A new study suggests that many American adults are willing to use antibiotics without a prescription or guidance from a medical professional, a finding that raises concerns about the extent of antibiotic self-prescribing and the role that it's playing in fostering drug-resistant bacteria.
The study, published yesterday in Antimicrobial Agents and Chemotherapy, found that 5% of adults reported non-prescription use of antibiotics in the past 12 months, while 25% said they were willing to use antibiotics without contacting a doctor, nurse, or hospital. Just over 14% reported storing antibiotics at home for future use.
The researchers said that the results, which come from a survey of 400 racially and socioeconomically diverse adult patients at three public and private primary care clinics in Houston, indicate that significant numbers of people may be using, or intend to use, antibiotics without a doctor's prescription each year.
"Even our estimated prevalence of 5% suggests that 164,250 primary care patients in an adult population of 3,285,000 are using non-prescription antibiotics annually," the authors wrote. The study is the first to ask patients about intended use of antibiotics without a prescription, and not just past use, the authors said.
Commonly used for self-limiting symptoms
Among the respondents who said they had used antibiotics without a prescription during the past year, respiratory symptoms were the most common reason given, despite the fact that antibiotics are by and large unnecessary for such symptoms.
"Most often these were self-limiting symptoms, like cough or sore throat, and they were mostly viral, so you don't need antibiotics in the first place," corresponding author Larissa Grigoryan, MD, PhD, of Baylor College of Medicine, told CIDRAP News.
Those who reported that they intended to use antibiotics without a prescription ranked toothache, sore throat, ear pain, urinary tract infection, and respiratory symptoms as the most common reasons for self-prescribing. The antibiotics most commonly listed in non-prescription use were amoxicillin, azithromycin, ciproflaxin, and ampicillin.
The respondents said the most common source of these antibiotics (40%) were a US store or pharmacy, despite the fact that such sales are illegal. Although respondents did not provide details on how they obtained the antibiotics, Grigoryan said that previous studies have shown it is easier to obtain antibiotics without a prescription in ethnic drug stores.
Other sources of non-prescription antibiotics were foreign countries (24%), relatives or friends (20%), and leftovers from previous prescriptions (12%). Of those who reported storing antibiotics at home, 74% said they were from previous prescriptions.
Grigoryan and her colleagues noted that the prevalence of past non-prescription antibiotic use, intended use, and storage were not significantly different across racial and ethnic groups. This finding is noteworthy because previous studies have indicated that antibiotic self-prescribing was more common among Latino immigrants. But the study found a higher risk of intended use among patients from public primary clinics, younger patients, and those with less money and education.
Self-prescribing and antibiotic resistance
Grigoryan called the finding that 25% of adults would likely use non-prescription antibiotics in the future for self-limiting symptoms "really alarming," and said that the extent of self-prescribing is a concern on several levels. One concern is adverse events. "Many of the antibiotics used can cause severe side effects," Grigoryan said.
For example, some respondents reported storing fluoroquinolones, which can cause "disabling and potentially permanent serious side effects" according to the Food and Drug Administration.
Furthermore, Grigoryan added, "this kind of inappropriate use really fosters the development of resistance."
Experts in antibiotic stewardship agree.
"This is a dangerous practice, because antibiotics are not harmless drugs and it’s important to use the right drug at the right time," Lauri Hicks, DO, director of the Office of Antibiotic Stewardship at the Centers for Disease Control and Prevention (CDC), told CIDRAP News.
"This practice contributes to unnecessary antibiotic use, the spread of antibiotic resistance, inappropriate treatment of infections, and increases the potential for side effects and complications," Hicks said.
The CDC estimates that antibiotic-resistant infections cause more than 23,000 deaths and sicken more than 2 million Americans each year.
Grigoryan said public education campaigns on the appropriate use of antibiotics, which have had some success in Europe, are likely the most effective way to reduce self-prescribing. "I think that's a strategy we should use," she said.
The CDC's "Get Smart: Know When Antibiotics Work" campaign advises people not to take an antibiotic for viral infections like a cold or the flu, not to save antibiotics for future use, and not to take antibiotics prescribed for someone else.
See also:
Jul 11 Antimicrob Agents Chemother study
CDC's Get Smart: Know When Antibiotics Work campaign
