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ARTICLE

Antimicrobial Stewardship Initiatives Need to Focus on More Than Reducing Resistance Rates

NOV 01, 2016 | ALEXANDRA HANRETTY, PHARMD, AND JASON C. GALLAGHER, PHARMD, FCCP, FIDSA, BCPS
Antimicrobial use without a pre­scription is a global issue that is not limited to developing countries. Taking antibiotics without a pre­scription, or as not originally in­tended, has been associated with shorter treatment durations than prescribed, inappropriate dosing, and the use of expired medications that may have decreased in potency.1
 
Any use of antimicrobials selects for bacterial resis­tance, and so controlling overuse and misuse of these drugs is paramount.2 National and global efforts have targeted the medical community and the general public in an attempt to reduce inappropriate antimicrobial pre­scribing and provide education. However, these efforts are most immature in the area of greatest antimicrobial use in humans—the outpatient setting.2,3
 
Zoorob and colleagues conducted a survey study to estimate the prevalence of nonprescription antibiotic use, with a focus on the sources of nonprescription an­timicrobials and the willingness of respondents to take antibiotics without a prescription. In their study, “non­prescription use” referred to use of an antibiotic without the guidance of a medical professional. This included the use of antibiotics prescribed previously that had been stored by patients for future use. Patients were recruit­ed from both public- and private-sector health clinics to ensure both economic and ethnic diversity, which was successful.
 
Over half of the respondents reported having some college education or greater. Thirty-eight percent report­ed an annual income <$20,000 and 23% were uninsured. Nonprescription antibiotic use in the prior 12 months was reported in 5% of respondents.
 
A pharmacy or store in the United States was the most common source of these antimicrobials, followed by ac­quisition from another country, a friend or relative, and using a remaining supply from a past prescription. Al­though only 5% of respondents reported taking a non­prescription antibiotic within the past 12 months, 25.4% reported they were willing to use antibiotics without a prescription and 74% reported having antibiotics stored at home.4 Therefore, the population “at risk” of self-guid­ed, nonprescription antimicrobials is significantly high­er than that which actually reported using them.


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