Antibiotic Self-Medication and Antibiotic Resistance: Multilevel Regression Analysis of Repeat Cross-Sectional Survey Data in Europe

Abstract

Antibiotic resistance is a global public health issue with several anthropogenic drivers, including antibiotic consumption. Recent studies have highlighted that the relationship between antibiotic consumption and antibiotic resistance is contextualised by a variety of socioeconomic, cultural, and governance-related drivers of consumption behaviour and contagion that have been underexamined. A potential complication for research and policy is that measures of antibiotic consumption are often reliant on prescribing or sales data which may not easily take into account the dynamics of community consumption that include self-medication; for example, the preservation and use of leftover medication or the obtaining of antibiotics without a prescription. This study uses repeated cross-sectional survey data to fulfil two core aims: firstly, to examine the individual-level and national-contextual determinants of self-medication among antibiotic consumers in European countries, and secondly, to examine the relationship between self-medication behaviour and antibiotic resistance at the national level. This study is particularly novel in its application of a multilevel modelling specification that includes individual-level factors with both time-variant and persistent national characteristics to examine antibiotic consumption behaviours. The key findings of the study are that survey respondents in countries with persistently higher levels of inequality, burdens of out-of-pocket health expenditure, and corruption have an increased probability of self-medicating with antibiotics. The study also highlights that overall levels of antibiotic consumption and antibiotic self-medication do not correlate and are associated heterogeneously with changes in different pathogen/antibiotic pairs. In summary, the study emphasises that antibiotic stewardship and antibiotic resistance, whilst related by biological mechanisms, are also inherently social issues. Attempts to improve antibiotic stewardship and address the challenge of antibiotic resistance should also attend to structural challenges that underlie challenges to antibiotic stewardship in the community, such as the effects of inequality and reduced access to healthcare services.

Editorial for the Special Issue “Spatial and regional aspects of health”

“…The second part of the special issue includes four papers that discuss regional and spatial aspects of the healthcare sector more broadly. Two of them investigate the impact of public investments (Vadia, Blankart 2021, Fidrmuc et al 2022, one analyses antibiotic self-medication (Anderson 2021) and one the effects of Malaria on the height distribution in Italy (Percoco 2021). Vadia, Blankart (2021) investigate the role of public funding in cardiovascular device innovation.…”

“…Results indicate that the injection of EU funds is associated with a significant but small decrease in the readmission rate in the following year, but not with a change in mortality. Anderson (2021) considers drivers and consequences of antibiotic self-medication in Europe using extensive survey data from the Eurobarometer. The author explores the individual-level and national-contextual determinants of self-medication among antibiotic consumers in European countries.…”

Acculturation and Subjective Norms Impact Non-Prescription Antibiotic Use among Hispanic Patients in the United States

“…Recent studies have documented the determinants of non-prescription antibiotic use across low-, middle-, and high-income countries and found that patient-level (sociocultural and sociodemographic) factors and healthcare system barriers contribute to non-prescription antibiotic use [ 7 , 8 , 9 ]. In the United States (US), Hispanic communities have one of the highest reported prevalence rates of non-prescription antibiotic use, with the prevalence ranging from 19 to 66% [ 9 ].…”