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7/27/2019 RRL FOREIGN.docx
1/11
Non-prescription antimicrobial use worldwide: a systematic review.
Morgan DJ,Okeke IN,Laxminarayan R,Perencevich EN,Weisenberg S.
Source
University of Maryland, School of Medicine, Baltimore, MD, USA. [email protected]
AbstractIn much of the world antimicrobial drugs are sold without prescription or oversight by health-care
professionals. The scale and effect of this practice is unknown. We systematically reviewed published
works about non-prescription antimicrobials from 1970-2009, identifying 117 relevant articles. 35
community surveys from five continents showed that non-prescription use occurred worldwide and
accounted for 19-100% of antimicrobial use outside of northern Europe and North America. Safety issues
associated with non-prescription use included adverse drug reactions and masking of underlying
infectious processes. Non-prescription use was common for non-bacterial disease, and antituberculosis
drugs were available in many areas. Antimicrobial-resistant bacteria are common in communities with
frequent non-prescription use. In a few settings, control efforts that included regulation decreased
antimicrobial use and resistance. Non-prescription antimicrobial and antituberculosis use is commonoutside of North America and northern Europe and must be accounted for in public health efforts to
reduce antimicrobial resistance.
Survey of non-prescribed use of antibiotics for children inan urban community in Mongolia
Abstract
Objective
To estimate the prevalence and identify the determinants of non-prescription use of
antibiotics for children in Mongolia.
Methods
A community-based cross-sectional survey was undertaken in 10 subdistricts in
Ulaanbaatar, Mongolias capital. We used a structured questionnaire to collect data from a
random sample of 540 households with at least one child aged < 5 years. Logistic regression
was used to identify factors associated with antibiotic misuse.
Findings
Of 503 participating caregivers, 71% were mothers; 42.3% (95% confidence interval, CI:
37.846.9) of caregivers had used non-prescribed antibiotics to treat symptoms in their
child during the previous 6 months. Symptoms commonly treated were cough (84%), fever
(66%), nasal discharge (65%) and sore throat (60%). Amoxicillin was the most commonly
used antibiotic (58%). Pharmacies were the main source (86%) of non-prescribed
antibiotics. Non-prescribed use by mothers was significantly associated with keeping
http://www.ncbi.nlm.nih.gov/pubmed?term=Morgan%20DJ%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Morgan%20DJ%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Okeke%20IN%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Okeke%20IN%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Okeke%20IN%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Laxminarayan%20R%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Laxminarayan%20R%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Laxminarayan%20R%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Perencevich%20EN%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Perencevich%20EN%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Perencevich%20EN%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Weisenberg%20S%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Weisenberg%20S%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Weisenberg%20S%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Weisenberg%20S%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Perencevich%20EN%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Laxminarayan%20R%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Okeke%20IN%5BAuthor%5D&cauthor=true&cauthor_uid=21659004http://www.ncbi.nlm.nih.gov/pubmed?term=Morgan%20DJ%5BAuthor%5D&cauthor=true&cauthor_uid=216590047/27/2019 RRL FOREIGN.docx
2/11
antibiotics at home (odds ratio, OR: 1.7; 95% CI: 1.042.79), caregiver self-medication (OR:
6.3; 95% CI: 3.810.5) and older child's age (OR: 1.02; 95% CI: 1.011.04). Caregivers with
a better knowledge of antibiotics were less likely to give children non-prescribed antibiotics
(OR: 0.7; 95% CI: 0.60.8).
Conclusion
The prevalence of non-prescribed antibiotic use for young children was high in Ulaanbaatar.
Because such use leads to the spread of bacterial resistance to antibiotics and related health
problems, our findings have important implications for public education and the
enforcement of regulations regarding the sale of antibiotics in Mongolia.
Utilization of antimicrobial agents with and without prescriptionby out-patients in selected pharmacies in South-eastern Nigeria.
Esimone CO,Nworu CS,Udeogaranya OP.
Source
Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka,
410001, Enugu State, Nigeria.
