Each year in the United States, at least 2 million people are infected with an antibiotic-resistant bacteria — 23,000 of whom die as a result. And the rate at which new resistance mechanisms are spreading means many more could be at risk.
What’s more, many patients are unintentionally contributing to their own antibiotic resistance. How? A scoping review of 31 studies recently published in Annals of Internal Medicine and authored by George Germanos, MD, shows an increasingly large number of Americans are using antibiotics without a prescription or medical guidance.
Although prevalence varies across different communities, the researchers found up to 66 percent of people could be misusing antibiotics by storing pills for future use, diverting them to others or simply intending to use them without a prescription.
“Very frequently, we found the highest reported prevalence was in populations that had limited access to healthcare,” Germanos tells Florence Health. “We need to educate people about the effects of antibiotics.”
What Did the Study Find?
The researchers focused on four populations: Patients within healthcare settings, patients outside of healthcare settings, Hispanic populations and injection drug users. Antibiotics were often obtained without a prescription from various sources, including previously prescribed courses, local markets and family or friends.
The prevalence of storing antibiotics for future use ranged from 14 percent to 48 percent across all groups. The highest estimate of nonprescription use (48 percent) was reported from a 2018 national Internet survey of parents, in which a majority of respondents said they diverted leftover antibiotics to their child’s siblings, unrelated children or unrelated adults.
Several of the surveyed studies also reported that nonprescription antibiotic use was prevalent in Hispanic populations, with the highest prevalence (66 percent) measured from a 2014 survey of migrant workers in Florida.
Studies of injection drug users showed rates of nonprescription antibiotic use ranged from 5 percent to 32 percent in order to treat abscesses and injection-related wounds.
According to the research, the following are factors influencing nonprescription use of antibiotics:
- Lack of insurance or healthcare access
- Costs of physician visit or of antibiotics
- Relatives or friends providing antibiotics
- Availability in ethnic stores or on the street
- Long waiting periods in clinics
- Embarrassment about seeking care for a sexually transmitted infection
- Drug users’ concerns about being mistreated
- Lack of transportation to/from medical care
- Maintaining job or not missing pay
- Previous response to antibiotic treatment
Why Does the Study Matter?
The use of antibiotics without a prescription could increase unnecessary drug use, as well as the global risk for antimicrobial resistance. Germanos said that when patients take nonprescription antibiotics unnecessarily, they could be selecting for resistance.
“People are just trying to do what’s best for their child or for their own wellbeing,” Germanos said. “It’s not like they’re trying to act in a harmful way. But they don’t know the side effects or the potential complications of taking antibiotics inappropriately.”
Germanos said our healthcare system needs to place a greater emphasis on antibiotic stewardship — making sure the right drug is administered for the right duration and for the right microbe.
What Can Healthcare Providers Do?
A greater understanding of risk factors is essential in limiting this unsafe practice. Germanos recommends that healthcare providers take the time to highlight some of the harms of antibiotic misuse to their patients.
“Education is the best start,” Germanos said. “And of course, increasing access to healthcare.”
Simply reminding patients to take their prescription to completion and not to reuse or redistribute leftovers could go a long way. And check out the following resources, provided by the CDC, to brush up on best practices for prescribing and taking antibiotics: