E-Mycin (erythromycin) Drug / Medicine Information

NOTICE: This Consumer Medicine Information (CMI) is intended for persons living in Australia.

erythromycin (as ethyl succinate)

CONSUMER MEDICINE INFORMATION

What is in this leaflet

This leaflet answers some common questions about E-Mycin tablets and mixtures.

It does not contain all the available information. It does not take the place of talking
to your doctor or pharmacist.

All medicines have benefits and risks. Your doctor has weighed the risks of you taking
E-Mycin against the benefits expected for you.

If you have any concerns about taking this medicine, talk to your doctor or pharmacist.

Keep this leaflet with your medicine.

You may need to read it again.

What E-Mycin is used for

E-Mycin is used to:

treat certain bacterial infections

control acne, in addition to other acne treatments

prevent infections in people with a history of rheumatic disease, congenital heart
disease or other acquired valvular heart disease and who are allergic to penicillin
antibiotics.

E-Mycin is an antibiotic that belongs to a group of medicines called macrolides. These
medicines work by killing or stopping the growth of bacteria, which cause infections
or make acne worse.

E-Mycin will not work against infections caused by viruses, such as colds or flu.

Ask your doctor if you have any questions about why E-Mycin has been prescribed for
you.

Your doctor may have prescribed E-Mycin for another reason.

E-Mycin is available only with a doctor’s prescription.

There is no evidence that E-Mycin is addictive.

Before you take E-Mycin

When you must not take it

Do not take E-Mycin if you are allergic to:

medicines containing erythromycin (e.g. EES) or any other antibiotic from the macrolide
group (e.g. clarithromycin, roxithromycin)

any of the ingredients listed at the end of this leaflet.

Some of the symptoms of an allergic reaction may include:

Skin rash, itching or hives;

Swelling of the face, lips, tongue or other parts of the body;

Shortness of breath, wheezing or troubled breathing.

Do not take E-Mycin if you are taking any of the following medicines:

terfenadine or astemizole

cisapride, pimozide or domperidone

class IA and III antiarrhythmics e.g. quinidine, disopyramide, procainamide, amiodarone
and sotalol

certain neuroleptics and tri- and tetracyclic antidepressants

arsenic trioxide, methadone, budipine, certain fluoroquinolones, imidazole anti-mycotics
and anti-malarials e.g. petamidine i.v.

simvastatin, lovastatin or atorvastatin

ergotamine or dihydroergotamine

Taking E-Mycin with any of the above medicines may cause serious side effects.

Ask your doctor or pharmacist if you are not sure if you are taking one of the above
medicines.

Do not take E-Mycin if you have:

severe liver disease

heart rhythm disorders from birth of have developed it

irregular heartbeat or severe chronic heart failure

deficiency of potassium and magnesium in blood

Do not take E-Mycin if the packaging shows signs of tampering or the tablets or mixtures
do not look quite right.

Do not take E-Mycin if the expiry date (EXP) printed on the label has passed.

If you take this medicine after the expiry date, it may not work as well.

Do not use any E-Mycin mixture left in the bottle after 10 days.

If you are not sure whether you should start taking E-Mycin, talk to your doctor.

Before you start to take it

Tell your doctor if you are allergic to any other medicines, foods, dyes or preservatives.

Tell your doctor if you are pregnant or plan to become pregnant.

Your doctor will discuss the risks and benefits of taking E-Mycin during pregnancy.

Tell your doctor if you are breastfeeding or wish to breastfeed.

Your doctor will discuss the risks and benefits of taking E-Mycin when breastfeeding.

Tell your doctor if you have any medical conditions including:

liver problems

heart problems

myasthenia gravis, a condition in which the muscles become weak and tire easily

eye disorder

pneumonia

If you have not told your doctor about any of the above, tell them before you start
taking E-Mycin.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including medicines
you can buy without a prescription from a pharmacy, supermarket or health food shop.

