Background:
Use of antibiotics without a prescription may increase unnecessary and inappropriate drug use or doses as well as global risk for antimicrobial resistance.
Purpose:
To perform a scoping review of research on the prevalence of nonprescription antibiotic use in the United States and to examine the factors that influence it.
Data Sources:
Searches of PubMed, EMBASE, CINAHL, Scopus, and relevant Web sites without language restrictions from January 2000 to March 2019.
Study Selection:
Studies reporting nonprescription use of antibiotics, storage of antibiotics, intention to use antibiotics without a prescription, and factors influencing nonprescription use.
Data Extraction:
Two reviewers independently screened citations and full texts and performed data abstraction.
Data Synthesis:
Of 17 422 screened articles, 31 met inclusion criteria. Depending on population characteristics, prevalence of nonprescription antibiotic use varied from 1% to 66%, storage of antibiotics for future use varied from 14% to 48%, and prevalence of intention to use antibiotics without a prescription was 25%. Antibiotics were obtained without a prescription from various sources, including previously prescribed courses, local markets or stores, and family or friends. Reported factors contributing to nonprescription use included easy access through markets or stores that obtain antibiotics internationally for under-the-counter sales, difficulty accessing the health care system, costs of physician visits, long waiting periods in clinics, and transportation problems.
Limitation:
Scarce evidence and heterogeneous methods and outcomes.
Conclusion:
Nonprescription antibiotic use is a seemingly prevalent and understudied public health problem in the United States. An increased understanding of risk factors and pathways that are amenable to intervention is essential to decrease this unsafe practice.
Primary Funding Source:
None.
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Author, Article and Disclosure Information
Baylor College of Medicine, Houston, Texas (L.G., G.G., R.Z.)
University of Pennsylvania, Philadelphia, Pennsylvania (S.J.)
Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (J.L.R., B.W.T.)
Boston University School of Medicine, Boston, Massachusetts (M.K.P.)
Acknowledgment: The authors thank Lara Ouellette, a Texas Medical Center librarian, for helping with the search strategy.
Grant Support: No grant support was received for this study. Dr. Germanos is supported in part by the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services (grant number T32 HP1003). Dr. Trautner's work is supported in part by the Houston Veterans Affairs Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413) and by Department of Veterans Affairs funding (HSR&D 16-025).
Disclosures: Dr. Grigoryan reports grants from the Antibacterial Resistance Leadership Group of the National Institutes of Health, Zambon Pharmaceuticals, and the Department of Veterans Affairs Health Services Research & Development Service outside the submitted work. Dr. Trautner reports grants from Zambon Pharmaceuticals, the Department of Veterans Affairs Rehabilitation Research & Development Service and Health Services Research & Development Service, the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Centers for Disease Control and Prevention and other support from Paratek Pharmaceuticals outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0505.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: Larissa Grigoryan, MD, PhD, Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098; e-mail, [email protected]
Current Author Addresses: Drs. Grigoryan, Germanos, and Zoorob: Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098.
Ms. Juneja: 4105 Spruce Street, Unit C3, Philadelphia, PA 19104.
Drs. Raphael and Trautner: Center for Innovations in Quality, Effectiveness and Safety (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030.
Dr. Paasche-Orlow: Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118.
Author Contributions: Conception and design: L. Grigoryan, R. Zoorob, S. Juneja, J.L. Raphael, M.K. Paasche-Orlow, B.W. Trautner.
Analysis and interpretation of the data: L. Grigoryan, G. Germanos, S. Juneja, J.L. Raphael, M.K. Paasche-Orlow, B.W. Trautner.
Drafting of the article: L. Grigoryan, G. Germanos, R. Zoorob, S. Juneja, B.W. Trautner.
Critical revision of the article for important intellectual content: L. Grigoryan, S. Juneja, J.L. Raphael, M.K. Paasche-Orlow, B.W. Trautner.
Final approval of the article: L. Grigoryan, G. Germanos, R. Zoorob, S. Juneja, J.L. Raphael, M.K. Paasche-Orlow, B.W. Trautner.
Provision of study materials or patients: L. Grigoryan, R. Zoorob.
Statistical expertise: L. Grigoryan.
Administrative, technical, or logistic support: L. Grigoryan, S. Juneja.
Collection and assembly of data: L. Grigoryan, G. Germanos, S. Juneja, B.W. Trautner.
This article was published at Annals.org on 23 July 2019.
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