It is important to understand the links between different factors promoting SMA and to assess the changing trends in order to derive strategies aimed at reducing drug-related health risks.

BackgroundIn recent decades, the Kingdom of Saudi Arabia has seen an exponentially growing antibiotic resistance, which is exacerbated by the use of antibiotics without a prescription and other various factors. However, no published data are available on factors influencing non-prescription use of antibiotics among the general public in Saudi Arabia using an in-depth interview technique.MethodsSemi-structured interviews were carried out with 40 Saudi participants from the Eastern Province of Saudi Arabia, selected via snowball sampling technique. Participants were enrolled based on the following inclusion criteria: 18 years of age or older and had self-medicated themselves with antibiotics in the past two years. Data collection was continued until data saturation was attained. Interviews were audiotaped, transcribed verbatim and analysed using NVivo 10 software.ResultsParticipants (80% female) had a mean (SD) age of 30 years (10.2). Self-medication with antibiotics was associated with various inappropriate antibiotic use behaviours and negative outcomes such as antibiotic resistance, treatment failures and adverse events. Interviews revealed that different reasons contribute to the rise of self-medication with antibiotics, ranging from difficulty accessing healthcare services, participant’s cultural beliefs and practices, lack of knowledge about antibiotics and antibiotic resistance, and weak regulatory enforcement.ConclusionsThe findings of the present study will aid in generating data that may provide an insight when designing future interventions to promote public health awareness regarding safe and effective use of antibiotics.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6088-z) contains supplementary material, which is available to authorized users.

BackgroundAntibiotic resistance is a growing problem worldwide. It has considerable implications on societies’ health and resources. However, there has been no systematic review on non-prescription antibiotics in Middle Eastern (ME) countries.PurposeTo review relevant studies published in ME countries to establish the prevalence, possible causes and clinical outcomes of self-medication with antibiotics (SMA) and identify recommendations to reduce irrational use of antibiotics.Material and methodsDatabases (PubMed, Scopus, ProQuest, Web of Science) were searched for peer reviewed research published between January 2000 and June 2016 on SMA among adults aged ≥18 years living in the ME. A hand search for relevant citations and key journals was also performed. Articles were scrutinised for country of origin, sample size, recall period, prevalence rate, determinants and possible causes of SMA, type of antibiotic, source of supply, indication for SMA, inappropriate use, source of drug information, clinical outcomes and recommendations to address the problem where possible.Results22 studies were found. The prevalence of SMA ranged from 19% to 82%. Age, gender, educational and income levels were the main determinants of SMA. The reasons for SMA varied across studies. Sociocultural, economic and regulatory factors were the most commonly cited reasons for SMA. Penicillins were the antibiotics most commonly used; the antibiotics were obtained mainly via stored leftover drugs at home, pharmacies/drug stores without prescriptions and friends/relatives. SMA was mainly for sore throat, fever and respiratory problems, such as cold/flu and cough. The primary sources of drug information and recommendations included relatives/friends and previous successful experience with the same antibiotic. Inappropriate drug use such as incorrect indication, short and long duration of treatment, exchange/sharing of antibiotics, and storing antibiotics at home for use at a later time were reported. Negative and positive outcomes of SMA were identified. Some recommendations were made based on the problems that were found, but these were not evaluated.ConclusionThe prevalence of SMA is high in ME countries. Thus we have to understand the links between different factors promoting SMA and assess the changing trend in order to help us derive strategies aimed at reducing drug related health risks among the ME population.No conflict of interest