Some medicines may interfere with EES. These include:

medicines used to prevent blood clotting, such as warfarin, acenocoumarol

some medicines used for epilepsy such as phenytoin, carbamazepine, hexobarbital, phenobarbital
(phenobarbitone) and valproate

theophylline, a medicine used to treat asthma

diltiazem, verapamil, felodipine and mibefradil, medicines used to treat high blood
pressure and certain heart conditions

digoxin, a medicine used to treat heart failure

omeprazole and cimetidine, used to prevent ulcers by reducing amount of acid produced
in stomach

ciclosporin, used to prevent organ transplant rejection or to treat certain problems
with the immune system

tacrolimus, used as an adjunct to kidney transplantation

triazolam, zopiclone and midazolam, used to treat sleeplessness

nefazodone and St. John’s wort, medicines used to treat depression

alprazolam used to treat anxiety disorders

methylprednisolone, a corticosteroid

vinblastine, a medicine used to treat Hodgkin’s Disease

sildenafil, used to treat erectile dysfunction in adult males

mizolastine and ebastine medicines used to treat allergies such as hay fever

ritonavir, used to treat infections in patients with advanced HIV infection

medicines used to treat fungal infections such as ketoconazole, itraconazole, fluconazole

rifabutin, rifampicin, clindamycin, lincomycin, chloramphenicol, streptomycin, colistin
and bactericidal betalactam antibiotics (e.g. penicillin, cephalosporin)

bromocriptine, used to treat various conditions including Parkinson’s Disease

colchicine, used for pain relief in gout

alfentanil, a medicine used for pain relief during anaesthesia

cilostazol, a medicine used in the treatment of painful calves, due to poor blood
flow to the muscles

diphenoxylate with atropine used to treat diarrhoea

opiates used as analgesics.

Your doctor can tell you what to do if you are taking any of these medicines. You
may need different amounts of yours medicines, or you may need to take different medicines.

If you are not sure whether you are taking any of these medicines, check with your
doctor or pharmacist.

Your doctor and pharmacist have more information on medicines to be careful with or
avoid while taking E-Mycin.

How to take E-Mycin

Follow all directions given to you by your doctor and pharmacist carefully.

They may differ from the information contained in this leaflet.

If you do not understand the instructions on the bottle, ask your doctor or pharmacist
for help.

How much to take

The usual adult dose is one E-Mycin tablet (400 mg) every six hours but this may vary
from person to person.

Your doctor will tell you how many tablets you will need to take. This depends on
the infection being treated and how severe it is.

For children, their doctor will work out the dose according to their age, body weight
and how severe the infection is.

Your doctor will adjust the amount or frequency of your doses according to the infection
being treated and the severity of the condition.

How to take it

Tablets: Swallow whole with a glass of water.

Mixture: Always shake the bottle well before using a metric measure to measure the
correct dose.

Shaking the bottle and using a medicine measure will make sure that you get the correct
dose. You can buy a medicine measure from your pharmacist.

When to take it

Space the doses of E-Mycin evenly apart and take them at about the same time each
day.

This will allow E-Mycin to have its best effect and also help you to remember when
to take it.

E-Mycin can be taken with or without food. However, taking E-Mycin with food may help
reduce the chance of a stomach upset occurring.

How long to take it for

Keep taking E-Mycin until you finish the tablets or mixture, or for as long as your
doctor recommends.

If you are being treated for an infection, E-Mycin is usually taken for one to two
weeks. Your infection may not clear completely if you stop taking your medicine too
soon.

For controlling acne, E-Mycin is normally taken for a few months.

Check with your doctor if you are not sure how long you should be taking E-Mycin.

If you forget to take it

If it is almost time for your next dose, skip the dose you missed and take your next
dose when you are meant to.

Otherwise, take the missed dose as soon as you remember, and then go back to taking
your medicine as you would normally.

Do not take a double dose to make up for the dose you missed.

If you have any questions or are not sure what to do, ask your doctor or pharmacist.

If you take too much (overdose)

Immediately telephone your doctor, or the Poisons Information Centre (telephone 13
11 26), or go to Accident and Emergency at the nearest hospital, if you think you
or anyone else may have taken too much E-Mycin.

Do this even if there are no signs of discomfort or poisoning.

You may need urgent medical attention.

If you take too much E-Mycin, you may have nausea, vomiting or problems with your
hearing.

While you are taking E-Mycin

Things you must do

If you are taking E-Mycin for an infection and your symptoms do not improve within
a few days, or if they become worse, tell your doctor.

If your baby develops irritability with feeding or has severe vomiting during treatment
with E-Mycin, tell your doctor immediately. This may be a sign of a stomach disorder
in the infant.