AbstractOBJECTIVE:
We conducted a study in out-patient pharmacies in South-eastern Nigeria in order to determine the extent
of self-medication of antimicrobial agents in this area, assess the dosing error associated with this
practice and to ascertain the extent of involvement of community pharmacies.
METHOD:
A survey was carried out daily in selected community pharmacies for a period of 90 days. Data werecollected on the number of patients visiting these shops for antimicrobial agents, the number getting their
medication with a prescription, the number getting their order without prescription and on the type and
dose of antimicrobial agents received. MAIN OUT-COME MEASURE: The percentage of patients with
prescription and without prescription was compared. The percentage under-dosages or over-dosages
associated with how each antimicrobial agent was obtained were compared. The total DDDs of
antimicrobial agents dispensed within this period with and without prescription were compared.
RESULTS:
A total of 4,128 outpatients visited the shops for antimicrobial agents within the period and were involved
in the study. Of this number, 1,742 (42.2%) came with a prescription from qualified medical personnel and
2,386 (57.8%) came without a prescription. A total of 13,693.13 DDDs of antimicrobial agents was
dispensed, of which 56.38% was dispensed with prescription and 43.62% was dispensed without
prescription. The degrees of under-dosing were significantly (P < 0.05) higher in regimen filled withoutprescription when compared to those filled with prescription.
CONCLUSION:
Majority of the patients in this region still obtains their antimicrobial agents without a proper prescription,
which is associated with sub-therapeutic dosing of these agents. There is a need for better regulation of
antimicrobial agents dispensing and utilization in the region.
http://www.ncbi.nlm.nih.gov/pubmed?term=Esimone%20CO%5BAuthor%5D&cauthor=true&cauthor_uid=17464572http://www.ncbi.nlm.nih.gov/pubmed?term=Esimone%20CO%5BAuthor%5D&cauthor=true&cauthor_uid=17464572http://www.ncbi.nlm.nih.gov/pubmed?term=Nworu%20CS%5BAuthor%5D&cauthor=true&cauthor_uid=17464572http://www.ncbi.nlm.nih.gov/pubmed?term=Nworu%20CS%5BAuthor%5D&cauthor=true&cauthor_uid=17464572http://www.ncbi.nlm.nih.gov/pubmed?term=Nworu%20CS%5BAuthor%5D&cauthor=true&cauthor_uid=17464572http://www.ncbi.nlm.nih.gov/pubmed?term=Udeogaranya%20OP%5BAuthor%5D&cauthor=true&cauthor_uid=17464572http://www.ncbi.nlm.nih.gov/pubmed?term=Udeogaranya%20OP%5BAuthor%5D&cauthor=true&cauthor_uid=17464572http://www.ncbi.nlm.nih.gov/pubmed?term=Udeogaranya%20OP%5BAuthor%5D&cauthor=true&cauthor_uid=17464572http://www.ncbi.nlm.nih.gov/pubmed?term=Udeogaranya%20OP%5BAuthor%5D&cauthor=true&cauthor_uid=17464572http://www.ncbi.nlm.nih.gov/pubmed?term=Nworu%20CS%5BAuthor%5D&cauthor=true&cauthor_uid=17464572http://www.ncbi.nlm.nih.gov/pubmed?term=Esimone%20CO%5BAuthor%5D&cauthor=true&cauthor_uid=174645727/27/2019 RRL FOREIGN.docx
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Rational antibiotic use and academic staff.
Cagri Buke A,Ermertcan S,Hosgor-Limoncu M,Ciceklioglu M,Eren S.
