"Antibiotic Use without a prescription ..."

[AllisS]

August 9, 2019

Antibiotic Use Without a Prescription in the U.S.

Stephen G. Baum, MD reviewing Grigoryan L et al. Ann Intern Med 2019 Jul 23

A literature review confirms what we suspected: A vast amount of antibiotic consumption bypasses the individual prescription route.

Antibiotic misuse and overuse contributes substantially to the serious and growing problem of microbial antibiotic resistance. Some, if not most, of the misuse and overuse can be traced to antibiotic prescribing for conditions that do not require antibiotic treatment and do not benefit from it.

To delineate pathways by which antibiotics are taken without prescription and to identify factors that might foster the use of these pathways, investigators have conducted a scoping literature review of 31 studies reporting nonprescription use of antibiotics. The studies centered on four populations: patients or parents of patients outside healthcare settings, patients or parents of patients within healthcare settings, Hispanic/Latino persons, and injection drug users.

Although the rates of following nonprescription pathways differed among the populations, the main finding focused on the availability of antibiotics through domestic or foreign online markets selling food, pet food, and health food or via leftover drugs from prior prescriptions for a patient or a patient's family or friends. Factors influencing the degree to which prescriptions were circumvented included finances, lack of insurance or easy access to healthcare, embarrassment about seeking care, and membership in a Hispanic/Latino community; the latter was thought to be based on traditions in the countries of origin.

Comment

Despite the admitted lack of hard data on this topic and the inherent limitations related to a systematic review, this is a very important report. The greatest looming problem in infectious diseases, in my estimation, is not the emergence of any specific infectious agent or agents but rather the current and projected increase in antimicrobial resistance. These authors have opened Pandora's medicine cabinet and we would be wise to take a closer look at what is in there, how to clean it out, and how allowing it to persist will adversely affect us all.