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

Perhaps the most concerning finding from this study is that the majority of respondents were willing to use antimicrobials without guidance from a medical pro­fessional. In a study of the Latino immigrant population in and outside the United States, it was discovered that antimicrobials were commonly acquired without a pre­scription, presumably to be used for self-treatment.5 Pre­viously, it was thought this practice may be most com­mon in Latino communities, a finding suggested by the dispensing practices of pharmacies and stores in New York City, which found that stores in Hispanic commu­nities were more likely to sell antibiotics without a pre­scription.6 The study by Zoorob and colleagues helps to establish the framework that inappropriate antimicro­bial use may extend to all communities and, aside from where they were acquired, the greater impact may be that many people do not think they need medical guid­ance to take antibiotics.4
The results of this study are supported by studies con­ducted in Spain, which found an increase in pharmacist dispensing of antimicrobials without a prescription from 2008 to 2014, a practice that is also considered illegal in Spain.7,8 This finding may be indicative from increased patient requests to self-medicate rather than seek medi­cal guidance. Having a greater understanding of the rea­soning for using antimicrobials without a prescription may be helpful in developing ways to educate the public and change common attitudes and beliefs.
In countries with high rates of resistance and nonpre­scription antibiotic use, a correlation between antimi­crobial use and multidrug-resistant organisms has been shown. In those countries that developed initiatives to curb antimicrobial misuse, the result was a decrease in rates of resistance.1 Zapata-Cahafiero and colleagues found that even when pharmacists identified antimi­crobial resistance as a problem, they were still likely to dispense antimicrobials without a prescription.7 This may suggest that community antimicrobial stewardship initiatives directed toward pharmacists should not focus solely on reducing resistance rates.
Nonprescription antimicrobial use in the United States is not limited to a certain race or ethnicity, and many pa­tients may still be willing to use antimicrobials without medical guidance. The study by Zoorob and colleagues differs from past studies conducted in the United States, as it is more applicable to the general population.1,5 The actual number of patients who used, were willing to use, or who have antibiotics stored at home may actually be higher than reported in this study, as surveys may un­derestimate the problem. Patients may want to answer what they believe is correct when they are in the pres­ence of medical professionals, and respondents may be subject to recall bias.

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