Despite warnings from experts, the overuse of antibiotics continues to be a leading cause of the development of drug-resistant superbugs.

Previous research has suggested that many people throughout the United States self-diagnose and self-prescribe antibiotics, oftentimes when this therapy is unnecessary. Data also show that antimicrobial resistance at the community level is high in areas with frequent use of non-prescription antibiotics.

“Most studies addressing non-prescription antibiotic use in the U.S. have been restricted to Latin American immigrants, but more socioeconomically and ethnically diverse data are needed,” explains Larissa Grigoryan, MD. To address this research gap, Dr. Grigoryan and colleagues had a study published in Antimicrobial Agents and Chemotherapy that estimated the prevalence of non-prescription antibiotic use in the previous 12 months. The analysis involved 400 adults who were treated at socioeconomically and ethnically diverse family practice clinics across the Houston area. Participants were given a self-administered standardized questionnaire on antibiotic use, asking about intended use and storage of antibiotics as well as patient characteristics associated with non-prescription use.

A Significant Problem

Approximately 5% of respondents reported using systemic antibiotics without a prescription for them in the last 12 months, meaning that many adults appear to hoard antibiotics. “About 25% of our respondents reported that they intended to use antibiotics without consulting a doctor first,” says Dr. Grigoryan. Another 14% of survey respondents noted that they stored antibiotics at home.

“Rates of non-prescription antibiotic use, intention for use, and storage were similar across racial and ethnic groups,” Dr. Grigoryan adds. “The problem of non-prescription use does not appear to be confined to Latino communities.”


Related: Many Adults ‘Hoarding,’ Self-Prescribing Antibiotics


In terms of the sources for antibiotics used by survey participants without a prescription, 40% had obtained them from a store or pharmacy in the U.S. and 12% had leftover antibiotics from previous prescriptions. In addition, 24% used non-prescription antibiotics that were obtained abroad and 20% used non-prescription antibiotics were received from relatives or friends. For storage of antibiotics, the major source was leftover antibiotics from previous prescriptions (74%). In 4% of cases, antibiotics used without a prescription were drugs intended for use in animals rather than humans. “Public clinic patients, those with less education, and younger patients were more likely to express intention to use antibiotics without a prescription,” says Dr. Grigoryan.

Analyzing Implications

Respiratory symptoms, such as a sore throat, runny nose, or cough, were commonly reported reasons for using antibiotics without a prescription. These are conditions that typically would get better without any antibiotic treatment. “In addition to increasing risks for antimicrobial resistance,” Dr. Grigoryan says,” self-diagnosis and treatment with previously prescribed antibiotics puts patients at risk for potentially dangerous side effects.” These include disruption of bowel bacteria, diarrhea, and other ailments.  Even if the choice of a previously used antibiotic is appropriate, the quantity will be insufficient to cure most ailments due to previous use.

“The overuse of antibiotics is a major health concern that warrants further investigation,” Dr. Grigoryan says. “Costs, access to care, and difficulty getting doctor’s appointments may be driving some of this non-prescription use, but we need data to better understand the reasons behind this phenomenon.” Regardless of the reasoning, Dr. Grigoryan notes that the findings highlight the need for community antimicrobial stewardship to focus more on non-prescription antibiotic use.

Larissa Grigoryan, MD, has indicated to Physician’s Weekly that she has no financial disclosures to report.

References

Zoorob R, Grigoryan L, Nash S, Trautner BW. Non-prescription antimicrobial use in a primary care population in the United States: evidence for action. Antimicrob Agents Chemother. 2016 Jul 11 [Epub ahead of print]. Available at: http://aac.asm.org/content/early/2016/06/22/AAC.00528-16.abstract?sid=68c26512-c6a4-4242-9fba-6c4ba0aedec9.

Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis. 2011;11:692-701.

Spellberg B, Guidos R, Gilbert D, et al. The epidemic of antibiotic-resistant infections: A call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis. 2008;46:155-164.