Non-prescription acquisition of antibiotics: Prevalence, motives, pathways and explanatory factors in the Swedish population

Abstract

Prior studies indicate prevalence of unregulated non-prescription use of antibiotics also in the northern European countries. The aim of this study is to investigate the extent to which antibiotics are acquired without prescription in Sweden, and people’s attitudes and motives linked to this practice. We use data from an online survey of a representative sample of the Swedish general population which included questions about respondents’ antibiotic use, attitudes towards antibiotics, health care contacts, self-rated health and trust in health care. We also asked about their reason for obtaining/not obtaining antibiotics without a prescription. The results show that, in the last five years, 2,3% of the respondents had acquired antibiotics in other ways than from a Swedish physician having issued a prescription, and 4,3% reported that they are likely to do so in the future. We also show that the two most important reasons for non-prescription acquisition were physicians’ refusal to prescribe antibiotics followed by travel abroad. The most important reason for not obtaining antibiotics without a prescription was to not contribute to antibiotic resistance. Using logistic regression, we show that non-prescription acquisition of antibiotics, and the intention to engage in this practice in the future, are strongly associated with low trust in health care.

Challenges and Obstacles for Veterinary Antimicrobial Agents’ Data Collection for an “One Health” European Goal to Address Antimicrobial Resistances

“…A possible type of under-reporting that has been identified but is not considered as such in the reports originates in the legislation of some countries themselves. The acquisition of antibiotics without prescription, for instance, is a critical issue, even for countries that achieved their objective, have strong collecting systems, and have never officially underreported, like Sweden [10].…”

A survey on self-medication for the prevention or treatment of COVID-19 and distrust in healthcare of veterans in a primary care setting in the United States

“…In contrast, a link between self-medication with antibiotics and distrust in healthcare was seen in a cohort of 4243 Swedish survey respondents. 8 Other studies have documented an association between trust in the healthcare provider and delay of antibiotics; however, there is limited data on the link between trust in the healthcare system and the use of antibiotics. 28 , 29 …”

“…In contrast, a link between selfmedication with antibiotics and distrust in healthcare was seen in a cohort of 4243 Swedish survey respondents. 8 Other studies have documented an association between trust in the healthcare provider and delay of antibiotics; however, there is limited data on the link between trust in the healthcare system and the use of antibiotics. 28,29 The overall distrust score among our survey respondents was a mean (SD) of 2.2 (0.6) or a composite score of 19.9 (15.9), which is moderate and falls between rates reported in studies in the United States.…”

“… 3 , 6 , 7 Poor access to care and distrust may be associated with use of medications without medical guidance. 6 , 8 A systematic review by Ayosanmi et al on self-medication practices for prevention and treatment of COVID-19 found that prevalence of self-medication ranged widely (from 3% to 96% in various countries and different study populations), but this review did not include any studies from the United States.…”

Fighting the hidden pandemic of antimicrobial resistance in paediatrics: recommendations from the International Pediatric Association

“…Even in Sweden, a country with very strong legislation and regulation of antibiotics, a recent survey showed that 2.3% of the respondents had acquired antibiotics without prescription. 5 This will require careful attention to access to healthcare so children who require antibiotics can secure an appropriate drug at the correct dose for the ideal length of time after evaluation by a healthcare provider. An important point is to establish the early diagnosis of the infection, demanding the adequate taking of samples, the request for cultures and the use of molecular tools that identify the aetiology and avoid the inappropriate administration of antibiotics.…”