Restricting over-the-counter antibiotics to save the world from superbugs caused a 26 percent spike in hospitalizations for poor children.
April 24, 2026
Original Paper
Prescription Rules and Child Health Inequality
SSRN · 6598518
The Takeaway
Public health policies designed to reduce antibiotic resistance often ignore the barriers they create for families without easy access to doctors. When sales were restricted to prescription-only to slow down the evolution of resistant bacteria, pediatric hospitalizations rose sharply among low-income households. These families could no longer afford the entry fee of a doctor's visit just to get a basic medicine. A policy intended for global stewardship ended up creating a lethal trade-off that punished the most vulnerable. True health equity requires considering how global environmental goals impact the local ability to treat a sick child.
From the abstract
Restricting over-the-counter antibiotic sales can improve antimicrobial stewardship but may also raise the cost of treatment where access to prescribers is limited. Brazil's 2011 antibiotic regulation required prescriptions for all dispensing nationwide, creating a common policy shock whose local bindingness depended on pre-existing physician supply. Exploiting cross-municipal variation in physician density before the reform, the estimates show no detectable average effect on pediatric lower-res