Source
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University,Bornova Izmir, Turkey. [email protected]
AbstractThis study was devised to determine the knowledge, attitude and behaviour of an educated group of
people towards antibiotic use and self-medication with antibiotics. Of 1380 members of academic staff
(excluding those from the Faculty of Medicine) of Ege University, 602 were chosen by systematic
sampling methods. Two groups were formed. Group A included academic staff from the Faculties of
Dentistry and Pharmacy and Group B, members of all other faculties. The mean age was 37.4+/-11.0 and
47.0% were females. The mean antibiotic knowledge score was 7.16+/-3.32. Self-medication with
antibiotics was admitted by 45.8% of the total samle and 15.6% of the respondents used antibiotics until
their symptoms disappeared regardless of the period of prescription. In Group A 48.8% and in Group B
80.7% of the respondents believed that antibiotics could be used for common cold. It is concluded that
priority should be given to knowledge-based behaviour education programmes for the more highlyeducated community; there must also be restriction on the sale of antibiotics without prescription.
Self-medication with antibiotics in Jordanian population.
Al-Azzam SI,Al-Husein BA,Alzoubi F,Masadeh MM,Al-Horani MA.
Source
Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology,
Irbid, Jordan. [email protected]
AbstractOBJECTIVES:
A survey was conducted to estimate the prevalence of self-medication with antibiotics in Jordan and
evaluate the factors associated with antibiotic misuse.
METHODS:
Validated questionnaire was used to collect data from a sample of 1943 households (9281 persons)
selected from among different cities in Jordan.
RESULTS:
842 (39.5%) of 2133 antibiotic users identified via the survey had used antibiotics without a prescription
within a one-month study period. Self-medication with antibiotics was found to be significantly associated
with age, income, and level of education. The main reason for self-medication as reported by the
participants was their previous experience on the efficacy of treatment. The main sources of antibiotics
were the previously prescribed pharmaceuticals stored in the household and those purchased in
pharmacies.
CONCLUSION:
The prevalence of self-medication with antibiotics in Jordan is alarmingly high. Given the growing global
resistance to antibiotics and the documented health problems related to their inappropriate use, our
findings may have major public health policy implications in Jordan.
http://www.ncbi.nlm.nih.gov/pubmed?term=Cagri%20Buke%20A%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Cagri%20Buke%20A%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Ermertcan%20S%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Ermertcan%20S%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Ermertcan%20S%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Hosgor-Limoncu%20M%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Hosgor-Limoncu%20M%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Hosgor-Limoncu%20M%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Ciceklioglu%20M%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Ciceklioglu%20M%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Ciceklioglu%20M%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Eren%20S%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Eren%20S%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Eren%20S%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Al-Azzam%20SI%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Al-Azzam%20SI%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Al-Husein%20BA%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Al-Husein%20BA%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Al-Husein%20BA%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Alzoubi%20F%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Alzoubi%20F%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Alzoubi%20F%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Masadeh%20MM%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Masadeh%20MM%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Masadeh%20MM%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Al-Horani%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Al-Horani%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Al-Horani%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Al-Horani%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Masadeh%20MM%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Alzoubi%20F%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Al-Husein%20BA%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Al-Azzam%20SI%5BAuthor%5D&cauthor=true&cauthor_uid=18165197http://www.ncbi.nlm.nih.gov/pubmed?term=Eren%20S%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Ciceklioglu%20M%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Hosgor-Limoncu%20M%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Ermertcan%20S%5BAuthor%5D&cauthor=true&cauthor_uid=12507839http://www.ncbi.nlm.nih.gov/pubmed?term=Cagri%20Buke%20A%5BAuthor%5D&cauthor=true&cauthor_uid=125078397/27/2019 RRL FOREIGN.docx
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Antibiotic use and health-seeking behaviour in anunderprivileged area of Per.
Kristiansson C,Reilly M,Gotuzzo E,Rodriguez H,Bartoloni A,Thorson A,Falkenberg
T,Bartalesi F,Tomson G,Larsson M.
Source
Department of Public Health Science, Division of International Health (IHCAR), Karolinska Institutet,
Stockholm, Sweden. [email protected]
AbstractOBJECTIVE:
To describe the health-seeking behaviour and use of antibiotics in the urban community of Yurimaguas in
the Amazonian area of Peru.
