Excelencia Tecnol\u00f3gica en Salud (CENETEC), and Secretar\u00eda de Salud (2022, January 03). Gu\u00eda de Pr\u00e1ctica Cl\u00ednica. Diagn\u00f3stico y tratamiento de Faringoamigdalitis Aguda. Evidencias y Recomendaciones (2009). Available online: http:\/\/www.cenetec-difusion.com\/CMGPC\/IMSS-073-08\/ER.pdf."},{"key":"ref_24","unstructured":"Centro Nacional de Excelencia Tecnol\u00f3gica en Salud (CENETEC), and Secretar\u00eda de Salud (2022, January 03). Gu\u00eda de Pr\u00e1ctica Cl\u00ednica. Diagn\u00f3stico y Tratamiento de la Infecci\u00f3n Aguda, no Complicada del Tracto Urinario en la Mujer. Evidencias y Recomendaciones (2009). Available online: http:\/\/www.cenetec-difusion.com\/CMGPC\/IMSS-077-08\/ER.pdf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"ii11","DOI":"10.1093\/jac\/dkx503","article-title":"Defining the appropriateness and inappropriateness of antibiotic prescribing in primary care","volume":"73","author":"Smith","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1001\/jama.2016.4151","article-title":"Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010\u20132011","volume":"315","author":"Hersh","year":"2016","journal-title":"J. Am. Med. Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S116","DOI":"10.1016\/j.jval.2011.11.008","article-title":"Antibiotic-prescribing practices of primary care prescribers for acute diarrhea in New Delhi, India","volume":"15","author":"Kotwani","year":"2012","journal-title":"Value Health"},{"key":"ref_28","first-page":"545","article-title":"Antibiotic prescription for adults with acute diarrhea at King Chulalongkorn Memorial Hospital, Thailand","volume":"94","author":"Supcharassaeng","year":"2011","journal-title":"J. Med. Assoc. Thail."},{"key":"ref_29","first-page":"17","article-title":"Cumplimento Normativo en el Control de la Venta y la Dispensaci\u00f3n de Antibi\u00f3ticos en Farmacias y Perspectivas en M\u00e9xico en Combate a la Resistencia Antimicrobiana (RAM)","volume":"4","year":"2018","journal-title":"Boletin. Conamed."},{"key":"ref_30","first-page":"151","article-title":"Simulated clients in drugstores: Prescriptive behaviour of drugstore attendants","volume":"17","author":"Bronfman","year":"2000","journal-title":"J. Soc. Adm. Pharm."},{"key":"ref_31","unstructured":"Bronfman, M., and Castro, R. (1999). Coords. Salud, Cambio Social y Pol\u00edtica. Perspectivas Desde Am\u00e9rica Latina, Edamex."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e3587","DOI":"10.1097\/MD.0000000000003587","article-title":"A Systematic Review of Antibiotic Prescription Associated with Upper Respiratory Tract Infections in China","volume":"95","author":"Li","year":"2016","journal-title":"Medicine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4106","DOI":"10.1128\/AAC.00209-16","article-title":"Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections","volume":"60","author":"McKay","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_34","first-page":"651","article-title":"Update on the adverse effects of antimicrobial therapies in community practice","volume":"66","author":"Mohsen","year":"2020","journal-title":"Can. Fam. Physician"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/5\/915\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:35:55Z","timestamp":1760124955000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/5\/915"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,16]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["antibiotics12050915"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics12050915","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,16]]}}}