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.