METHOD:
Cross-sectional survey of caregivers of 798 children aged 6-72 months by interview using a semi-
structured questionnaire. Reported symptoms were classified as illnesses where antibiotics would or
would not be recommended based on principles of the integrated management of childhood illnesses
algorithm.
RESULTS:
Forty-one per cent of consultations were with health care professionals; 71% of antibiotics were obtained
through the formal public health sector and prescribed mainly by medical doctors. All prescribed
antibiotics were on the Peruvian essential drugs list. When prescribing, doctors and nurses hardly
discriminated between illnesses where antibiotic treatment was or was not indicated; there was no
significant difference in antibiotic prescribing rates between the two (doctors, P = 0.24; nurses, P = 0.32).
Not all caregivers sought help for children with severe symptoms.
CONCLUSION:
Although most of the antibiotics were prescribed by doctors and nurses, they were commonly prescribed
for illnesses where they were not indicated. The use of antibiotics needs to be rationalized, and barriers to
health care must be overcome.
Availability of antibiotics as over-the-counter drugs inpharmacies: a threat to public health in Vietnam.
Van Duong D,Binns CW,Van Le T.
Source
Hanoi School of Pharmacy, Vietnam.
AbstractA survey on the use of antibiotics purchased through retail pharmacies was conducted in the Badinh
district of Hanoi, Vietnam. The survey found that purchasers visit a pharmacy when they or those who felt
they needed antibiotics had minor symptoms such as cough (34.1%), sore throat (32.5%), stomach
upsets (10.0%) and diarrhoea (8.8%). The most often purchased antibiotics were ampicillin (31.1%),
amoxyllin (16.7%), cotrimoxazol (11.6%), tetracycline (5.2%) and cephalexin (4.8%). The median of the
purchased quantity was 10 tablets, the mean 11.34 tablets (95%CI 9.65-12.97). About 30% of the
purchasers intended to take antibiotics for three days or less. The mean cost of a antibiotic purchase was
US$1.27 (95%CI 1.06-1.39). The main reason for not taking a full course of antibiotics was not economic
http://www.ncbi.nlm.nih.gov/pubmed?term=Kristiansson%20C%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Kristiansson%20C%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Reilly%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Reilly%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Reilly%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Gotuzzo%20E%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Gotuzzo%20E%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Gotuzzo%20E%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Rodriguez%20H%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Rodriguez%20H%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Rodriguez%20H%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Bartoloni%20A%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Bartoloni%20A%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Bartoloni%20A%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Thorson%20A%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Thorson%20A%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Thorson%20A%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Falkenberg%20T%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Falkenberg%20T%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Falkenberg%20T%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Falkenberg%20T%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Bartalesi%20F%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Bartalesi%20F%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Bartalesi%20F%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Tomson%20G%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Tomson%20G%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Tomson%20G%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Larsson%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Larsson%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Larsson%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Van%20Duong%20D%5BAuthor%5D&cauthor=true&cauthor_uid=9438468http://www.ncbi.nlm.nih.gov/pubmed?term=Van%20Duong%20D%5BAuthor%5D&cauthor=true&cauthor_uid=9438468http://www.ncbi.nlm.nih.gov/pubmed?term=Binns%20CW%5BAuthor%5D&cauthor=true&cauthor_uid=9438468http://www.ncbi.nlm.nih.gov/pubmed?term=Binns%20CW%5BAuthor%5D&cauthor=true&cauthor