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Kharaba Z, Al-Azzam S, Altawalbeh SM, Alkwarit A, Salmeh NA, Alfoteih Y, Araydah M, Karasneh R, Aldeyab MA. Health literacy, knowledge, household disposal, and misuse practices of antibiotics among UAE residents: a nationwide cross-sectional study. Expert Rev Anti Infect Ther 2024; 22:103-113. [PMID: 37978885 DOI: 10.1080/14787210.2023.2284878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The study aimed to evaluate health literacy, knowledge, household disposal, and misuse practices of antibiotics among the United Arab Emirates (UAE) residents. RESEARCH DESIGN AND METHODS An observational cross-sectional study was conducted between May 1st and August 31st, 2022. The study encompassed a sample of 1074 participants. RESULTS Participants involved in a medical field (OR: 1.98, 95% CI: 1.45-2.69, p < 0.001) were more likely to have adequate health literacy. Most participants rarely (n = 315; 29.33%) or sometimes (n = 292; 27.19%) sought help from a doctor or pharmacist with reading the instructions and leaflets of antibiotics. A bachelor`s degree was associated with a reduced odds ratio of self-medication with antibiotics (OR: 0.46, 95% CI: 0.29-0.75, p = 0.002). Only 10.61% of unneeded antibiotics were returned to the pharmacy, 79.42% were disposed of at home and 10% were disposed of using other disposal practices. CONCLUSIONS Higher levels of adequate health literacy were observed in those involved in the medical field and those with higher educational levels. The prevalence of self-medication with antibiotics among the UAE population was low. These findings highlight the importance of improving health literacy, promoting responsible antibiotic use, and encouraging proper disposal practices among the population.
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Affiliation(s)
- Zelal Kharaba
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Sayer Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Alin Alkwarit
- Department of Pharmacy, Pharmacy intern, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Noor Abdulkareem Salmeh
- Department of Pharmacy, Pharmacy intern, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Yassen Alfoteih
- College of Dentistry, City University Ajman, Ajman, UAE
- College of Humanities, City University Ajman, Ajman, UAE
| | - Mohammad Araydah
- Department of Internal Medicine, Princes Basma Teaching Hospital, Irbid, Jordan
| | - Reema Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Mamoon A Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
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Al-Omrani H, Marwah MK, Al-Whaib R, Mekkawy M, Shokr H. Patterns of Drug Utilization and Self-Medication Practices: A Cross Sectional Study. PHARMACY 2023; 11:183. [PMID: 38133458 PMCID: PMC10747327 DOI: 10.3390/pharmacy11060183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/12/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Self-medication (SM) is a growing phenomenon worldwide that has recently been classified as one of the most serious public health problems. SM can result in an incorrect self-diagnosis, inappropriate treatment, potential adverse reactions, interactions, and the masking of more sinister disease. OBJECTIVES To assess the prevalence of SM practices amongst healthcare professionals and the general population in Saudi Arabia and to identify the sociodemographic contributing factors to this practice. METHODS A total of 540 participants were enrolled in this study. Participants were asked to complete the study questionnaire comprising two sections to gather demographic information and to collect data regarding SM practice. RESULTS The prevalence of SM practice among the study participants was 78.6%, and it was the highest among the middle age groups of (21-40 years) 82% compared to the younger and older age groups. The observed prevalence was higher in the female participants (53.7%) and those who live alone. Type of education did not affect the attitude of SM (p = 0.374); however, level of education strongly affected the prevalence of the SM, with higher incidence among university graduates (p < 0.001). Analgesics with antipyretics properties were the most self-medicated drugs. Patients considering their illnesses minor was the main reason behind the high prevalence of this practice. Among healthcare professions the highest prevalence of SM was found among pharmacists (95%), followed by physicians, nurses, and other medical practitioners. CONCLUSION The general population should be better educated and made conscious about the consequences, risks, and side effects of SM. Awareness campaigns may prove to be useful in this matter, allowing the patient to consider the appropriateness of this practice. Individuals in the age group of 21-40 years, females, and those who live alone should be considered priority target populations in the design and implementation of SM awareness projects.
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Affiliation(s)
- Hamod Al-Omrani
- Pharmacy Practice Department, College of Clinical Pharmacy, King Faisal University, Al-Ahsaa 31982, Saudi Arabia
| | - Mandeep Kaur Marwah
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
| | - Razan Al-Whaib
- Pharmacy Practice Department, College of Clinical Pharmacy, King Faisal University, Al-Ahsaa 31982, Saudi Arabia
| | - Mohammed Mekkawy
- High Institute of Public Health, Alexandria University, Alexandria 21526, Egypt
| | - Hala Shokr
- Pharmacy Division, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
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Carney KA, Wisnieski L, Lackey T, Noah D. Prevalence and Factors of Self-medication with Antibiotics in Claiborne County, Tennessee. JOURNAL OF APPALACHIAN HEALTH 2023; 5:59-71. [PMID: 38023112 PMCID: PMC10629894 DOI: 10.13023/jah.0501.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Introduction Antimicrobial resistance (AMR) is a serious concern to public health, causing an estimated 35,000 deaths annually in the U.S. Misuse of antimicrobials increases the rate of AMR. Self-medication with antibiotics (SMA) is a primary contributor to AMR that can be addressed through education. SMA has been reported at rates of 3% to 66% in the U.S. but has not been evaluated in Appalachia.1 Low health literacy and barriers to accessing care have been correlated with SMA and are common in many areas of Appalachia. Purpose This study aims to assess factors associated with SMA, demographic differences in knowledge of / beliefs about SMA, and describe practices and beliefs of those who self-medicate in the Cumberland Gap region. Methods Structured interviews were conducted in a rural health clinic and in a dental office to ascertain demographic information, knowledge of appropriate antibiotic use, and behaviors associated with self-medication. Inferential statistics (chi-squared, Fisher's exact, and ANOVA tests) were conducted. Results In the last 3 years, 41% of the 78 respondents had practiced SMA. A higher percentage of those who believed that antibiotics are used to treat viral infections have self-treated compared to those who did not hold that belief. Of those who SMA, convenience was the most common reason, while the common symptoms treated were congestion and fever. Implications The current study provides a first estimate of SMA in the Central Appalachian Region and finds the prevalence to be higher than previously reported in other regions of the U.S. Future studies could include larger, more representative samples and longitudinal study designs to confirm these findings.
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Affiliation(s)
| | | | - Tristan Lackey
- Lincoln Memorial University-College of Veterinary Medicine
| | - Donald Noah
- Lincoln Memorial University-College of Veterinary Medicine
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4
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Muflih SM, Al-Azzam S, Karasneh RA, Bleidt BA, Conway BR, Bond SE, Aldeyab MA. Public knowledge of antibiotics, self-medication, and household disposal practices in Jordan. Expert Rev Anti Infect Ther 2023; 21:477-487. [PMID: 36843495 DOI: 10.1080/14787210.2023.2182770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND This study aimed to assess public understanding of antibiotics, self-medication, and drug disposal practices. METHODS A cross-sectional self-administered online survey was undertaken in Jordan. RESULTS The study was completed by 1,105 participants. When asked about their knowledge of antibiotics, rational antibiotic use, and disposal practices, 16% percent believed they should discontinue antibiotics once they felt better, and 12% agreed to take the same antibiotics prescribed to others for the same illness. Self-medication with antibiotics was practiced by 44% of the participants. Prior experience, healthcare costs, and pharmacy location were all major determinants of self-medication. Only 6.4% of unneeded antibiotics were returned to the pharmacy, 60% were kept at home, and 26.6% were disposed of at home. Almost half of those who kept the antibiotics said they would use them again, and one-third said they would give them to friends and family. Respondents who had used antibiotics within the previous 6 months (p = 0.052) and relied on medication leaflets (p = 0.031) and physician recommendations (p = 0.001) were less likely to self-medicate with antibiotics. CONCLUSIONS The study highlighted areas of inappropriate use of antibiotics, self-medication and the improper antibiotic disposal that can inform antimicrobial stewardship.
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Affiliation(s)
- Suhaib M Muflih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Sayer Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Reema A Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Barry A Bleidt
- Department of Socio behavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University, Davie-Fl, USA
| | - Barbara R Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Stuart E Bond
- Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Mamoon A Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
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Healthcare System Distrust and Non-Prescription Antibiotic Use: A Cross-Sectional Survey of Adult Antibiotic Users. Antibiotics (Basel) 2023; 12:antibiotics12010079. [PMID: 36671280 PMCID: PMC9854942 DOI: 10.3390/antibiotics12010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 01/03/2023] Open
Abstract
Antibiotic resistance is a major public health concern driven by antibiotic overuse. Antibiotic stewardship programs are often limited to clinical settings and do little to address non-prescription antibiotic use in community settings. This study investigates the association between non-prescription antibiotic use and healthcare system distrust in the United States and Mexico. An online survey was deployed in the United States and Mexico with enhanced sampling through in-person recruiting in the border region. Non-prescription antibiotic use was defined as having bought or borrowed non-prescription oral or injectable antibiotics within the last 3 years. The survey included a previously validated 10-item scale to measure healthcare system distrust. Logistic regression was used to model the use of non-prescription antibiotics by the level of healthcare system distrust, adjusted for demographic characteristics and antibiotic knowledge. In total, 568 survey participants were included in the analysis, 48.6% of whom had used non-prescription oral or injectable antibiotics in the last 3 years. In the fully adjusted regression model, the odds of using non-prescription antibiotics were 3.2 (95% CI: 1.8, 6.1) times higher for those in the highest distrust quartile versus the lowest. These findings underscore the importance of community-based antibiotic stewardship and suggest that these programs are particularly critical for communities with high levels of healthcare system distrust.
