Cost, availability and affordability of antibiotics in Islamic Republic of Iran

Cost, availability and accessibility can influence the patterns of antibiotic use, adherence to prescriptions and the development of antimicrobial resistance.

To assess the cost, availability and affordability of antibiotics in Islamic Republic of Iran using the WHO access, watch and reserve classification.

We analysed secondary data for March 2023 to March 2024 on cost, availability and affordability of antibiotics in Islamic Republic of Iran, using the WHO access, watch and reserve classification. Cost and affordability were compared between the access, watch and reserve antibiotic groups using the Kruskal-Wallis and Mann-Whitney U tests. P ≤ 0.05 was considered statistically significant.

Most injectable antibiotics were unaffordable while most oral formulations were affordable. Among the injectables, streptomycin was the cheapest (15 000 IRR/defined daily dose), followed by procaine-benzylpenicillin (82 325 IRR/defined daily dose), while temocillin was the most expensive (25 828 000 IRR/defined daily dose). However, streptomycin and temocillin were not in the essential medicines list. Among the orals, nitrofurantoin was the cheapest (12 370 IRR/defined daily dose) while linezolid was the most expensive (1 030 558 IRR/defined daily dose). There were statistically significant differences in prices (P = 0.007) and affordability (P = 0.035) between the access, watch and reserve groups. Affordability was significantly lower for the reserve group of antibiotics (P = 0.04).

Our findings show that although access antibiotics remain largely affordable, watch group antibiotics were used excessively. Targeted policies are needed on the pricing, production, distribution, and prescription of antibiotics in Islamic Republic of Iran to promote rational use and curb antimicrobial resistance.