Using antibiotics without prescription prevalent public health problem

People using antibiotics without a prescription seems to be a prevalent public health problem. Antibiotics were obtained through various means, including saving leftover prescriptions for later use, getting them from friends and family, or obtaining them from local markets "under the counter,” according to findings from a scoping review published in Annals of Internal Medicine.

When people take antibiotics without a prescription, they often take unnecessary medication or choose an inappropriate drug or dose. This practice is associated with avoidable adverse events and may also increase the risk for inducing antibiotic resistance. It is important to understand how prevalent nonprescription antibiotic use is and the factors that contribute to the issue, researchers said.

Researchers from Baylor College of Medicine and the Center for Innovations in Quality, Effectiveness, and Safety reviewed 31 published studies to determine the prevalence of nonprescription antibiotic use in the U.S. and to examine the factors that influence that use. The prevalence of nonprescription antibiotic use varied from 1 percent among people visiting a clinic to 66 percent among Latino migrant workers.

Storage of antibiotics for future use varied from 14 percent to 48 percent and a quarter of the people in one study reported intention to use antibiotics without a prescription. Factors that contribute to nonprescription use include lack of insurance or healthcare access, cost of a physician visit or prescription, embarrassment about seeking care for a sexually transmitted infection, not being able to get time off of work to visit a clinic or physician's office, and several other reasons. According to the researchers, more studies are needed to quantitate nonprescription antibiotic use and explore potentially modifiable factors that contribute to unsafe practices.

An additional study published in Annals of Internal Medicine found that more than 6 million Americans take aspirin daily without their physician's recommendation. Physicians and medical professional societies have widely supported aspirin use for primary prevention of cardiovascular disease (CVD) in persons at increased risk. However, current evidence-based guidelines from the American Heart Association and the American College of Cardiology (AHA/ACC) recommend against routine aspirin use in persons older than 70 years and those with increased bleeding risk. However, the extent to which these populations take aspirin for primary prevention in the U.S. is unknown.

Researchers from Beth Israel Deaconess Medical Center and Harvard Medical School used data from the Sample Adult component of the 2017 National Health Interview Survey (NHIS), a nationally representative in-person household survey of health and disability among U.S. adults, to characterize aspirin use for primary prevention of CVD. They found that among adults aged 40 years or older without CVD, 23.4 percent (approximately 29 million persons) reported taking daily aspirin for prevention. Of these, 22.8 percent (6.6 million persons) did so without a physician's recommendation.

Nearly half of adults aged 70 years or older without CVD reported aspirin use. After adjustment, older age, male sex, and cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes, and smoking were statistically significantly associated with aspirin use.

The authors noted that a history of peptic ulcer disease was not significantly associated with lower aspirin use. According to the authors, these findings show a tremendous need for healthcare practitioners to talk to their patients about aspirin use.