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Mena Lora AJ, Rojas-Fermin R, Bisono B, Almonte M, Bleasdale SC. A nationwide survey of antimicrobial dispensation practices in pharmacies and bodegas in the Dominican Republic. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e173. [PMID: 36483416 PMCID: PMC9726472 DOI: 10.1017/ash.2022.314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 06/17/2023]
Abstract
In many developing countries, antimicrobials are available without prescriptions in pharmacies and stores. We performed a survey to describe antimicrobial availability, training, and use recommendations for common symptoms in the Dominican Republic. Pharmacy recommendations varied, whereas aminopenicillins are routinely recommended at bodegas. Frontline staff are gatekeepers and potential targets for stewardship education.
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Affiliation(s)
| | - Rita Rojas-Fermin
- Hospital General Plaza de la Salud, Santo Domingo, Dominican Republic
| | | | - Marcos Almonte
- Baptist Medical Center, Trenton, New Jersey, United States
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Akhtar SS, Heydon S, Norris P. Bringing Medicine from Pakistan and Self-Medication Among Pakistani Mothers in New Zealand. J Immigr Minor Health 2022; 24:682-688. [PMID: 34091799 PMCID: PMC8179088 DOI: 10.1007/s10903-021-01228-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 02/05/2023]
Abstract
Worldwide migration leads to people bringing beliefs and practices from one country into another, including those related to self-medication. This study explores the self-medication practices of Pakistani mothers for their children and their reasons for self-medication. We interviewed 23 immigrants. Each interview lasted 60-80 min and was conducted in Urdu. Participants had been living in New Zealand on average 3.25 years. They talked about their prior knowledge and experiences regarding self-medication behaviour for their children. The majority of the mothers treat their children at home before visiting a general practitioner (GP) due to previous unsatisfactory experiences. There was a significant relationship between participants who had family members in healthcare professions, their experiences of healthcare services and self-medication. Bringing medicines from Pakistan is a key source for self-medication practices. Self-medication awareness programs could help mothers to practice safe and responsible use of medicines for the benefit of their children.
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Affiliation(s)
| | - Susan Heydon
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Sardá V, Trick WE, Zhang H, Schwartz DN. Spatial, Ecologic, and Clinical Epidemiology of Community-Onset, Ceftriaxone-Resistant Enterobacteriaceae, Cook County, Illinois, USA. Emerg Infect Dis 2021; 27:2127-2134. [PMID: 34287121 PMCID: PMC8314837 DOI: 10.3201/eid2708.204235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We performed a spatial and mixed ecologic study of community-onset Enterobacteriaceae isolates collected from a public healthcare system in Cook County, Illinois, USA. Individual-level data were collected from the electronic medical record and census tract–level data from the US Census Bureau. Associations between individual- and population-level characteristics and presence of ceftriaxone resistance were determined by logistic regression analysis. Spatial analysis confirmed nonrandom distribution of ceftriaxone resistance across census tracts, which was associated with higher percentages of Hispanic, foreign-born, and uninsured residents. Individual-level analysis showed that ceftriaxone resistance was associated with male sex, an age range of 35–85 years, race or ethnicity other than non-Hispanic Black, inpatient encounter, and percentage of foreign-born residents in the census tract of isolate provenance. Our findings suggest that the likelihood of community-onset ceftriaxone resistance in Enterobacteriaceae is influenced by geographic and population-level variables. The development of effective mitigation strategies might depend on better accounting for these factors.
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9
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AlOtieschan S, Alsalim A, Albabtain S, Almujahid M, Obeid D, Alhabradi F, Alenazi T. Public Perception Toward Ministry of Health Regulations for Antibiotic Dispensing and Its Impact on Pharmacy and Family Physician Visits. Cureus 2021; 13:e14981. [PMID: 34123675 PMCID: PMC8194502 DOI: 10.7759/cureus.14981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Antibiotic dispensing regulations have been implemented in most countries worldwide. Saudi Arabia’s Ministry of Health (MOH) recently implemented a policy for dispensing antibiotics, in which pharmacies in Saudi Arabia are strictly prohibited from dispensing antibiotics without a medical prescription. Failure to adhere to the regulations will result in a fine and may lead to the revoking of the pharmacy's license. The aim of this study was to investigate public perception among the Saudi population toward the recently implemented policy, to examine the effect of antibiotic dispensing regulations on consumers’ request for non-prescribed antibiotics at retail pharmacies, and to elucidate the implications of the recent policies on patient visitation to family physicians. Method A cross-sectional study was conducted using three questionnaires targeting the general public in Saudi Arabia in addition to pharmacists and family physicians working in Saudi Arabia. Results A total of 380 participants completed the questionnaire for the general public, 299 for the pharmacist questionnaire, and 94 for the family physician questionnaire. Most participants in the general public questionnaire obtained their antibiotics using a prescription after consulting with a family physician (72.4%). Most of these individuals also agreed with the strict regulations for antibiotic dispensing (82.1%). Most pharmacist participants either always or frequently received requests to dispense antibiotics without a prescription from customers (71.5%). In addition, most physicians (59.6%) acknowledged that patient demand increased after the implementation of the new policies. Conclusion Our assessment of public perception towards the recent regulation for dispensing antibiotics indicates that most participants who participated in the General Public questionnaire supported the MOH’s strict regulations for antibiotic dispensing. However, customer requests for antibiotics without a prescription from pharmacists were a bit high, which could be attributed to customers' lack of awareness of the regulations. The results also indicate an increase in the number of family physician visits after the regulations were implemented.
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Affiliation(s)
- Salman AlOtieschan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,College of Medicine, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Abdulrahman Alsalim
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Shahad Albabtain
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Dana Obeid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Faisal Alhabradi
- Department of Orthopedics, King Abdulaziz Medical City, Riyadh, SAU.,Department of Academic Affairs, Prince Sultan Military Medical City, Riyadh, SAU
| | - Thamer Alenazi
- Department of Medicine, King Abdulaziz Medical City, Riyadh, SAU.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,College of Medicine, King Abdullah International Medical Research Center, Riyadh, SAU
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10
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The General Population's Inappropriate Behaviors and Misunderstanding of Antibiotic Use in China: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:antibiotics10050497. [PMID: 33925971 PMCID: PMC8146421 DOI: 10.3390/antibiotics10050497] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 12/27/2022] Open
Abstract
The general population has increasingly become the key contributor to irrational antibiotic use in China, which fuels the emergence of antibiotic resistance. This study aimed to estimate the prevalence of the general population’s irrational use behaviors of antibiotics and identify the potential reasons behind them. A systematic review and meta-analysis were performed concerning four main behaviors relevant to easy access and irrational use of antibiotics and common misunderstandings among the population about antibiotics. Four databases were searched, and studies published before 28 February 2021 were retrieved. Medium and high-level quality studies were included. Random effects meta-analysis was performed to calculate the prevalence of the general population’s irrational behaviors and misunderstandings relevant to antibiotic use. A total of 8468 studies were retrieved and 78 met the criteria and were included. The synthesis showed the public can easily obtain unnecessary antibiotics, with an estimated 37% (95% CI: 29–46) of the population demanding antibiotics from physicians and 47% (95% CI: 38–57) purchasing non-prescription antibiotics from pharmacies. This situation is severe in the western area of China. People also commonly inappropriately use antibiotics by not following antibiotic prescriptions (pooled estimate: 48%, 95% CI: 41–55) and preventatively use antibiotics for non-indicated diseases (pooled estimate: 35%, 95% CI: 29–42). Misunderstanding of antibiotic use was also popular among people, including incorrect antibiotic recognition, wrong antibiotic use indication, inappropriate usage, and ignorance of potential adverse outcomes. Over-and inappropriate use of antibiotics is evident in China and a multifaceted antibiotic strategy targeted at the general population is urgently required.
