Determinants of Self-Medication With Antibiotics in European and Anglo-Saxon Countries: A Systematic Review of the Literature

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.

Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

“…This self-medication rate was comparatively much lower than those reported in other studies conducted among adults, which were 5.3% to 20.4% in Malaysia [35,[39][40][41]44], and 22.4% to 76.6% in other countries [42,43,[45][46][47][48][49], in which respondents obtained antibiotics from the pharmacy without prescriptions, followed by antibiotics shared by family or friends, and purchased from clinics without consultation. A systematic review reported that age is not a strong determinant in self-medication with antibiotics [50]; therefore, the lower rate of self-medication in this study might not be due to subject selection for elderly population. A potential reason for the low rate of self-medication in this study is the recruitment of respondents from a public tertiary hospital, where medications are supplied with prescriptions.…”

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…Community pharmacists are often the first healthcare professional that patients consult with regarding URTIs such as a cold or cough. This is because they are typically more accessible than physicians, especially in rural communities 155 . Other factors include long waiting times to see a physician or nurse in PHCs in LMICs, losing income because of loss of work, as well as possibly having to travel long distances to access healthcare professionals in PHCs along with the associated costs 69,134,306,[352][353][354][355][356] .…”

“…A number of systematic reviews regarding the management of URTIs and ways to improve both the prescribing and dispensing of antibiotics for patients with URTIs have also been published 21,43,45,57,61,74,85,108,153,154 . These include systematic reviews determining possible reasons behind dispensing antibiotics without a prescription 141,155 , patient-related determinants regarding antibiotic use 156 , and reviews assessing the influence of targeted communications among patients to reduce excessive antibiotic use 157 . In addition, initiatives such as GRIP (Global Respiratory Infection Partnership Declaration) help reduce unnecessary antibiotic utilization through recommending non-antibiotic treatments for patients with URTIs 158,159 .…”

“Two-colour capsules”: Self-management of health and the commonly used non-prescribed antibiotics amongst pharmacy customers

“…The ndings con rm the inappropriate use antibiotics among Maputo city private pharmacy clients and the drugs often being used incorrectly or inappropriately for self-diagnosed health problems. Medicines are an important part of the process of healthcare seeking, being essential to the health care system, to health care providers and to the individuals [19]. With most customers using non prescribed antibiotics combinations to self-treat, self-diagnosed and self-perceived illnesses, this research highlighted the easy accessibility of a variety of antibiotics by customers at private pharmacies in the city.…”