If you are about to be started on any new medicine, remind your doctor and pharmacist
that you are taking E-Mycin.

Tell any other doctors, dentists, and pharmacists who treat you that you are taking
this medicine.

If you are going to have surgery, tell the surgeon or anaesthetist that you are being
given this medicine.

It may affect other medicines used during surgery.

If you become pregnant while taking E-Mycin, tell your doctor.

If you get severe diarrhoea, tell your doctor or pharmacist immediately. Do this even
if it occurs several weeks after you have stopped taking E-Mycin.

Do not take any diarrhoea medicine without checking with your doctor.

Diarrhoea may mean that you have a serious condition affecting your bowel. You may
need urgent medical care.

If you have to have any urine tests, tell your doctor you are taking E-Mycin.

E-Mycin may affect the results of some tests.

If you develop itching with swelling or skin rash or difficulty breathing while you
are taking E-Mycin, do not take any more and contact your doctor immediately.

If you get a sore, white mouth or tongue while taking or soon after stopping E-Mycin,
tell your doctor. Also tell your doctor if you get vaginal itching or discharge.

This may mean you have a fungal infection called thrush. Sometimes, the use of E-Mycin
allows fungi to grow and the above symptoms to occur. E-Mycin does not work against
fungi.

Things you must not do

Do not use E-Mycin to treat any other conditions unless your doctor tells you to.

Do not give E-Mycin to anyone else, even if they have the same condition as you.

Do not stop taking E-Mycin, even if you feel better after a few days, unless advised
by your doctor.

If you stop taking E-Mycin too soon, the infection may not clear completely or your
symptoms may return.

If possible, your doctor will gradually reduce the amount you take each day before
stopping the medicine completely.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you
are taking E-Mycin.

E-Mycin treats infections and controls acne in most people, but it may have unwanted
side effects in some people.

All medicines can have side effects. Sometimes they are serious, most of the time
they are not. You may need medical treatment if you get some of the side effects.

Ask your doctor or pharmacist to answer any questions you may have.

Do not be alarmed by this list of possible side effects.

You may not experience any of them.

If any of the following happen, stop taking E-Mycin and tell your doctor immediately
or go to Accident and Emergency at the nearest hospital:

signs of an allergic reaction such as any type of skin rash, itching, or hives; swelling
of the face, lips, tongue or other parts of the body; shortness of breath, wheezing,
troubled breathing

watery and severe diarrhoea, which may also be bloody.

The above list includes very serious side effects. You may need urgent medical attention
or hospitalisation.

Tell your doctor immediately or go to Accident and Emergency at the nearest hospital
if you notice any of the following:

yellowing of the eyes or skin (jaundice)

severe stomach cramps

feeling generally unwell and having poor appetite

loss of hearing

ringing or buzzing in the ears

fast, irregular or pounding heart beat, palpitations

chest pain

muscle pain, weakness and joint swelling

dizziness, drowsiness, confusion, hallucinations, fits

any type of skin rash, itching, hives, serious scaly red rash with bumps under skin
and blisters

severe diarrhoea especially if bloody

any vision problems.

in infants, irritability with feeding or severe vomiting.

The above list includes serious side effects which may require medical attention.

Tell your doctor if you notice any of the following and they worry you:

stomach cramps and pains

feeling sick, vomiting, accumulation of gas and severe diarrhoea

oral thrush (white, furry sore tongue and mouth)

vaginal thrush (sore and itchy vagina, vaginal discharge).

Weight loss

Fever, headache

The above list includes the more common and mild side effects of E-Mycin.

Tell your doctor if you notice anything that is making you feel unwell.

Other side effects not listed above may also occur in some people.

After you have finished taking E-Mycin

Tell your doctor immediately if you notice any of the following side effects, particularly
if they occur several weeks after stopping treatment with E-Mycin:

severe abdominal cramps or stomach cramps

watery and severe diarrhoea, which may also be bloody

fever, in combination with one or both of the above.

You may have a serious condition affecting your bowel. These are rare but serious
side effects. Therefore, you may need urgent medical attention.

Do not take any medicine for diarrhoea without first checking with your doctor.

After taking E-Mycin

Storage

Keep E-Mycin where children cannot reach it.

A locked cupboard at least one-and-a-half metres above the ground is a good place
to store medicines.