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11
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Zhang W, Williams A, Griffith N, Gaskins J, Bookstaver PB. Online availability of fish antibiotics and documented intent for self-medication. PLoS One 2020; 15:e0238538. [PMID: 32881969 PMCID: PMC7470343 DOI: 10.1371/journal.pone.0238538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
Self-medication and antibiotic utilization without healthcare oversight may lead to delayed appropriate treatment, transmission of communicable infections, untoward adverse events, and contribute to antimicrobial resistance. Previous data suggest people obtain over-the-counter (OTC) animal antibiotics for their personal use. This study examined the availability of OTC fish antibiotics online and the documented intent for self-medication. The authors conducted a web-based cross-sectional study using Google search engine to identify vendor websites selling fish antibiotics in the United States. Vendor websites were included if product information, consumer reviews, and comments were publicly available. Nine fish antibiotics were chosen due to their possibility of having consequences to human misuse. The cost and availability of fish antibiotics was recorded. The proportion of reviews and comments related to human consumption was calculated. Consumer review traffic based on “likes” and “dislikes” received was compared between human- and non-human consumption-related reviews. Selected fish antibiotics were purchased and evaluated for physical appearance and compared to FDA-approved available equivalents. We found 24 website vendors with online ordering available for OTC fish antibiotics. Cost varied significantly by antibiotic and quantity ranging from USD $8.99 to $119.99. There were 2,288 reviews documented for the 9 selected antibiotics being sold. Among consumer reviews, 2.4% were potentially associated with human consumption. Human consumption-related reviews constituted 30.2% of all “likes” received and 37.5% of all “dislikes” received. Human consumption-related reviews received an average of 9.2 likes compared to 0.52 likes for non-human consumption-related reviews. The 8 fish antibiotics purchased were consistent with FDA-approved equivalents in physical appearance. Although infrequent, antibiotics intended for fish use are being purchased online without a prescription for self-medication to circumvent professional medical care. Reviews related to human consumption generate significant online traffic compared to reviews unrelated to human consumption.
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Affiliation(s)
- Weiwei Zhang
- Department of Clinical Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- * E-mail: (PBB); (WZ)
| | - Austin Williams
- University of South Carolina College of Pharmacy, Columbia, South Carolina, United States of America
| | - Nicole Griffith
- University of Virginia Health, Charlottesville, Virginia, United States of America
| | - Jessica Gaskins
- South Carolina Aquarium, Charleston, South Carolina, United States of America
| | - P. Brandon Bookstaver
- University of South Carolina College of Pharmacy, Columbia, South Carolina, United States of America
- Prisma Health Richland, Columbia, South Carolina, United States of America
- * E-mail: (PBB); (WZ)
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12
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Sambakunsi CS, Småbrekke L, Varga CA, Solomon V, Mponda JS. Knowledge, attitudes and practices related to self-medication with antimicrobials in Lilongwe, Malawi. Malawi Med J 2020; 31:225-232. [PMID: 32128032 PMCID: PMC7036431 DOI: 10.4314/mmj.v31i4.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The use of antimicrobials is associated with the emergence of antimicrobial resistance (AMR), and self-medication increases the risk of the inappropriate use of antimicrobials. This study aims to describe the knowledge, attitudes, and practices (KAP) regarding self-medication with antimicrobials among residents in Lilongwe, Malawi. Methodology This study has a cross-sectional, mixed-methods design. We conducted two focus group discussions (n=15) to describe community attitudes towards self-medication with antimicrobials and used a structured questionnaire to collect data on individual KAP regarding self-medication from 105 respondents. Results Self-medication was common, and the sources of these medicines were market vendors, pharmacies, drugs shared with friends and family and those leftover from previous treatments. The lack of medical supplies, long distances to health facilities, poor attitudes of medical professionals towards patients, and past experience with the disease and treatment are the main factors that influence self-medication. KAP respondents had little knowledge of antimicrobials, their use, or any awareness of AMR. Seventy-four per cent (n=78) were unable to differentiate antimicrobials from other categories of medicines, and 92.4% wrongly responded that antimicrobials could be used to stop a fever. Concerning attitudes towards self-medication, over 54% wrongly believe that antimicrobials are effective in treating common colds. In regard to practice, 53% reported that they would use antimicrobials to treat upper respiratory infections, and 41% agreed that they must complete antibiotic therapy even if they are improving. Logistic regression analysis found that stocking antimicrobials at home for future use significantly promotes self-medication whereas an awareness of AMR would reduce self-medication. Conclusion Self-medication is a public health risk that needs to be addressed urgently. Findings from this study point to the need for multifaceted interventions.
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Affiliation(s)
- Cecilia S Sambakunsi
- Pharmacy Medicines and Poisons Board, Lilongwe 3, Malawi.,College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Lars Småbrekke
- Department of Pharmacy UIT - The Arctic University of Norway, Tromso, Norway
| | - Christine A Varga
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Vernon Solomon
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - John S Mponda
- Department of Pharmacy, College of Medicine, Blantyre, Malawi
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Lu J, Wang X, Lin L, Xuan Z, Hu YJ, Zhou X. The Association between Changes in External Environment Caused by Migration and Inappropriate Antibiotic Use Behaviors among Chinese University Students: A Cross-Sectional Study. Antibiotics (Basel) 2019; 8:antibiotics8040200. [PMID: 31661819 PMCID: PMC6963784 DOI: 10.3390/antibiotics8040200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 01/21/2023] Open
Abstract
Objectives: This study aims to explore how changes in external factors caused by migration impact antibiotic use behaviors among Chinese university students in comparison to their peers from host areas and origin areas. Migration status was determined by host universities and origin areas, which were broadly defined as eastern vs. western regions in China. Methods: This study analyzed secondary data from a cross-sectional study conducted in China about the antibiotic use behaviors of university students in 2015. Students were divided into four groups: eastern local students (E-Es), western local students (W-Ws), eastern–western migrant students (E-Ws), and western–eastern migrant students (W-Es). Results: After controlling for gender, grade, major, hometown (rural or urban), and parents’ education, E-Ws reported a significantly higher odds of asking for antibiotics (OR = 2.13; 95% CI = 1.54–3.03; p < 0.001) and taking antibiotics prophylactically (OR = 1.85; 95% CI = 1.32–2.56; p < 0.001) compared with E-Es; W-Es reported a significantly lower odds of asking for antibiotics (OR = 0.56; 95% CI = 0.37–0.83; p < 0.01) and taking antibiotics prophylactically (OR = 0.57; 95% CI = 0.41–0.81; p < 0.01) compared with W-Ws. Discussion: Regional differences likely interacted with students’ migration status in forming different antibiotic use behaviors. Factors including financial incentives and loose regulations of antibiotic over-prescription by health providers and peer influence may contribute to worsened antibiotic use behaviors among E-Ws.
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Affiliation(s)
- Jingjing Lu
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou 310058, China.
| | - Xiaomin Wang
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou 310058, China.
| | - Leesa Lin
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA.
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Yanhong Jessika Hu
- Murdoch Children's Research Institute, University of Melbourne. Royal Children's Hospital, Melbourne VIC 3052, Australia.
| | - Xudong Zhou
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou 310058, China.
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Grigoryan L, Germanos G, Zoorob R, Juneja S, Raphael JL, Paasche-Orlow MK, Trautner BW. Use of Antibiotics Without a Prescription in the U.S. Population: A Scoping Review. Ann Intern Med 2019; 171:257-263. [PMID: 31330541 DOI: 10.7326/m19-0505] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Use of antibiotics without a prescription may increase unnecessary and inappropriate drug use or doses as well as global risk for antimicrobial resistance. PURPOSE To perform a scoping review of research on the prevalence of nonprescription antibiotic use in the United States and to examine the factors that influence it. DATA SOURCES Searches of PubMed, EMBASE, CINAHL, Scopus, and relevant Web sites without language restrictions from January 2000 to March 2019. STUDY SELECTION Studies reporting nonprescription use of antibiotics, storage of antibiotics, intention to use antibiotics without a prescription, and factors influencing nonprescription use. DATA EXTRACTION Two reviewers independently screened citations and full texts and performed data abstraction. DATA SYNTHESIS Of 17 422 screened articles, 31 met inclusion criteria. Depending on population characteristics, prevalence of nonprescription antibiotic use varied from 1% to 66%, storage of antibiotics for future use varied from 14% to 48%, and prevalence of intention to use antibiotics without a prescription was 25%. Antibiotics were obtained without a prescription from various sources, including previously prescribed courses, local markets or stores, and family or friends. Reported factors contributing to nonprescription use included easy access through markets or stores that obtain antibiotics internationally for under-the-counter sales, difficulty accessing the health care system, costs of physician visits, long waiting periods in clinics, and transportation problems. LIMITATION Scarce evidence and heterogeneous methods and outcomes. CONCLUSION Nonprescription antibiotic use is a seemingly prevalent and understudied public health problem in the United States. An increased understanding of risk factors and pathways that are amenable to intervention is essential to decrease this unsafe practice. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
| | - George Germanos
- Baylor College of Medicine, Houston, Texas (L.G., G.G., R.Z.)
| | - Roger Zoorob
- Baylor College of Medicine, Houston, Texas (L.G., G.G., R.Z.)
| | - Shivanki Juneja
- University of Pennsylvania, Philadelphia, Pennsylvania (S.J.)
| | - Jean L Raphael
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (J.L.R., B.W.T.)
| | | | - Barbara W Trautner
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (J.L.R., B.W.T.)