_uid=9438468http://www.ncbi.nlm.nih.gov/pubmed?term=Binns%20CW%5BAuthor%5D&cauthor=true&cauthor_uid=9438468http://www.ncbi.nlm.nih.gov/pubmed?term=Van%20Le%20T%5BAuthor%5D&cauthor=true&cauthor_uid=9438468http://www.ncbi.nlm.nih.gov/pubmed?term=Van%20Le%20T%5BAuthor%5D&cauthor=true&cauthor_uid=9438468http://www.ncbi.nlm.nih.gov/pubmed?term=Van%20Le%20T%5BAuthor%5D&cauthor=true&cauthor_uid=9438468http://www.ncbi.nlm.nih.gov/pubmed?term=Van%20Le%20T%5BAuthor%5D&cauthor=true&cauthor_uid=9438468http://www.ncbi.nlm.nih.gov/pubmed?term=Binns%20CW%5BAuthor%5D&cauthor=true&cauthor_uid=9438468http://www.ncbi.nlm.nih.gov/pubmed?term=Van%20Duong%20D%5BAuthor%5D&cauthor=true&cauthor_uid=9438468http://www.ncbi.nlm.nih.gov/pubmed?term=Larsson%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Tomson%20G%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Bartalesi%20F%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Falkenberg%20T%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Falkenberg%20T%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Thorson%20A%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Bartoloni%20A%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Rodriguez%20H%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Gotuzzo%20E%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Reilly%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18397405http://www.ncbi.nlm.nih.gov/pubmed?term=Kristiansson%20C%5BAuthor%5D&cauthor=true&cauthor_uid=183974057/27/2019 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constraint, but the purchasers' poor knowledge about antibiotics. Logistic regression analysis indicates
that age of purchasers, length of symptoms and kinds of treatment used before visiting a pharmacy could
be used as predictive variables for the decision to buy antibiotics in preference to alternative drugs.
Antibiotics are used when illness lasts longer than one week and antibiotics have not yet been taken.
Antibiotics are also purchased by young rather than old people. The study documents the need for better
health education about the rational use of antibiotics in the general public.
Self-medication with antibiotics in rural
population in Greece: a cross-sectional
multicenter study
Eystathios Skliros, Panagiotis Merkouris, Athanasia
Papazafiropoulou*, Aristofanis Gikas, George Matzouranis, Christos
Papafragos, Ioannis Tsakanikas, Irene Zarbala, Alexios Vasibosis, PetroulaStamataki and Alexios Sotiropoulos
* Corresponding author: Athanasia [email protected]
Author Affiliations
3rd Department of Internal Medicine and Center of Diabetes, General Hospital of
Nikaia "Ag. Panteleimon" - Piraeus, Greece, 3 D.Mantouvalou Street, GR-184 54
Nikaia, Greece
For all author emails, pleaselog on.
BMC Family Practice 2010, 11:58 doi:10.1186/1471-2296-11-58
The electronic version of this article is the complete one and can be found online
at:http://www.biomedcentral.com/1471-2296/11/58
Received:24 February 2010
Accepted:8 August 2010
Published:8 August 2010
mailto:[email protected]:[email protected]:[email protected]://www.biomedcentral.com/1471-2296/11/58http://www.biomedcentral.com/1471-2296/11/58http://www.biomedcentral.com/bmcfampract/logonhttp://www.biomedcentral.com/bmcfampract/logonhttp://www.biomedcentral.com/bmcfampract/logonhttp://www.biomedcentral.com/1471-2296/11/58http://www.biomedcentral.com/1471-2296/11/58http://www.biomedcentral.com/1471-2296/11/58http://www.biomedcentral.com/1471-2296/11/58http://www.biomedcentral.com/bmcfampract/logonhttp://www.biomedcentral.com/1471-2296/11/58mailto:[email protected]7/27/2019 RRL FOREIGN.docx
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2010 Skliros et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits
unrestricted use, distribution, and reproduction in any medium, provided the original
work is properly cited.
Abstract
Background
Self-medication is an important driver of antimicrobial overuse as well as a worldwide
problem. The aim of the present study was to estimate the use of antibiotics, without
medical prescription, in a sample of rural population presenting in primary care in
southern Greece.
Methods
The study included data from 1,139 randomly selected adults (545 men/594 women,
mean age SD: 56.2 19.8 years), who visited the 6 rural Health Centres of southern
Greece, between November 2009 and January 2010. The eligible participants were
sought out on a one-to-one basis and asked to answer an anonymous questionnaire.