Keep E-Mycin tablets in a cool, dry place where the temperature stays below 30°C.

Keep E-Mycin mixture in the refrigerator but not in the freezer.

Do not use any mixture left in the bottle after 10 days.

Do not store E-Mycin or any other medicine in the bathroom or near a sink.

Do not leave E-Mycin in the car or on window sills.

Heat and dampness can destroy some medicines.

Disposal

If your doctor tells you to stop taking E-Mycin, or your medicine has passed its expiry
date, ask your pharmacist what to do with any that is left over.

Product description

What it looks like

E-Mycin is available as a tablet and mixture.

Tablets are flesh pink in colour, oval-shaped, film-coated and marked “E-N” on one
side and a Greek alpha symbol on the other. Each pack contains 25 tablets.

Mixtures are available as two strengths:

E-Mycin 200

E-Mycin 400.

Both mixtures are pink, cherry flavoured and sugar-free. Each bottle contains 100
mL of mixture.

Ingredients

The active ingredient in E-Mycin tablets and mixtures is erythromycin (as erythromycin
ethyl succinate).

E-Mycin tablets

E-Mycin tablets contain 400 mg of erythromycin (as erythromycin ethyl succinate).

The E-Mycin tablets also contain the following inactive ingredients:

calcium hydrogen phosphate anhydrous

maize starch

sorbic acid

povidone

purified talc

sodium starch glycollate

magnesium stearate

Opadry Pink OY-B-34901 (contains colours titanium dioxide CI 77891[171]), iron oxide
red CI 77491 [172]).

E-Mycin tablets do not contain lactose, sucrose, gluten, tartrazine or any other azo
dyes.

E-Mycin mixtures

E-Mycin 200 – each 5 mL contains 200 mg of erythromycin (as erythromycin ethyl succinate).

E-Mycin 400 – each 5 mL contains 400 mg of erythromycin (as erythromycin ethyl succinate).

The mixtures also contain the following inactive ingredients:

sorbitol

propylene glycol alginate

sodium citrate

colloidal anhydrous silica

aspartame (951)

sodium benzoate (211)

erythrosine CI45430 (127)

Trusil Nature Identical Cherry Flavour (contains preservative 320).

E-mycin mixtures contain benzoates, aspartame, phenylalanine and sorbitol.

Products containing sorbitol may have a laxative effect or cause diarrhoea.

Phenylketonurics are warned that this product contains phenylalanine.

E-Mycin mixtures do not contain lactose, sucrose, gluten, tartrazine or any other
azo dyes.

Manufacturer

E-Mycin is made in Australia by:

Alphapharm Pty Ltd

Level 1, 30 The Bond

 30-34 Hickson Road

Millers Point NSW 2000

www.mylan.com.au

Australian Registration Numbers:

Tablet:

E-Mycin – AUST R 71310

Mixtures:

E-Mycin 200 – AUST R 48286

E-Mycin 400 – AUST R 48287

This leaflet was prepared in August 2021..

e-mycin_cmi/Aug21

Antibiotics: The Classy Medication! | CareerStep

I chose the title for this blog article for two reasons. First of all, antibiotics are amazing medicines and secondly, when it comes to the final exam, students quite frequently miss questions that deal with the different classes of antibiotics.

The American Academy of Pediatrics recently updated an article entitled The History of Antibiotics published on www.healthychildren.org. If you have some time, it’s an interesting read. I would like to pull out just a couple of paragraphs from it to show why I think antibiotics are classy.

The term antibiotics literally means “against life”; in this case, against microbes, and the discovery of antimicrobial drugs (antibiotics) was one of the most significant medical achievements of the 20th century.

• Before antibiotics, 90% of children with bacterial meningitis died. Among those children who lived, most had severe and lasting disabilities, from deafness to mental retardation.
• Strep throat was at times a fatal disease, and ear infections sometimes spread from the ear to the brain, causing severe problems.
• Other serious infections, from tuberculosis to pneumonia to whooping cough, were caused by aggressive bacteria that reproduced with extraordinary speed and led to serious illness and sometimes death.

Through his discovery of penicillin in the 1920s, British scientist Alexander Fleming won the Nobel Prize in Physiology and Medicine. By 1941, other researches in Europe and the United States found that even low levels of penicillin cured very serious infections and saved many lives, and by the mid to late 1940s, it became widely accessible to the general public and newspapers hailed it as a “miracle drug!”

The first class of antibiotics we’ll discuss are the penicillins. A few of the most common of these are:  amoxicillin, ampicillin, dicloxacillin, nafcillin, and piperacillin. Notice that penicillins end in “cillin.” (a great study tip!) Some well-known brand names are Amoxil and Augmentin.

Another class of antibiotics are the, cephalosporins. These are broad-spectrum antibiotics because they are used on strains of bacteria that have become resistant to penicillin. You will recognize some of these brand names: Keflex, Rocephin, Ceftin. Looking at some of the generic names, you’ll again see a pattern you can remember for testing: cefuroxime, cefprozil, ceftriaxone, and cephalexin.  They all begin with the “cef” sound which sounds a lot like cephalosporin, right?

So what’s the alternative if a patient is allergic to penicillin? Macrolide antibiotics. These types of antibiotics reduce production of proteins, which bacteria need to survive, and this slows the growth of or even kills the bacteria. The most common macrolides are Zithromax (azithromycin), Biaxin (clarithromycin), and Ery-Tab (erythromycin). Notice that they all end in “mycin.”

One last class that we’ll talk about is quinolones. These work on bacteria by making it difficult or impossible to repair their DNA, and you’re probably familiar with these: Cipro (ciprofloxacin) and Levaquin (levofloxacin). Study tip: they both end in “floxacin.”

We will conclude this with a few important notes about antibiotics in general that you will need to know.

• Metronidazole (Flagyl) – Do not drink alcohol while taking this medication (not fun side effects)!
• Vancomycin – Fairly toxic and is considered a “drug of last resort.”
• Female patients will need to be informed that contraceptives can be less effective while taking an antibiotic and backup contraception should be used while taking the antibiotic.
• Penicillins or sulfa-containing medications should be counted on dedicated counting trays because of the high prevalence of penicillin and sulfa allergy in the general population.

GBUZ VO “Suzdal Republic of Belarus” – 7 dangers of uncontrolled use of antibiotics

7 dangers of uncontrolled use of antibiotics

Antibiotics are necessary for the treatment of many infections, but they lose their effectiveness. Bacteria resist their influence by adapting and finding ways to survive after exposure to such drugs.

Bacteria and medicine fight

Bacterial cells are very adaptable – they can naturally become resistant to antibiotics over time, but we make things worse by overuse

and misuse of our medicines. This is already a risky situation, and it will only get worse if we do not take urgent action.

Here are the top 6 causes of antibiotic resistance. They are associated with factors such as:

• Overprescription of antibiotics.
• Large number of patients who did not complete a full course of antibiotics.
• Overuse of antibiotics in livestock and fish farming.
• Poor infection control in healthcare facilities.
• Poor hygiene and sanitation.

Antibiotic discovery challenge

The use of antibiotics has saved millions of lives, but their widespread use to treat any infection, whether serious, minor or even viral, has led to an increase in antibiotic resistance. Antibiotics target bacteria exclusively, but sometimes it’s hard to tell viral from bacterial infections without expensive tests.

Proactive antibiotics are often faster and easier than taking precautions and prescribing only the right treatment.

Another problem with antibiotics is the inability to control their use by the patient. Doses of antibiotics are designed to kill entire populations of pathogens. When antibiotics are not taken for the entire prescribed course, pathogenic bacteria can adapt to the presence of antibiotics at low doses and eventually form a population that is completely resistant to the antibiotic regardless of dosage.

The use of antibiotics is also not limited to humans. Every day antibiotics are used in the treatment of livestock and fish to prevent infections. Similar to overuse in humans, uncontrolled use of antibiotics creates a reservoir of bacteria that can become resistant, rendering the antibiotic useless.

As cities become more densely populated, people are exposed to more pathogens all the time. Hospitals and clinics are accepting more and more patients with infections, and it is not always possible to contain the spread of the pathogen in the population. Detecting, isolating, or treating all infectious diseases is often not feasible, resulting in the addition of new pathogens to the local community. Combined with the lack of hygiene, healthcare facilities are the perfect breeding ground for bacteria.

Finally, one of the latest contributing factors to antibiotic resistance is the lack of new antibiotics under development. After an unprecedented number of antibiotic discoveries over the past 40 years, the number of new antibiotics being discovered has fallen to an all-time low. Without new drugs to combat the ever-increasing incidence of antibiotic resistance, society lacks options for treating infections.