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15
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Lescure D, Paget J, Schellevis F, van Dijk L. Determinants of Self-Medication With Antibiotics in European and Anglo-Saxon Countries: A Systematic Review of the Literature. Front Public Health 2018; 6:370. [PMID: 30619809 PMCID: PMC6304439 DOI: 10.3389/fpubh.2018.00370] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Self-medication with antibiotics, which comes in different forms [e.g., leftover or over-the-counter (OTC) use], contributes to antimicrobial resistance as it often happens in a non-prudent manner. In order to tackle this persistent public health problem, its drivers need to be known. The aim of this study was therefore to identify determinants of self-medication with antibiotics via a systematic literature review. Methods: A comprehensive search on determinants of self-medication with antibiotics in the ambulatory care was conducted in PubMed, Scopus, and Embase for studies published between January 2000 and March 2017. There was no limit on the language nor on the type of study. The search was restricted to European and Anglo-Saxon countries. Pairs of reviewers independently screened the abstracts and full texts and performed a quality assessment. Results: From the initial 664 abstracts, 54 publications that included 44 countries were retrieved of which most identified patient related determinants. Important determinants include storing antibiotics at home, poor access to healthcare, and having the intention to self-medicate. Healthcare professionals contribute to the practice of self-medication when catering for demanding and socially vulnerable patients. Healthcare system related determinants include dispensing antibiotics in whole packages and the lack of enforcement of medicine regulations. For some determinants (e.g., patients' age) contradictory results were found. Conclusion: Self-medication with antibiotics is driven by a variety of determinants on the patient, healthcare professional, and system levels. Policy makers should recognise the complexity of self-medication in order to develop multifaceted interventions that target healthcare professionals and patients simultaneously.
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Affiliation(s)
- Dominique Lescure
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - John Paget
- Department of Primary Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Francois Schellevis
- Department of General Practice and Elderly Care Medicine, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Liset van Dijk
- Department of Primary Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
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16
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Hu J, Wang Z. Non-prescribed antibiotic use and general practitioner service utilisation among Chinese migrants in Australia. Aust J Prim Health 2018; 22:434-439. [PMID: 26328599 DOI: 10.1071/py15076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/02/2015] [Indexed: 11/23/2022]
Abstract
Non-prescribed antibiotic use occurs worldwide and is an important contributor to antibiotic resistance. Social and health system factors were related to the practice of self-medication with antibiotics. This study aims to investigate the practice of non-prescribed antibiotic use, and to assess the impact of primary health service access and use on this practice among Australian Chinese migrants. Four-hundred and twenty-six participants, who self-identified as Chinese and who had been residing in Australia for at least 12 months, were recruited through several Australian Chinese social websites to participate in an online health survey about antibiotic use and health services use from July to October 2013. Logistic regression analyses were conducted to assess the associations between health services utilisation factors and the use of non-prescribed antibiotics. In total, 20.2% (86/426) participants reported having used antibiotics without medical consultation in the last 12 months. Of 170 antibiotic users, 50.6% (86/170) used antibiotics without medical consultation. Chinese migrants who self-evaluated as 'satisfied' with the experiences of GP services were less likely to self-medicate with antibiotics. In addition, Chinese migrants without any perceived barriers to using primary health services in Australia were less likely to use non-prescribed antibiotics. Among Australian Chinese migrants, over half of antibiotic users admitted that they had used antibiotics without medical consultation. Participants with positive experience and perception of primary health services, primarily GP services, had a lower risk of using non-prescribed antibiotics.
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Affiliation(s)
- Jie Hu
- Centre for Chronic Disease, School of Medicine, University of Queensland, Herston, Qld 4029, Australia
| | - Zhiqiang Wang
- Centre for Chronic Disease, School of Medicine, University of Queensland, Herston, Qld 4029, Australia
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Martínez-González NA, Coenen S, Plate A, Colliers A, Rosemann T, Senn O, Neuner-Jehle S. The impact of interventions to improve the quality of prescribing and use of antibiotics in primary care patients with respiratory tract infections: a systematic review protocol. BMJ Open 2017; 7:e016253. [PMID: 28611111 PMCID: PMC5726136 DOI: 10.1136/bmjopen-2017-016253] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/02/2017] [Accepted: 05/11/2017] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Respiratory tract infections (RTIs) are the most common reason for primary care (PC) consultations and for antibiotic prescribing and use. The majority of RTIs have a viral aetiology however, and antibiotic consumption is ineffective and unnecessary. Inappropriate antibiotic use contributes greatly to antibiotic resistance (ABR) leading to complications, increased adverse events, reconsultations and costs. Improving antibiotic consumption is thus crucial to containing ABR, which has become an urgent priority worldwide. We will systematically review the evidence about interventions aimed at improving the quality of antibiotic prescribing and use for acute RTI. METHODS AND ANALYSIS We will include primary peer-reviewed and grey literature of studies conducted on in-hours and out-of-hours PC patients (adults and children): (1) randomised controlled trials (RCTs), quasi-RCTs and/or cluster-RCTs evaluating the effectiveness, feasibility and acceptability of patient-targeted and clinician-targeted interventions and (2) RCTs and other study designs evaluating the effectiveness of public campaigns and regulatory interventions. We will search MEDLINE (EBSCOHost), EMBASE (Elsevier), the Cochrane Library (Wiley), CINHAL (EBSCOHost), PsychINFO (EBSCOHost), Web of Science, LILACS (Latin American and Caribbean Literature on Health Sciences), TRIP (Turning Research Into Practice) and opensgrey.eu without language restriction. We will also search the reference lists of included studies and relevant reviews. Primary outcomes include the rates of (guideline-recommended) antibiotics prescribed and/or used. Secondary outcomes include immediate or delayed use of antibiotics, and feasibility and acceptability outcomes. We will assess study eligibility and risk of bias, and will extract data. Data permitting, we will perform meta-analyses. ETHICS AND DISSEMINATION This is a systematic review protocol and so formal ethical approval is not required. We will not collect confidential, personal or primary data. The findings of this review will be disseminated at national and international scientific meetings. TRIAL REGISTRATION NUMBER PROSPERO trial (CRD42017035305).
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Affiliation(s)
| | - Samuel Coenen
- Department of Primary and Interdisciplinary Care (ELIZA), Centre for General Practice, University of Antwerp - Campus Drie Eiken, Wilrijk, Belgium
| | - Andreas Plate
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Annelies Colliers
- Department of Primary and Interdisciplinary Care (ELIZA), Centre for General Practice, University of Antwerp - Campus Drie Eiken, Wilrijk, Belgium
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
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Boyd SE, Moore LSP, Gilchrist M, Costelloe C, Castro-Sánchez E, Franklin BD, Holmes AH. Obtaining antibiotics online from within the UK: a cross-sectional study. J Antimicrob Chemother 2017; 72:1521-1528. [PMID: 28333179 PMCID: PMC5890662 DOI: 10.1093/jac/dkx003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/20/2016] [Accepted: 12/30/2016] [Indexed: 11/14/2022] Open
Abstract
Background Improved antibiotic stewardship (AS) and reduced prescribing in primary care, with a parallel increase in personal internet use, could lead citizens to obtain antibiotics from alternative sources online. Objectives A cross-sectional analysis was performed to: (i) determine the quality and legality of online pharmacies selling antibiotics to the UK public; (ii) describe processes for obtaining antibiotics online from within the UK; and (iii) identify resulting AS and patient safety issues. Methods Searches were conducted for 'buy antibiotics online' using Google and Yahoo. For each search engine, data from the first 10 web sites with unique URL addresses were reviewed. Analysis was conducted on evidence of appropriate pharmacy registration, prescription requirement, whether antibiotic choice was 'prescriber-driven' or 'consumer-driven', and whether specific information was required (allergies, comorbidities, pregnancy) or given (adverse effects) prior to purchase. Results Twenty unique URL addresses were analysed in detail. Online pharmacies evidencing their location in the UK ( n = 5; 25%) required a prescription before antibiotic purchase, and were appropriately registered. Online pharmacies unclear about the location they were operating from ( n = 10; 50%) had variable prescription requirements, and no evidence of appropriate registration. Nine (45%) online pharmacies did not require a prescription prior to purchase. For 16 (80%) online pharmacies, decisions were initially consumer-driven for antibiotic choice, dose and quantity. Conclusions Wide variation exists among online pharmacies in relation to antibiotic practices, highlighting considerable patient safety and AS issues. Improved education, legislation, regulation and new best practice stewardship guidelines are urgently needed for online antibiotic suppliers.
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Affiliation(s)
- Sara Elizabeth Boyd
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Luke Stephen Prockter Moore
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Mark Gilchrist
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Ceire Costelloe
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Enrique Castro-Sánchez
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, UK
| | - Alison Helen Holmes
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK
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Kusturica MP, Tomić Z, Bukumirić Z, Horvat O, Pavlović N, Mikov M, Sabo A. Antibiotics in Serbian Households: a Source of Potential Health and Environmental Threats? Cent Eur J Public Health 2016; 23:114-8. [PMID: 26851420 DOI: 10.21101/cejph.a4093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/15/2015] [Indexed: 11/15/2022]
Abstract
AIM Worldwide data indicate that antibiotics are frequently used inappropriately. The objective of this study was to investigate the extent of storage and wastage of antibacterial agents in households in Novi Sad, Serbia. METHODS The study was performed in 8 months period (December 2011-July 2012) in households in Novi Sad, Serbia. The households were randomly selected from the telephone directory. The interviewer performed the survey visiting each household. RESULTS The total number of antibacterial agents in the 383 surveyed households was 318, constituting 7.3% of the total stored medications. From 383 families included in the study antibiotics were found in 178 (46.5%). In 13 (7.3%) families were found more than one pack of the same antibiotics. The median number of antibacterial agents per household was 1 (range 1-5). The most common antibacterial agents that were not in current use were cephalexin (22.1%) and amoxicillin (16.6%), followed by doxycycline (11.4%), sulfamethoxazole/trimethoprim (11.4%) and amoxicillin/clavulanic acid (9.2%). The percentage of expired antibacterial agents was 20.8%, while 85.2% were not currently in use. CONCLUSION Antibacterial agents were commonly encountered in Serbian households, and a relatively large percentage was wasted. Informational and educational activities aimed at improving the public knowledge about antimicrobials play the leading role in reducing imprudent use of antibiotics.
