Self-Medication With Antibiotics: An Element Increasing Resistance

Assessing the Reasons and Adverse Effects of Self-Medication in the Context of the COVID-19 Pandemic in Sierra Leone. A Case Study of Moriba Town Section

Background

The impact of COVID-19 pandemic on healthcare resources has led to an increase in self-medication as a coping mechanism. The purpose of the study is to investigate the prevalence of self-medication, the reasons behind it, and its potential consequences during the pandemic.

Methods

A community-based cross-sectional study was conducted in Moriba Town, Bo City, Southern Sierra Leone. Using a multistage systematic sampling technique, 246 adult participants were selected. Data were collected using Kobo collect electronic platform and analyzed using SPSS version 26.0.

Results

Out of the 246 adult residents who were sampled, 63 (26%) practiced self-medication. Among them, females (33 or 52%) were more prevalent than males (30 or 48%). The most dominant age groups for self-medication were 38-47 (22 or 35%) and 28-37 (18 or 29%). The major reasons for self-medication were fear of infection (189 or 77%), fear of quarantine (199 or 81%), and stigma (189 or 77%). Delays in treatment (113 or 46%) and unavailability of Covid-19 medications (92 or 37%) were also cited. However, a majority of respondents (162 or 66%) denied the influence of friends or media (168 or 68%) on their decision to self-medicate. Reasons like "delay in receiving treatment" and "influence of friends" showed significant association with self-medication (pValue <0.05). More than half of the respondents 177 (72%) did not practice self-medication before the pandemic. Adverse reactions due to self-medication included skin rashes and blisters 29 (45%) and drowsiness 24 (38%).

Conclusion

The prevalence of unsupervised medication before and after the pandemic was minimal suggesting little impact of the pandemic. Fear and social stigma were the main drivers for self-medication. To promote safety and informed health decisions, regulatory measures, and awareness campaigns are essential to control unsupervised medication sales, improve drug labeling, and educate the public about the dangers of self-medication.

Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance

INTRODUCTION

Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription.

AREAS COVERED

A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing antibiotics without a prescription). However, considerable variation was seen with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients.

EXPERT OPINION

ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.

Self-Medication Practices Among the Geriatric Population: A Systematic Literature Review

The ageing population is increasingly using self-medication due to comorbidities. Most people who self-medicate use over-the-counter (OTC) medications bought from private pharmacies as their primary source of medicine. The use of self-medication may lead to an increased risk of unfavourable health outcomes. People over the age of 65 are more vulnerable to adverse drug reactions (ADRs). Our article aims to gain insights into self-medication in the geriatric population. We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE) via Google Scholar and PubMed databases. The PubMed search technique was customised for each database and was as follows: (self-medication (Title/Abstract)) AND (geriatric (Title/Abstract) OR elderly (Title/Abstract) OR old (Title/Abstract)). Also, we used other databases like the World Health Organization (WHO), the Ministry of Health and Family Welfare(MOHFW) under the Government of India, etc. The keywords used for the search strategy were 'over-the-counter drugs', adverse drug reactions', self-prescribed drugs', and non-prescription drugs'. Articles that were not relevant to the review topic are excluded. Through our review, we found that most geriatric people use self-medication because of their previous experience with that medication, a lack of seriousness regarding the consequences of using OTC medications, and suggestions from family members, friends, or neighbours. Abdominal pain, headache, cough, joint pain, and fever are the conditions for which the geriatric age group mainly uses self-medication. The primary source of self-medication is directly from the pharmacy, and the most commonly consumed drug for self-medication is analgesics. Most people know about the risks associated with self-medication. However, people continue to participate in this risky self-medication behaviour to get quick relief from a mild illness. This issue can be resolved by providing such a group with free consultations or medical insurance. Pharmacists' role in self-medication is also important. Counselling regarding the hazards of self-medication and selling the drugs to consumers without a doctor's prescription must be avoided.

The Utility of Internet-Enabled Antibiotic Self-Medication and Its Associated Factors Among Patients Attending Private Clinics in Kawempe Division in Kampala Capital City, Uganda: Community-Based Cross-Sectional Study

Introduction

The expanding practice of internet-based antibiotic self-medication raises public health concerns as it increases antibiotic resistance and introduces avoidable risks. This study aims to examine the utility of internet-enabled antibiotic self-medication and its associated factors among patients attending private clinics in Kawempe division in Kampala Capital City, Uganda.

Methods

This was an analytical cross-sectional study that enrolled participants attending private clinics in Kawempe Division's randomly selected zones. These were interviewed using a structured questionnaire, and the data were analyzed using STATA version 12 software. Logistic regression analysis was used, and variables with p ≤ 0.05 were considered as significantly associated with internet-enabled antibiotic self-medication.

Results

Out of the 313 respondents, 246 (79%) reportedly had ever used internet sources to self-medicate with antibiotics. Factors such as being male; single; had knowledge of antibiotics; believed that Internet should be used for antibiotic self-medication; Distance to the nearest medical center/hospital from your residence/workplace of about 5 km and residing near a drug shop/pharmacy that gives antibiotics without a prescription increased internet-enabled antibiotic self-medication. Furthermore, the variables of more than three household members; common practice of antibiotic self-medication in a household; did not agree that one can recover from the illness without a doctor's prescription and medical workers who did not explain adequately the antibiotics medication given for the illness decreased internet-enabled antibiotic self-medication.

Conclusion

This study found that internet-enabled antibiotic self-medication practice is highly utilized and is associated with a variety of individual, household, and healthcare system factors. This necessitates strict adherence to national drug policy regulations governing antibiotic use. Furthermore, community health education is critical in combating such medication practices.