Personal beliefs and healthcare system barriers contribute to inappropriate antibiotic use by patients, report researchers presenting findings at the IDWeek 2023 annual meeting.
Over-the-counter antibiotic use includes accessing medications left over from previously prescribed treatment, obtained from social media and purchased over the counter in other countries or illegally in stores and markets in the United States .
Overuse and misuse of antibiotics contribute to a growing threat of antimicrobial resistance, and it’s hard to say how common it is, noted Lindsey A. Laytner, PhD, MPH, of Baylor College of Medicine in Houston. in Texas, in his presentation.
“This is an understudied area. We don’t systematically collect this data, so we don’t actually know what the true prevalence is. The factors that contribute to this dangerous practice in the United States are also under-researched,” said Laytner.
To investigate, researchers conducted in-depth interviews with 86 adults (median age, 49 years; 62% female) to identify patients’ motivations for using over-the-counter antibiotics. All answered “yes” when asked in a previous survey if they would use antibiotics without contacting a doctor, nurse, dentist or clinic.
Laytner said several important themes emerged.
Almost all respondents reported the use of over-the-counter antibiotics for symptoms that, for the most part, did not warrant antibiotic use. These included COVID-19, flu and cold symptoms, as well as managing pain, allergies and even wounds.
Treating symptoms ineffectively
Many thought they “knew their bodies, knew what they had and knew how to care for themselves” without a health care provider, Laytner said.
They also felt that over-the-counter medications “do not always work and that antibiotics are like gold or a panacea and because it is difficult to get a prescription they should be kept on hand” , she explained.
Various healthcare system barriers also contribute to inappropriate antibiotic use, including long wait times to make an appointment and see the doctor during appointments; high costs of clinic visits and prescriptions; and transportation issues.
Many patients chose to use over-the-counter antibiotics out of “convenience,” Laytner added.
She says the findings could help inform community-level education efforts about inappropriate antibiotic use and shape policies to promote antibiotic stewardship.
Access to care and education
Commenting on the study of Medscape Infectious DiseasesEmily Sydnor Spivak, MD, associate professor of medicine at the University of Utah School of Medicine in Salt Lake City, said she “wasn’t totally surprised by the results, but found it very interesting to see how there was a theme of empowerment, or ‘I know my body,’ which seemed to drive patients to receive antibiotics to relieve their symptoms.”
“There is a need to educate patients about the role of antibiotics, how they work and how they don’t actually relieve symptoms and have downsides and side effects,” said Spivak, who is also medical director of antimicrobial stewardship programs at University of Utah Health and VA Salt Lake City Health Care System.
“Given lack of access to healthcare as a reason why some patients use over-the-counter antibiotics, we need to think about access to the healthcare system and changes in processes and policies to enable greater access. Without better access or better interaction with the healthcare system, we cannot educate patients,” Spivak said.
The study had no commercial funding. Laytner and Spivak do not report any relevant financial information.
IDWeek 2023 Annual Meeting: Summary 1016. Presented October 12, 2023.
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