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Affiliation(s)
- Milica Paut Kusturica
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zdenko Tomić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zoran Bukumirić
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olga Horvat
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nebojša Pavlović
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Momir Mikov
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ana Sabo
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Nonprescription Antimicrobial Use in a Primary Care Population in the United States. Antimicrob Agents Chemother 2016; 60:5527-32. [PMID: 27401572 DOI: 10.1128/aac.00528-16] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/20/2016] [Indexed: 11/20/2022] Open
Abstract
Community antimicrobial resistance rates are high in communities with frequent use of nonprescription antibiotics. Studies addressing nonprescription antibiotic use in the United States have been restricted to Latin American immigrants. We estimated the prevalence of nonprescription antibiotic use in the previous 12 months as well as intended use (intention to use antibiotics without a prescription) and storage of antibiotics and examined patient characteristics associated with nonprescription use in a random sample of adults. We selected private and public primary care clinics that serve ethnically and socioeconomically diverse patients. Within the clinics, we used race/ethnicity-stratified systematic random sampling to choose a random sample of primary care patients. We used a self-administered standardized questionnaire on antibiotic use. Multivariate regression analysis was used to identify independent predictors of nonprescription use. The response rate was 94%. Of 400 respondents, 20 (5%) reported nonprescription use of systemic antibiotics in the last 12 months, 102 (25.4%) reported intended use, and 57 (14.2%) stored antibiotics at home. These rates were similar across race/ethnicity groups. Sources of antibiotics used without prescriptions or stored for future use were stores or pharmacies in the United States, "leftover" antibiotics from previous prescriptions, antibiotics obtained abroad, or antibiotics obtained from a relative or friend. Respiratory symptoms were common reasons for the use of nonprescription antibiotics. In multivariate analyses, public clinic patients, those with less education, and younger patients were more likely to endorse intended use. The problem of nonprescription use is not confined to Latino communities. Community antimicrobial stewardship must include a focus on nonprescription antibiotics.
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Francois Watkins LK, Sanchez GV, Albert AP, Roberts RM, Hicks LA. Knowledge and Attitudes Regarding Antibiotic Use Among Adult Consumers, Adult Hispanic Consumers, and Health Care Providers--United States, 2012-2013. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2015. [PMID: 26203631 PMCID: PMC4584863 DOI: 10.15585/mmwr.mm6428a5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Louise K. Francois Watkins
- Epidemic Intelligence Service, CDC
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
- Corresponding author: Louise K. Francois Watkins, , 404-639-4755
| | - Guillermo V. Sanchez
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Alison P. Albert
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Rebecca M. Roberts
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Lauri A. Hicks
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
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Kusturica MP, Tomic Z, Bukumiric Z, Ninkovic L, Tomas A, Stilinovic N, Sabo A. Home pharmacies in Serbia: an insight into self-medication practice. Int J Clin Pharm 2015; 37:373-8. [PMID: 25616627 DOI: 10.1007/s11096-015-0071-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 01/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Worldwide data indicate that self-medication is frequently used inappropriately. Although self-medication is encouraged in most of the countries by introducing over-the-counter drugs, it bears the risk of misuse of drugs issued on prescription due to low observance of legislation of medicines requiring prescription by some pharmacies. OBJECTIVE The objective of this study was to explore the self-medication practice, with an emphasis on self-medication with prescription-only medications. SETTING Households in Novi Sad city, Serbia. METHOD The study was conducted over 8 month period (December 2011-July 2012) and involved a random sample of households. The questionnaire-based study and personal insight into household drug supplies was performed by a trained interviewer. Main outcome measure Number of drugs obtained without prescription or without consulting a physician in surveyed households. RESULTS The total number of drug items present in the 383 households was 4,384 with a median of 11 drugs per household. More than a half of drugs in households were prescription-only medication (58.5 %). Approximately one third of prescription-only medications were obtained without prescription. The most common drugs obtained without prescription were anti-inflammatory and antirheumatic products and antibacterials for systemic use. Ibuprofen and diclofenac were the most common self-medicated drugs. Number of prescription-only medications bought with ought prescription was significantly higher in households with children under 12 years of age compared to other types of households. CONCLUSION Our survey indicated that self-medication with prescription drugs appeared to be a rather common practice, which is far away from the concept of "responsible self-medication", especially regarding antibiotics.
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Affiliation(s)
- Milica Paut Kusturica
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000, Novi Sad, Serbia,
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Can over-the-counter antibiotics coerce people for self-medication with antibiotics? ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(15)60886-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Grazier MR, Armenian P, Vohra R. Illicit Distribution of Prescription Drugs. Ann Pharmacother 2014; 48:1070-1076. [DOI: 10.1177/1060028014535908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To report a case of life-threatening cinchonism from illicit purchase of chloroquine and survey local ethnic markets to determine what medications are sold without a prescription. Case Report: A 44-year-old Hmong woman presented with abdominal pain and vomiting 30 minutes after ingesting 20 presumed acetaminophen pills in a self-harm gesture. Initial vital signs were normal, and an electrocardiogram (ECG) showed normal sinus rhythm, QRS = 130 ms, and QTc = 455 ms. Her systolic blood pressure dropped to 84 mm Hg, which was unchanged after 3 L normal saline, but improved after 150 mEq NaHCO3. A repeat ECG showed QRS = 114 ms and QTc = 588 ms. Serum labs were significant for K 2.8 mmol/L and Mg 1.8 mg/dL; 2.5 hours later, the family brought in the medication, which was 250 mg tablets of chloroquine phosphate. K and Mg were repleted, and she was admitted to the intensive care unit with complete recovery. Serum chloroquine level 9 hours after ingestion was 530 ng/mL (therapeutic = 20-400 ng/mL). Methods: We identified local ethnic markets through patient and hospital employee referrals and Internet searches. Results: In our survey, 3 of 4 ethnic markets sold prescription medications: 35 were identified, of which 5 are discontinued by the FDA (diphenidol, phenacetin, metamizole, phenylbutazone, and sibutramine). Conclusions: A variety of prescription medications, including 5 discontinued by the FDA, were available in markets serving our community’s ethnic minorities. Health care workers should be aware of this public health risk, which can result in serious toxicity, as described in this case of chloroquine overdose.
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Affiliation(s)
| | | | - Rais Vohra
- California Poison Control System–Fresno/Madera Division, Madera, CA, USA
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Fixed drug eruption associated with sulfonamides sold in Latino grocery stores - Greater Washington, DC, area, 2012-2013. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2013; 62:914-6. [PMID: 24257199 PMCID: PMC4585367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In March 2012, a Salvadoran-American boy aged 7 years living in Maryland developed three slightly painful, well-demarcated, flat, gray-brown patches on his torso. A dermatologist in Washington, DC, suspected a fixed drug eruption (an erythema multiforme-like adverse drug reaction that occurs in the same location each time the person uses a particular medication). The child had recently taken a cough and cold remedy, Baczol Antigripal, which was made in El Salvador and purchased in a Maryland suburb of Washington, DC, without a prescription. The Baczol Antigripal ingredients included the sulfonamide-containing antibiotic trimethoprim-sulfamethoxazole (TMP/SMX), which is a common cause of fixed drug eruption. In June 2013, another Salvadoran-American child, a girl aged 14 years living in northern Virginia, was evaluated for a similar fixed drug eruption likely caused by a Baczol product purchased near her home. In August 2013, staff members from the Children's National Medical Center investigated the availability of Baczol products in grocery stores in Salvadoran neighborhoods of Washington, DC, and neighboring suburbs. TMP/SMX-containing products were found in seven of 19 stores.
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Horton S, Stewart A. Reasons for self-medication and perceptions of risk among Mexican migrant farm workers. J Immigr Minor Health 2012; 14:664-72. [PMID: 22170398 DOI: 10.1007/s10903-011-9562-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although the frequency of self-medication among Mexican migrants has been well-documented in the public health literature, the multiple reasons for this practice are poorly understood. Most studies point to migrants' cultural preferences for Mexican medications, their prior experiences in countries where antibiotics are loosely regulated, and their lack of access to health care as the primary factors behind their self-medication. Based on participant observation and in-depth interviews with 23 Mexican migrants in a farm working community in the interior of California, we argue that occupational vulnerability is an equally important factor that encourages self-medication. All 23 of our interviewees reported having engaged in some degree of self-medication, notable in this location 8 h from the US-Mexico border. Among interviewees, occupational vulnerability represented an even more important factor influencing self-medication than lack of health insurance or lack of legal documentation. While interviewees did express a preference for Mexican medications as more potent and effective, this did not necessarily translate to a preference for using them without a doctor's supervision. Finally, we show that rather than remaining unaware of the risks of following this custom "transported from Latin America", Mexican migrants devised an elaborate hierarchy of resort of the safest self-medication practices to follow.
