Leftover antibiotics ‘major barrier to antimicrobial stewardship’
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Key takeaways:
- Nearly three-quarters of people who stop taking antibiotics save them, and half plan to use them in the future.
- Among people who stop taking antibiotics, 77% said it was because they “felt better.”
Nearly half of patients who responded to a survey said they stop antibiotic treatment early, usually because they feel better, and three-quarters said they keep the leftover antibiotics, often intending to use them in the future.
“Leftover antibiotics are a major barrier to antibiotic stewardship,” Jesal R. Shah, MD, an infectious diseases fellow at Baylor College of Medicine, said while presenting results of the survey at IDWeek. “The goal of this project was to quantify and describe the practice of taking leftover, previously prescribed antibiotics in the Houston area.”
Previous surveys have found high rates of nonprescription use of antibiotics, with 43% of participants in one study reporting they had used antibiotics without a prescription. People who had used nonprescription antibiotics in the past were 76% more likely to do it again.
Shah and colleagues conducted a cross-sectional survey of 564 patients at six publicly funded primary care clinics and two privately funded EDs in Houston from January 2020 through June 2021, assessing rates and reasons for stopping prescribed antibiotics and what was done with the leftover antibiotics.
The researchers also compared why patients at private and public clinics stopped taking antibiotics, as well as whether they had previously saved or used leftover antibiotics and if they would use the leftover medication in the future.
Among the participants, 72% were women, 47% were non-Hispanic Black and 16% were non-Hispanic white. They had a median age of 51 years.
In all, 45% of participants reported that they had stopped taking prescribed antibiotics early, 42% of whom had received care in the public health care system and 52% of whom had received care in the private health care system.
People treated in the private health care system were more likely to stop antibiotics early because of provider recommendations or side effects, the researchers found. Shah said private providers often give recommendations related to side effects such as diarrhea or rash, which he said may offer some explanation for this difference.
Among people who stopped taking antibiotics early, 77% reported it was “because they felt better,” whereas 18% reported they “forgot to finish all of the antibiotics.” For those who stopped antibiotics early, 74% kept the leftover antibiotics. Around half — 51% — of these patients said they intended to use the leftover antibiotics regardless of health care provider advice, and 26% reported they had previously used leftover antibiotics.
According to Shah, the leftover antibiotics could be related to overly long durations of therapy or inappropriate prescriptions.
Some study participants reported using the antibiotics for COVID-19, influenza or the common cold, and some reported using them to manage pain or allergies. In many cases, the researchers found participants used the antibiotics because they believed they understood their illnesses, with one participant referring to the medications as “gold” because it can be hard to get a prescription from their doctor.
“Improper use of antibiotics contributes to the growing threat of antimicrobial resistance,” Lindsey A. Laytner, PhD, MPH, a post-doctoral fellow at Baylor College of Medicine and co-author of the study, said in a press release. “Clinicians, pharmacists and community leaders must establish education efforts on safe antibiotic use, provide alternative treatment options for everyday symptoms and work to improve access to health care and related services.”
References:
- IDSA. Antibiotics “like gold” for some patients: Personal beliefs and health care barriers drive inappropriate antibiotic use. https://www.idsociety.org/news--publications-new/articles/2023/antibiotics-like-gold-for-some-patients-personal-beliefs-and-health-care-barriers-drive-inappropriate-antibiotic-use/. Published Oct. 11, 2023. Accessed Nov. 7, 2023.
- Shah JR, et al. Abstract 2272. Presented at: IDWeek, Oct. 11-15, 2023; Boston.
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Shah JR, et al. Abstract 2272. Presented at: IDWeek, Oct. 11-15, 2023; Boston.
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