Results
Use of antibiotics within the past 12 months was reported by 888 participants
(77.9%). 508 individuals (44.6%) reported that they had received antibiotics without
medical prescription at least one time. The major source of self-medication was the
pharmacy without prescription (76.2%). The antibiotics most frequently used for self-
medication were amoxicillin (18.3%), amoxicillin/clavulanic acid (15.4%), cefaclor
(9.7%), cefuroxim (7.9%), cefprozil (4.7%) and ciprofloxacin (2.3%). Fever (41.2%),
common cold (32.0%) and sore throat (20.6%) were the most frequent indications for
the use of self-medicated antibiotics.
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Conclusion
In Greece, despite the open and rapid access to primary care services, it appears that a
high proportion of rural adult population use antibiotics without medical prescription
preferably for fever and common cold.
Background
Since the introduction of penicillin, 60 years ago, antibiotics have played an important
and crucial role in the treatment of infectious diseases, especially those caused by
bacteria. However, the inappropriate use of those drugs has led to the phenomenon of
antimicrobial resistance, which is becoming a worldwide public health problem [1,2].
Recent studies in Europe, including Greece, have showed high rates of outpatient
antibiotic use and resistance [2-5]. In particular, a shift from the old narrow-spectrumantibiotics to the new broad-spectrum antibiotics was observed [3]. They also
recorded seasonal fluctuations with heightened winter peaks in countries with high
yearly use of antibiotics [3]. It is noteworthy, that our country had one of the highest
uses of antimicrobial agents in ambulatory care [5].
Self-medication is an important driver of antimicrobial overuse, especially, in low-
and middle-income countries, where antibiotics are easily obtained over the
counter[1,6,7]. Studies showed that the prevalence of actual self-medication was high
in eastern and southern Europe and low in northern and western Europe [8-10]. This
studies showed that the most common reasons for self-medication were throat
symptoms and bronchitis [8,10] while the main medication sources were pharmacies
and medication leftover from previous prescriptions [8-10]. In Greece, the limited
data concerning urban population indicate that the prevalence of self-medication is
high[11,12]. However, data about self-medication in rural areas are lacking.
Therefore, the aim of the present study was to evaluate the prevalence of self-
medication with antibiotics in rural population in Greece.
Methods
Population
The study included data from 1,139 adults (545 men/594 women, mean age SD:
56.2 19.8 years), who visited the 6 rural Health Centres of southern Greece, between
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November 2009 and January 2010. Physicians of the above Health Centres carried out
the study. Physicians asked each consecutive patient to fill an anonymous
questionnaire and to return it at the practice. The refusal rates were low. The
questionnaire included items relating to demographic characteristics, overall use of
antibiotics and self-medication with antibiotics. In particular, information about the
type of antibiotics, the sources of self-medication, the symptoms for which the drugs
were reportedly used, and duration of use were collected.
The study was conducted in accordance with the 2004 amendment of the Declaration
of Helsinki, the guidelines for Good Epidemiological Practice [13], and local
regulatory requirements. The protocol was approved by the local ethics committee in
each study area.
Statistical Analysis
Statistical analysis was preformed using programs available in the SPSS statistical
package (SPSS 15.0, Chicago, USA). All variables were tested for normal distribution
of the data. Data are shown as mean SD. A chi-square test was used for categorical
variables. P < 0.05 (two-tailed) was considered statistically significant.
Results
Use of antibiotics within the past 12 months was reported by 888 participants
(77.9%). 508 individuals (44.6%) reported that had received antibiotics without
medical prescription at least one time in the past 12 months. The major source of self-
medication was the pharmacy without prescription (76.2%) followed by leftover
medications at home (15.3%) and drugs obtained from relatives or friends (7.2%).
The most frequently self-medicated antibiotics were amoxicillin (18.3%),
amoxicillin/clavulanic acid (15.4%), cefaclor (9.7%), cefuroxim (7.9%), cefprozil
(4.7%) and ciprofloxacin (2.3%). Fever (41.2%), common cold (32.0%) and sorethroat (20.6%) were the most frequent indications for their use.