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Affiliation(s)
- Sarah Horton
- Department of Anthropology, College of Liberal Arts & Sciences, University of Colorado Denver, Denver, CO 80217-3364, USA.
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Mohanna M. Self-medication with Antibiotic in Children in Sana'a City, Yemen. Oman Med J 2012; 25:41-3. [PMID: 22125697 DOI: 10.5001/omj.2010.10] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Accepted: 12/04/2009] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To study the prevalence of self- medication with antibiotic in children presented to the outpatient department at Sam hospital, Sana'a city Yemen. METHODS This is a descriptive study conducted in the outpatient department of Sam hospital Sana'a city Yemen, during a five months period from Dec 2007 to Apr 2008. 2000 patients (1110 males and 890 females) were seen for different causes during that period. All patients were asked if they used antibiotics in the last 15 days without medical prescription, what type of antibiotic, why and how they obtained it. The age and sex of the patients were also recorded. RESULTS The age group of the patients ranged from 0-15 years. Of the 2000 patients interviewed, 1200(60%) had taken an antibiotic in the last 15 days without a medical prescription. Respiratory (80%) and gastrointestinal (13%) symptoms were most frequently reported. 312(26%) patients used the previous prescription paper to obtain antibiotics, while 888(74%) obtained antibiotics from pharmacies and drug stores without any prescription required. Amoxicillin, Trimethoprim-sulfamethoxazole and amoxicillin-clavulanic acid accounted for (85%) of the prescribed antibiotics. CONCLUSION The prevalence of self-medication with antibiotics in children in Yemen is alarmingly high. A majority of the patients had respiratory and gastrointestinal symptoms and the common prescribed antibiotics were amoxicillin, Trimethoprim-sulfamethoxazole and amoxicillin-clavulanic acid. Most of the antibiotics were obtained from pharmacies and drug stores without the requirement of a prescription. Therefore, intervention from health authorities is needed to urgently stop this practice.
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Affiliation(s)
- Mabrook Mohanna
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Sana'a University
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Non-prescription antimicrobial use worldwide: a systematic review. THE LANCET. INFECTIOUS DISEASES 2011; 11:692-701. [PMID: 21659004 DOI: 10.1016/s1473-3099(11)70054-8] [Citation(s) in RCA: 534] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In much of the world antimicrobial drugs are sold without prescription or oversight by health-care professionals. The scale and effect of this practice is unknown. We systematically reviewed published works about non-prescription antimicrobials from 1970-2009, identifying 117 relevant articles. 35 community surveys from five continents showed that non-prescription use occurred worldwide and accounted for 19-100% of antimicrobial use outside of northern Europe and North America. Safety issues associated with non-prescription use included adverse drug reactions and masking of underlying infectious processes. Non-prescription use was common for non-bacterial disease, and antituberculosis drugs were available in many areas. Antimicrobial-resistant bacteria are common in communities with frequent non-prescription use. In a few settings, control efforts that included regulation decreased antimicrobial use and resistance. Non-prescription antimicrobial and antituberculosis use is common outside of North America and northern Europe and must be accounted for in public health efforts to reduce antimicrobial resistance.
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Stockwell MS, Catallozzi M, Meyer D, Rodriguez C, Martinez E, Larson E. Improving care of upper respiratory infections among Latino Early Head Start parents. J Immigr Minor Health 2011; 12:925-31. [PMID: 20157849 DOI: 10.1007/s10903-010-9326-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Misconceptions about upper respiratory infections (URI) and their treatment are widely held, especially among Latino parents, and are associated with increased health care visits. The Centers for Disease Control and Prevention recommends community based interventions to educate families about URI. We designed a community-based, culturally competent health literacy intervention regarding URI, which was pilot tested with Latino Early Head Start (EHS) parents. In depth interviews were conducted to understand parents' perceptions. A paired-sample Wilcoxon signed rank test was used to assess change in pre-post knowledge/attitudes scores. Changes in care practices are described. Parents were very positive about this education, were open to non-antibiotic URI care, and reported that materials were helpful. Following the intervention, the mean composite knowledge/attitude score increased from 4.1 (total: 10) to 6.6 (P < .05). Families also reported improved care practices. EHS sites are promising locations for health literacy interventions regarding URI.
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Affiliation(s)
- Melissa S Stockwell
- Division of General Pediatrics, Columbia University, New York, NY 10032, USA.
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Landers TF, Ferng YH, McLoughlin JW, Barrett AE, Larson E. Antibiotic identification, use, and self-medication for respiratory illnesses among urban Latinos. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 2010; 22:488-95. [PMID: 20854641 PMCID: PMC3058843 DOI: 10.1111/j.1745-7599.2010.00539.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the extent to which antibiotic and nonantibiotic medications commonly used for upper respiratory infections (URIs) were correctly identified by a sample of urban dwelling Latinas and the association of medication identification with antibiotic use and self-medication. DATA SOURCES One hundred women completed an interview and were asked to identify whether a list of 39 medications (17 antibiotics, 22 nonantibiotics) were antibiotics or not, whether anyone in the household had used the medication, their ages, and the source of the medication. RESULTS Overall, participants correctly identified 62% of nonantibiotics and 34% of antibiotics. Seventy three (73%) women in the study reported antibiotic use by at least one member of the household in the past year. Among users, self-medication was reported in 67.2% of antibiotics for adults, but in only 2.4% of children. There was no difference in antibiotic recognition between those who self-medicated and those who did not, but antibiotic self-medication was associated with a significantly lower recognition of nonantibiotics (p= .01). IMPLICATIONS FOR PRACTICE Measures to improve antibiotic utilization should address self-medication and consider the cultural and social context in which antibiotic use occurs.
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Affiliation(s)
- Timothy F Landers
- Center for Interdisciplinary Research to Reduce Antimicrobial Resistance (CIRAR), Columbia University School of Nursing, New York, New York, USA.
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Vissman AT, Bloom FR, Leichliter JS, Bachmann LH, Montaño J, Topmiller M, Rhodes SD. Exploring the Use of Nonmedical Sources of Prescription Drugs Among Immigrant Latinos in the Rural Southeastern USA. J Rural Health 2010; 27:159-67. [DOI: 10.1111/j.1748-0361.2010.00323.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dameh M, Green J, Norris P. Over-the-counter sales of antibiotics from community pharmacies in Abu Dhabi. ACTA ACUST UNITED AC 2010; 32:643-50. [DOI: 10.1007/s11096-010-9418-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
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Gartin M, Brewis AA, Schwartz NA. Nonprescription antibiotic therapy: cultural models on both sides of the counter and both sides of the border. Med Anthropol Q 2010; 24:85-107. [PMID: 20420303 DOI: 10.1111/j.1548-1387.2010.01086.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antibiotic resistance is a global public health threat exacerbated by medically unwarranted or improper antibiotic use. Pharmacy counters at the U.S.-Mexico border provide an example of where lay decisions to use antibiotics in ways considered "risky" may be initiated and negotiated. We test how cultural and public health knowledge of antibiotics is distributed among pharmacy staff, local Mexican clients, and U.S. medical tourists in the bordertown of Nogales using a cultural consensus tool. We find that shared cultural models across these groups include public health statements; however, other shared statements are likely to reinforce antibiotic sales at pharmacy counters by those on both sides of the purchase as economic, rather than therapeutic, encounters. From a public health perspective, border pharmacy counters are not a location where increased "safe" knowledge about antibiotic use is being transmitted. However, we do find a positive relationship between "safe" knowledge and reductions in risky behavior.
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Affiliation(s)
- Meredith Gartin
- School of Human Evolution and Social Change Arizona State University, USA
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Mainous AG, Diaz VA, Carnemolla M. A community intervention to decrease antibiotics used for self-medication among Latino adults. Ann Fam Med 2009; 7:520-6. [PMID: 19901311 PMCID: PMC2775608 DOI: 10.1370/afm.1061] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Recent evidence in Latino communities indicates substantial self-medication with antibiotics obtained without a prescription (WORx). We implemented and evaluated a culturally sensitive educational intervention to decrease antibiotic self-medication. METHODS We conducted a community-based intervention with preintervention and postintervention measures in the intervention community (Charleston, South Carolina) as well as a postintervention measure in a control community (Greenville, South Carolina) 200 miles away. The 9-month culturally sensitive intervention included multiple media sources (pamphlets, radio, newspapers). We evaluated the use of antibiotics WORx in the United States, as well as the likelihood of importing antibiotics, by surveying Latino adults in the intervention (n = 250) and in the control community (n = 250). RESULTS Most adults in the intervention community (69%) and the control community (60%) reported some exposure to messages about the inappropriate use of antibiotics, and 25.9% in the intervention community and 8.6% in the control community reported seeing our patient education pamphlets. A substantial proportion of Latino adults in both the intervention (31%) and control communities (20%) have obtained antibiotics WORx in the United States. In multivariate analyses, exposure to an educational message was not a significant predictor of having acquired antibiotics WORx in the United States in past 12 months. The primary predictor of respondents' having acquired antibiotics WORx in the United States was whether they had bought antibiotics WORx outside the United States. CONCLUSIONS Novel approaches are needed to decrease the use of antibiotics WORx in Latino communities, as focusing only on education may not be sufficient to change behaviors common in their home countries.
