Self-medication of antibacterials without prescription (also called ‘ over-the-counter’ use)

Abstract

The availability of antimicrobial agents for self-medication may increase and could include antibacterial agents for oral or topical use. Wholesale deregulation of antibacterials would be undesirable and likely to encourage misuse of classes of agents currently important in the management of serious infections. Changed regulation from Prescription-Only Medicine (POM) to Pharmacy (P) medicine of selected agents with indications for short-term use in specific minor infections and illness is likely to have advantages to the user. However, safeguards to their use would need to be included in the Patient Information Leaflet (PIL). Agents and indications for self-medication are discussed. Any alteration in licensed status from POM to P will require careful risk-benefit assessment, including the likely impact on bacterial resistance. Safety issues also include concerns relating to age of the user, pregnancy, underlying disease and the potential for drug interactions. The importance of appropriate information with the PIL is emphasized, as is the role of the pharmacist, while ways of improving adverse event notification and monitoring are discussed. The paucity of good denominator-controlled data on the prevalence of in-vitro resistance is highlighted, and recommendations for improving the situation are made. There are currently no levels of resistance accepted by regulatory bodies on which to base a licensing decision, be it for granting a product licence, renewal of a licence or a change in licensed status from POM to P. Due consideration should be given to: the validation of user-defined indications in comparison with those medically defined; the enhancement of pharmacy advice in the purchase of such agents; improved safety monitoring; the establishment of systematic surveillance of susceptibility data.

In-home Drug Storage and Self-medication with Antimicrobial Drugs in Basrah, Iraq

“…10 Among the possible adverse consequences of self-medication to individual patients are those that include misdiagnosis and missed diagnosis, misuse of drugs (including unintentional access by children), increased risk of adverse reactions and drug interactions, particularly in children, the elderly, pregnant women and those with pre-existing diseases. 3 Misdiagnosis could have several adverse consequences, includes; a) partial or complete failure to treat an infection, b) failure accurately to identify or treat the presenting infection, c) exposure to the risks of antibacterials without benefit when no treatable bacterial infection is present, and d) failure to recognize that an infection might be a manifestation of underlying disease (e.g. sepsis in diabetes mellitus).…”

“…sepsis in diabetes mellitus). 3 In-home Drug Storage... Jassim Antimicrobial drug resistance is a rapidly increasing global problem and the prevalence varies widely among countries. 26,27 Prevalence of resistance is positively correlated with using drugs obtained without prescriptions, leftover drugs from treatment courses previously prescribed or drugs obtained from relatives or friends.…”

“…Furthermore, the prescription of fewer β-lactams may result in less super-infections with clostridium difficile and Candida spp. 3 Antimicrobial drugs from all classes were stored at home.…”

“…Moreover, the inappropriate use of antimicrobial drugs may result in a waste of resources, increased resistance of pathogens, serious health hazards, prolong suffering, increases in adverse reactions and drug interactions, and also delays in getting proper treatment when there is misdiagnosis. 1,2,3 On other hand, the use of antimicrobial drugs without medical guidance may lead to the use of insufficient dosages or incorrect or unnecessary drugs. 4 Self-medication and the use of leftover drugs are widespread in countries where drugs are sold without prescriptions.…”

Help-Seeking for Pre-Ulcer and Ulcer Conditions of Mycobacterium ulcerans Disease (Buruli Ulcer) in Ghana

“…Use of selfmedication for Buruli ulcer has been reported in a study in Benin. 7 Indiscriminate use of antibiotics is a concern because of potentially undesirable health effects 18 and implications for treatment, recovery, and pharmacodynamic interactions with WHO-recommended antibiotics (rifampin and streptomycin) when given later to respondents at health centers.…”