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Nonprescription antibiotic use widespread, further studies needed

The use of nonprescription antibiotics is a widespread public health issue in the United States that requires further attention, according to a review published in the Annals of Internal Medicine.

“Unlike most drugs that affect only an individual patient if used incorrectly, misuse of antibiotics can harm others by increasing within-household and even global risk for antimicrobial resistance and secondary contagious sequelae, such as Clostridioides difficile infection,” Larissa Grigoryan, MD, PhD, of Baylor College of Medicine, and colleagues wrote.

Researchers conducted a scoping review of multiple databases to evaluate studies that assessed nonprescription antibiotic use in the United States. The searches included studies from January 2000 to March 2019 that reported nonprescription use of antibiotics, storage of antibiotics, intended use of nonprescription antibiotics and other factors that could influence nonprescription antibiotic use.

Two reviewers screened the 17,422 articles found in the database search and identified 31 that met the inclusion criteria.

Among the included studies, the prevalence of nonprescription antibiotic use varied from 1% in adults surveyed within health care settings to 66% among Latino migrant workers in Florida. The storage of leftover antibiotics for future use ranged from 14% to 48% among study populations, and the prevalence of intention to use nonprescription antibiotics was 25%.

Factors that contributed to nonprescription drug use included easy access to nonprescription antibiotics through under-the-counter sales of antibiotics from international sources, difficulty accessing health care, the cost of physician visits, clinic wait times, transportation issues and embarrassment about seeking care for STIs.

Grigoryan and colleagues noted that further studies on the prevalence of nonprescription antibiotics in the general population are needed, as most existing studies targeted specific subgroups of the population.

The study authors also noted that more work needs to be done to assess risk factors and develop interventions to decrease nonprescription antibiotic use, as they were only able to identify one published intervention on the issue. The period after the intervention was implemented saw an increase in the purchase of nonprescription antibiotics in the United States rather than a decrease, suggesting that it may have only been successful in providing the population with more information about the availability of nonprescription antibiotics.

“Nonprescription antibiotic use is clearly a public health problem in all racial/ethnic groups, but many aspects are understudied,” Grigoryan and colleagues wrote. “The need to focus on nonprescription antibiotic use in community-based antimicrobial stewardship programs is urgent. Future studies should develop standardized measures and methods to quantitate nonprescription antibiotic use and explore potentially modifiable factors that contribute to this unsafe practice.”– by Erin Michael

Disclosures: Grigoryan reports grants from the Antibacterial Resistance Leadership Group of the National Institutes of Health, the Department of Veterans Affairs Health Services Research & Development Service and Zambon Pharmaceuticals outside the submitted work. Please see study for all other authors’ relevant financial disclosures.