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Affiliation(s)
- Arch G Mainous
- Department of Family Medicine, Medical University of South Carolina, 295 Calhoun St Charleston, SC 29425 USA.
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Dryden MS, Cooke J, Davey P. Antibiotic stewardship--more education and regulation not more availability? J Antimicrob Chemother 2009; 64:885-8. [PMID: 19729376 DOI: 10.1093/jac/dkp305] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Antibiotics are overused across the world by prescription, self-medication or over the counter (OTC) availability. In the UK, the agenda to increase patient choice has stimulated a move towards greater availability of OTC antibiotics. This trend needs to be urgently reviewed and controlled. The Medicines and Healthcare products Regulatory Agency is currently reviewing applications for reclassification of trimethoprim and nitrofurantoin from prescription-only medicines to pharmacy availability or OTC. It is important that anti-infectives do not become more freely available. With the quantity of antibiotic use linked to antibiotic resistance, Society should seek to preserve the use of this irreplaceable resource by education and regulation.
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Affiliation(s)
- Matthew S Dryden
- Department of Microbiology and Communicable Disease, Royal Hampshire County Hospital, Winchester, UK.
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Mainous AG, Everett CJ, Post RE, Diaz VA, Hueston WJ. Availability of antibiotics for purchase without a prescription on the internet. Ann Fam Med 2009; 7:431-5. [PMID: 19752471 PMCID: PMC2746509 DOI: 10.1370/afm.999] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. METHODS We conducted an Internet search using 2 major search engines (Google and Yahoo) with the key words "purchase antibiotics without a prescription" and "online (English only)." Vendors were compared according to the classes of antibiotics available, quantity, shipping locations, and shipping time. RESULTS We found 138 unique vendors selling antibiotics without a prescription. Of those vendors, 36.2% sold antibiotics without a prescription, and 63.8% provided an online prescription. Penicillins were available on 94.2% of the sites, macrolides on 96.4%, fluoroquinolones on 61.6%, and cephalosporins on 56.5%. Nearly all, 98.6%, ship to the United States. The mean delivery time was 8 days, with 46.1% expecting delivery in more than 7 days. Among those selling macrolides (n = 133), 93.3% would sell azithromycin in quantities consistent with more than a single course of medication. Compared with vendors that require a medical interview, vendors who sell antibiotics without a prescription were more likely to sell quantities in excess of a single course, and the antibiotics were more likely to take more than 7 days to reach the customer. CONCLUSIONS Antibiotics are freely available for purchase on the Internet without a prescription, a phenomenon that encourages self-medication and low quality of care.
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Affiliation(s)
- Arch G Mainous
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Feldman SR, Vallejos QM, Quandt SA, Fleischer AB, Schulz MR, Verma A, Arcury TA. Health care utilization among migrant Latino farmworkers: the case of skin disease. J Rural Health 2009; 25:98-103. [PMID: 19166568 DOI: 10.1111/j.1748-0361.2009.00205.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources. PURPOSE Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. METHODS Three hundred and four migrant and seasonal Latino farmworkers in North Carolina were enrolled in a longitudinal study of skin disease and health care utilization over a single agricultural season. Self-reported and dermatologist-diagnosed skin condition data were collected at baseline and at up to 4 follow-up assessments. Medical visit rates were compared to national norms. FINDINGS Self-reported skin problems and diagnosed skin disease were common among farmworkers. However, only 34 health care visits were reported across the entire agricultural season, and none of the visits were for skin diseases. Nevertheless, self-treatment for skin conditions was common, including use of non-prescription preparations (63%), prescription products (9%), and home remedies (6%). General medical office visits were reported in 3.2% of the assessments, corresponding to 1.6 office visits per person year. CONCLUSIONS The migrant farmworker population consists largely of young men who make little use of clinic services. Skin conditions are very common among these workers, but use of medical services for these conditions is not common. Instead, farmworkers rely primarily on self-treatment. Clinic-based studies of farmworker skin conditions will not account for most injury or disease in this population and have the potential for biased estimates.
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Affiliation(s)
- Steven R Feldman
- Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1071, USA.
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Abstract
OBJECTIVES A survey was conducted to estimate the prevalence of self-medication with antibiotics in Jordan and evaluate the factors associated with antibiotic misuse. METHODS Validated questionnaire was used to collect data from a sample of 1943 households (9281 persons) selected from among different cities in Jordan. RESULTS 842 (39.5%) of 2133 antibiotic users identified via the survey had used antibiotics without a prescription within a one-month study period. Self-medication with antibiotics was found to be significantly associated with age, income, and level of education. The main reason for self-medication as reported by the participants was their previous experience on the efficacy of treatment. The main sources of antibiotics were the previously prescribed pharmaceuticals stored in the household and those purchased in pharmacies. CONCLUSION The prevalence of self-medication with antibiotics in Jordan is alarmingly high. Given the growing global resistance to antibiotics and the documented health problems related to their inappropriate use, our findings may have major public health policy implications in Jordan.
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Gorwitz R, Kruszon‐Moran D, McAllister S, McQuillan G, McDougal L, Fosheim G, Jensen B, Killgore G, Tenover F, Kuehnert M. Changes in the Prevalence of Nasal Colonization withStaphylococcus aureusin the United States, 2001–2004. J Infect Dis 2008; 197:1226-34. [DOI: 10.1086/533494] [Citation(s) in RCA: 611] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Gentry K, Quandt SA, Davis SW, Grzywacz JG, Hiott AE, Arcury TA. Child healthcare in two farmworker populations. J Community Health 2007; 32:419-31. [PMID: 17940873 DOI: 10.1007/s10900-007-9062-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Children in farmworker families are medically underserved. Little research has documented the healthcare of these children. This analysis uses data collected from two populations of Latino farmworker families, one located in western North Carolina and western Virginia, and the other located in eastern North Carolina, to describe and compare child healthcare utilization and mothers' satisfaction with their children's healthcare. Child, mother, household and health services characteristics are examined as causes of variation in child healthcare utilization and mothers' satisfaction for each farmworker population. Results highlight strengths in the provision of healthcare to farmworker children, including most receiving care at a consistent healthcare facility, age appropriate time since last visit, and satisfaction with the care received. Shortcomings in farmworker child healthcare include few having a consistent healthcare provider, and many not receiving visits with recommended frequency. Differences observed in child health services between the two populations include dissatisfaction with care received, perceptions that healthcare staff members are disrespectful, and difficulties with transportation. Further research is needed to determine the best means of providing care to this underserved population.
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Affiliation(s)
- Kimberly Gentry
- Northwestern Carolina Oncology and Hematology, Mulberry Medical Park, 401 Mulberry Street SW, Suite 210, Lenoir, NC 28645, USA
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Cohen PA, McCormick D, Casey C, Dawson GF, Hacker KA. Imported compounded diet pill use among Brazilian women immigrants in the United States. J Immigr Minor Health 2007; 11:229-36. [PMID: 18066718 DOI: 10.1007/s10903-007-9099-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Accepted: 11/13/2007] [Indexed: 12/21/2022]
Abstract
In Brazil, compounded diet pills that combine amphetamines, benzodiazepines, antidepressants, diuretics and laxatives are often prescribed. In 2006, the Food and Drug Administration banned their sale in the United States (US) citing substantial safety concerns. This study evaluates the prevalence of, and factors associated with, use of these pills among Brazilian immigrant women aged 18-50. Pill use was assessed at one clinic and two churches using an anonymous survey (n = 307). While living in the US, 18% of clinic respondents and 9% of church respondents reported using these diet pills. Nearly two thirds of pill users reported adverse effects. In multivariate logistic regression analysis, being unmarried, college educated, dissatisfied with current weight, and advised by a US physician to lose weight were associated with greater odds of imported diet pill use. To enhance care of Brazilian immigrants, US physicians should become familiar with the health consequences of imported diet pills from Brazil.
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Affiliation(s)
- Pieter A Cohen
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA 02143, USA.
