Nonprescription Antimicrobial Use in a Primary Care Population in the United States

Abstract

c Community antimicrobial resistance rates are high in communities with frequent use of nonprescription antibiotics. Studies addressing nonprescription antibiotic use in the United States have been restricted to Latin American immigrants. We estimated the prevalence of nonprescription antibiotic use in the previous 12 months as well as intended use (intention to use antibiotics without a prescription) and storage of antibiotics and examined patient characteristics associated with nonprescription use in a random sample of adults. We selected private and public primary care clinics that serve ethnically and socioeconomically diverse patients. Within the clinics, we used race/ethnicity-stratified systematic random sampling to choose a random sample of primary care patients. We used a self-administered standardized questionnaire on antibiotic use. Multivariate regression analysis was used to identify independent predictors of nonprescription use. The response rate was 94%. Of 400 respondents, 20 (5%) reported nonprescription use of systemic antibiotics in the last 12 months, 102 (25.4%) reported intended use, and 57 (14.2%) stored antibiotics at home. These rates were similar across race/ethnicity groups. Sources of antibiotics used without prescriptions or stored for future use were stores or pharmacies in the United States, "leftover" antibiotics from previous prescriptions, antibiotics obtained abroad, or antibiotics obtained from a relative or friend. Respiratory symptoms were common reasons for the use of nonprescription antibiotics. In multivariate analyses, public clinic patients, those with less education, and younger patients were more likely to endorse intended use. The problem of nonprescription use is not confined to Latino communities. Community antimicrobial stewardship must include a focus on nonprescription antibiotics.

Prevalence of ‘unused’ antibiotics at homes in a central Indian district

“…5 Zoorob et al, in a study conducted in the USA observed that 14.2% of the respondent reported that they have antibiotics at their home. 6 An Iranian household survey reported that antibiotics were found in 9.8% of homes. 7 In our study, the most common point of origin for the unused antibiotics were public hospitals.…”

“…A study on unprescribed antibiotics usage in the USA also reported that about 74.0% of the respondents used leftover antibiotics. 6 A household survey conducted in Iran reported that 9.8% of homes had unused antibiotics left-overs from doctors' prescriptions. 7 We observed that most common health conditions for which the unused antibiotics were originally procured was the respiratory tract infection, followed by diarrhoea, followed by fever.…”

“…5 The study conducted in the USA also reported that most common reason for using unprescribed antibiotics was respiratory symptoms followed by urinary tract infections, tooth pain, stomach pain, and infection in general. 6 The most common formulation in which antibiotics were found in the homes were tablets/capsules. Similar to our study, the survey conducted in Iran also noted that most common formulations of unused antibiotics at home were capsule/tablets.…”

“…5 About 5% respondent of a study conducted in the USA reported having obtained nonprescription antibiotic in the last 12 months. 6 Those who procure the antibiotics without prescription are not informed of either the correct dosage or the duration for which the antibiotics are needed to be taken. As a result, they might not consume all the antibiotics they bought over the counter.…”

“…A systematic search for published literature was conducted using PubMed for designing the questionnaire. [5][6][7][8][9] We also consulted WHO's manual "How to investigate the use of medicines by consumers" for the construction of questionnaire. 10 The questionnaire had two parts: first part collected data related to the sociodemographic variable of household and the second part of questionnaire collected data related to unused antibiotics.…”