7 reasons why it is dangerous to take antibiotics without control

1. No antibiotics or 19th century health care

If we lose our antibiotics, it will be like going back in time, where infections we now consider minor can become fatal. An infected cut can be life-threatening, and a disease like pneumonia will again become a mass killer.

2. There may not be new drugs

Recently, not a single fundamentally new class of antibiotics has appeared on the shelves of pharmacies. Even if we find more drugs, simply replacing old antibiotics with new ones is not the best option, as they may also become ineffective.

3. Antibiotic resistance already exists

When we discuss antibiotic resistance, we are talking about a frightening future and trying to prevent the problem from getting worse. But this does not mean that this is a problem only for future generations. An estimated 25,000 people already die each year in Europe due to antibiotic-resistant infections.

4. Cancer chemotherapy and effective antibiotics go hand in hand

Chemotherapy is an important weapon in the fight against cancer, but did you know that this procedure destroys our white blood cells, which we need to fight infection? Without antibiotics, chemotherapy will become more dangerous.

5. Our greatest medical achievements are at stake

Organ transplantation is a marvel of modern medicine, but we need antibiotics to help the transplant patient because the transplant procedure itself can lead to infection. Plus, patients are given drugs that intentionally suppress their immune systems so that their bodies don’t reject the new organ. This suppression of the immune system makes the patient more susceptible to bacterial infections. If we lose our antibiotics, the transplant will become more risky or even impossible.

6. Everyone is at risk

Sometimes there is talk that antibiotic resistance is a “global problem”. And this problem affects all of us directly. For example, if you are given antibiotics when you don’t need them, you risk introducing antibiotic-resistant bacteria into your gut. If these bacteria continue to cause an infection, antibiotics may not work when you really need them. Sometimes antibiotics are needed very urgently. Have you heard of sepsis? It is a common and potentially life-threatening disease caused by an infection. The best way to manage sepsis is to treat it quickly with antibiotics. We probably don’t need to tell you what will happen if we run out of antibiotics to treat this infection.

7. What if you need surgery?

None of us wants to think about illness or major surgery, but we all understand that surgery can save lives. But a complex operation is associated with the risk of infection. Take heart bypass surgeries or joint replacements for example – if we don’t have antibiotics, these procedures, which are supposed to help people and alleviate suffering, may actually lead to more deaths caused by bacterial infections.

Antibiotic resistance is costing mankind dearly, but it is a problem that is costing us. If we don’t act, the problem will become more and more expensive, the drugs will only increase in price.

That is why it is important to stop taking antibiotics now! If you think you need an antibiotic, talk to several doctors about the results of the tests and never prescribe these drugs yourself.

Be healthy!

Why is the use of antibiotics without indications harmful?

Author – Administrator character.
Immediately about the current situation: coronavirus infection COVID 19 with or without pneumonia is NOT TREATED with antibiotics! Antibiotics can only work on bacteria and some protozoa, but they are basically incapable of acting on viruses. Why, then, in the spring in the USA and Europe, and then in our country, did they use azithromycin? Because it was supposed to act, let’s say, with its “side effect” on this disease, but this effect was not confirmed.
Antibiotics do not prevent bacterial complications! A bacterial infection can easily develop after a “prophylactic course” of antibiotics. But sometimes antibiotics may be prescribed in situations where the likelihood of developing a bacterial infection is very high, such as in patients with severe chronic obstructive pulmonary disease (COPD).
Antibiotics are not harmless medicines, they can cause serious side effects. It is one thing if they are used according to indications, for example, for the treatment of bacterial pneumonia, that is, the benefit outweighs the risk of possible side effects. Another thing is when a patient is prescribed an antibiotic based on similar reasons that are not an indication for antibiotic therapy: “you have been sick for 5 days”, “you have had a temperature for 3 days”, “you have a high ESR”, etc. Thus, patients who do not benefit from treatment may only experience side effects, such as antibiotic-associated diarrhea, tendon rupture, etc.
The problem of represcribing antibiotics is aggravated even more by the fact that in our country there is actually an over-the-counter sale of these drugs, that is, the patient prescribes treatment for himself, and also the pharmacist at the pharmacy advises.