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Esimone CO, Nworu CS, Udeogaranya OP. Utilization of antimicrobial agents with and without prescription by out-patients in selected pharmacies in South-eastern Nigeria. ACTA ACUST UNITED AC 2007; 29:655-60. [PMID: 17464572 DOI: 10.1007/s11096-007-9124-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Accepted: 03/25/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We conducted a study in out-patient pharmacies in South-eastern Nigeria in order to determine the extent of self-medication of antimicrobial agents in this area, assess the dosing error associated with this practice and to ascertain the extent of involvement of community pharmacies. METHOD A survey was carried out daily in selected community pharmacies for a period of 90 days. Data were collected on the number of patients visiting these shops for antimicrobial agents, the number getting their medication with a prescription, the number getting their order without prescription and on the type and dose of antimicrobial agents received. MAIN OUT-COME MEASURE: The percentage of patients with prescription and without prescription was compared. The percentage under-dosages or over-dosages associated with how each antimicrobial agent was obtained were compared. The total DDDs of antimicrobial agents dispensed within this period with and without prescription were compared. RESULTS A total of 4,128 outpatients visited the shops for antimicrobial agents within the period and were involved in the study. Of this number, 1,742 (42.2%) came with a prescription from qualified medical personnel and 2,386 (57.8%) came without a prescription. A total of 13,693.13 DDDs of antimicrobial agents was dispensed, of which 56.38% was dispensed with prescription and 43.62% was dispensed without prescription. The degrees of under-dosing were significantly (P < 0.05) higher in regimen filled without prescription when compared to those filled with prescription. CONCLUSION Majority of the patients in this region still obtains their antimicrobial agents without a proper prescription, which is associated with sub-therapeutic dosing of these agents. There is a need for better regulation of antimicrobial agents dispensing and utilization in the region.
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Affiliation(s)
- Charles Okey Esimone
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria
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Goossens H, Ferech M, Coenen S, Stephens P. Comparison of Outpatient Systemic Antibacterial Use in 2004 in the United States and 27 European Countries. Clin Infect Dis 2007; 44:1091-5. [PMID: 17366456 DOI: 10.1086/512810] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 12/22/2006] [Indexed: 11/03/2022] Open
Abstract
The European Surveillance of Antimicrobial Consumption (ESAC) project collects data on antibacterial use in Europe, applying the Anatomic Therapeutic Chemical classification system and defined daily dose methodology, as recommended by the World Health Organization. Comparable data for the United States have been collected from IMS Health. The IMS Health sales data, processed according to ESAC methodology, suggest that outpatient antibacterial use in the United States is high (only 3 of 27 European countries used more) and is mainly characterized by a shift towards newer antibiotics.
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Arcury TA, Vallejos QM, Feldman SR, Quandt SA. Treating skin disease: self-management behaviors of Latino farmworkers. J Agromedicine 2007; 11:27-35. [PMID: 17135140 DOI: 10.1300/j096v11n02_06] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Latino migrant and seasonal farmworkers experience high rates of skin disease that result from their working and living conditions. Knowledge of the ways farmworkers treat skin disease symptoms will provide a foundation for developing culturally appropriate health education, improving the delivery of health services, and improving occupational health policy for agricultural workers. The purpose of this paper is to describe skin disease self-management practices among Latino migrant and seasonal farmworkers in North Carolina. This analysis uses a qualitative design based on in-depth interviews with 30 Latino farmworkers (six females, 24 males). Computer assisted, systematic procedures are used to analyze the verbatim transcripts of these interviews. Participants shared a consistent set of health self-management actions in treating skin disease. These actions were within the domains of self-care and medical care. A model of skin disease self-management among Latino farmworkers includes the self-care actions of hygiene, use of home remedies and use of over-the-counter remedies, with farmworkers often combining different domains of self-care. While farmworkers acknowledge the benefits of medical care, they are also mindful of barriers to its use, including cost, transportation and language. The large percentage of farmworkers who experience skin problems indicates that health outreach workers who serve this population need to provide education on preventing and treating skin problems, and they need to recommend to farmworkers appropriate over-the-counter medicines for the treatment of these skin problems. Appropriate medical care for treating skin problems that are dangerous and reduce farmworkers' quality-of-life needs to be made available to this population.
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Affiliation(s)
- Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1084, USA.
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Metlay JP, Fishman NO, Joffe MM, Kallan MJ, Chittams JL, Edelstein PH. Macrolide resistance in adults with bacteremic pneumococcal pneumonia. Emerg Infect Dis 2006; 12:1223-30. [PMID: 16965701 PMCID: PMC3291219 DOI: 10.3201/eid1708.060017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We conducted a case-control study of adults with bacteremic pneumococcal pneumonia to identify factors associated with macrolide resistance. Study participants were identified through population-based surveillance in a 5-county region surrounding Philadelphia. Forty-three hospitals contributed 444 patients, who were interviewed by telephone regarding potential risk factors. In multivariable analyses, prior exposure to a macrolide antimicrobial agent (odds ratio [OR] 2.8), prior flu vaccination (OR 2.0), and Hispanic ethnicity (OR 4.1) were independently associated with an increased probability of macrolide resistance, and a history of stroke was independently associated with a decreased probability of macrolide resistance (OR 0.2). Fifty-five percent of patients with macrolide-resistant infections reported no antimicrobial drug exposure in the preceding 6 months. Among patients who reported taking antimicrobial agents in the 6 months preceding infection, failure to complete the course of prescribed drugs was associated with an increased probability of macrolide resistance (OR 3.4).
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Affiliation(s)
- Joshua P Metlay
- Center for Clinical Epidemiology and Biostatistics, Philadelphia Veterans Affairs Medical Center, 423 Guardian Drive, Philadelphia, PA 19104, USA.
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Knowledge, attitudes, and practices regarding antibiotic use among Latinos in the United States: review and recommendations. Am J Infect Control 2006; 34:495-502. [PMID: 17015154 DOI: 10.1016/j.ajic.2006.01.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 01/27/2006] [Indexed: 11/18/2022]
Abstract
Inappropriate use of antibiotics contributes to antimicrobial resistance worldwide. In Latin America, antibiotics are easily obtained over the counter. In the United States, the Latino population is the largest and fastest growing immigrant group. Hence, it is necessary to understand Latino cultural practices in regards to antibiotic use to develop effective interventions that reduce inappropriate antibiotic use among this population. We conducted a systematic review of descriptive and intervention studies measuring knowledge, attitudes, and practices of antibiotic use among Latinos in the United States. The search yielded only 11 descriptive studies and no interventions. The literature suggests that many Latinos in the United States self-prescribe antibiotics because of financial and sociocultural barriers and inaccurately believe that antibiotics help treat viral infections. Increased access to health care and appropriate culturally tailored interventions specific to Latinos are needed to promote judicious antibiotic use among Latinos.
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Metlay JP, Fishman NO, Joffe MM, Kallan MJ, Chittams JL, Edelstein PH. Macrolide resistance in adults with bacteremic pneumococcal pneumonia. Emerg Infect Dis 2006. [PMID: 16965701 PMCID: PMC3291219 DOI: 10.3201/eid1208.060017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We conducted a case-control study of adults with bacteremic pneumococcal pneumonia to identify factors associated with macrolide resistance. Study participants were identified through population-based surveillance in a 5-county region surrounding Philadelphia. Forty-three hospitals contributed 444 patients, who were interviewed by telephone regarding potential risk factors. In multivariable analyses, prior exposure to a macrolide antimicrobial agent (odds ratio [OR] 2.8), prior flu vaccination (OR 2.0), and Hispanic ethnicity (OR 4.1) were independently associated with an increased probability of macrolide resistance, and a history of stroke was independently associated with a decreased probability of macrolide resistance (OR 0.2). Fifty-five percent of patients with macrolide-resistant infections reported no antimicrobial drug exposure in the preceding 6 months. Among patients who reported taking antimicrobial agents in the 6 months preceding infection, failure to complete the course of prescribed drugs was associated with an increased probability of macrolide resistance (OR 3.4).
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Affiliation(s)
- Joshua P. Metlay
- Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA;,University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Neil O. Fishman
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Marshall M. Joffe
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael J. Kallan
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jesse L. Chittams
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Paul H. Edelstein
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Grigoryan L, Haaijer-Ruskamp FM, Burgerhof JGM, Mechtler R, Deschepper R, Tambic-Andrasevic A, Andrajati R, Monnet DL, Cunney R, Di Matteo A, Edelsein H, Valinteliene R, Alkerwi A, Scicluna E, Grzesiowski P, Bara AC, Tesar T, Cizman M, Campos J, Lundborg CS, Birkin J. Self-medication with antimicrobial drugs in Europe. Emerg Infect Dis 2006; 12:452-9. [PMID: 16704784 PMCID: PMC3291450 DOI: 10.3201/eid1203.050992] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Antimicrobial drug self-medication occurs most often in eastern and southern Europe and least often in northern and western Europe. We surveyed the populations of 19 European countries to compare the prevalence of antimicrobial drug self-medication in the previous 12 months and intended self-medication and storage and to identify the associated demographic characteristics. By using a multistage sampling design, 1,000–3,000 adults in each country were randomly selected. The prevalence of actual self-medication varied from 1 to 210 per 1,000 and intended self-medication from 73 to 449 per 1,000; both rates were high in eastern and southern Europe and low in northern and western Europe. The most common reasons for self-medication were throat symptoms (e.g., dry, inflamed, red, or sore throat, inflamed tonsils, tonsil pain). The main medication sources were pharmacies and medication leftover from previous prescriptions. Younger age, higher education, and presence of a chronic disease were associated with higher rates of self-medication. Attempts to reduce inappropriate self-medication should target prescribers, pharmacists, and the general public.
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Affiliation(s)
- Larissa Grigoryan
- Department of Clinical Pharmacology, University Medical Center Groningen, Groningen, the Netherlands.
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