Only 9.1% (57/630) of the participants who did not report self-medication with
antibiotics, had stored drugs at home compared to 49.2% (250/508) of the participants
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who reported self medication (P < 0.001). Finally, 31.5% of the participants reported
earlier discontinuation of antibiotics when symptoms improved.
Discussion
Our results showed that the prevalence of self-medication with antibiotics in rural
population in southern Greece was high. Our results are comparable to those of Jordan
were 46% of patients reported antimicrobial self-medication [6]. However,
antimicrobial drug self-medication prevalence varies widely among different
European regions. Studies in Denmark and Spain showed that self drug consumption
was 3% and 11% respectively[14,15]. In Malta and Lithuania the prevalence of self-
medication was 19% and 22% respectively [7,16]. A prospective survey of emergency
department patients in the USA established that 17% of patients had taken leftover
antibiotics without consulting a physician, most commonly for a cough (11%) or sore
throat (42%) [17]. A recent study in Europe reported that Greece had one of the
highest outpatient antibiotic uses in Europe with cephalosporins and macrolides being
the most frequently used antibiotics [3].
Substantial variation in the prevalence rates of antimicrobial drug self-medication
among the European regions suggests that socioeconomic factors play a role, as do
disparities in health care systems such as reimbursement policies, access to health
care, and drug dispensing policies [18]. Another factor is the acquisition ofantimicrobial drugs from pharmacies without prescription, which occurred most
frequently in eastern and southern European countries [18].
Although most of the responsibility regarding inappropriate antibiotic use belongs to
the physicians' prescribing practices, several studies found that patients, too,
contribute to inappropriate antibiotic usage [15,18]. Self-medication with antibiotics is
possible via several sources: a) they are legally available over the counter, b)
antibiotics initially prescribed by physicians are saved and subsequently used withoutmedical consultation, c) antibiotics are obtained through friends or relatives, and d)
they can be acquired via Internet [15,18].
In the present study the major source of self-medication was the pharmacy. It must be
mentioned that in Greece law still allows patients to obtain antibiotics from the
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pharmacists without any medical prescription. A study by Contopoulos-Ioannidis et
al., reported that 77% of Greek pharmacists offered antibiotics without a medical
prescription [19]. The same study showed that most of pharmacists offered expensive
broad-spectrum antibiotics. Antibiotics were most frequently offered for treatment of
patients with symptoms that were suggestive of a common cold [19].
Conclusions
In Greece, despite the open and rapid access to primary care services, it appears that a
high proportion of rural adult population prefers to use antibiotics without medical
prescription. The high prevalence of self-medication with antibiotics in rural
population in Greece emphasizes the role of the primary care physician who should
advise patients about the correct use of the prescribed antibiotics. Another important
intervention to reduce the major problem of self-medication with antibiotics in Greece
should be legislative changes banning unregulated sale of antibiotics without medical
prescription. Finally, efforts like the European Antibiotic Awareness Day [20]
emphasize the importance of using antibiotics responsibly by reducing their
unnecessary use and encourage people to follow their doctor's instructions on how to
take antibiotics in the appropriate way, especially in children.
Survey of antibiotic use of individuals visiting public healthcare
facilities in Indonesia.Hadi U,Duerink DO,Lestari ES,Nagelkerke NJ,Werter S,Keuter M,Suwandojo E,Rahardjo
E,van den Broek P,Gyssens IC;Antimicrobial Resistance in Indonesia 'Prevalence and
Prevention' study group.
Collaborators (30)
Source
Department of Internal Medicine, Dr. Soetomo Hospital - School of Medicine, Airlangga University, Jl.
Manyar Tirtomoyo II/21, Surabaya 60118, Indonesia. [email protected]
AbstractOBJECTIVES:
To estimate the antibiotic use of individuals visiting public healthcare facilities in Indonesia and to identify
determinants of use against a background of high resistance rates.
METHODS:
Patients on admission to hospital (group A), visiting a primary health center (group B), and healthy
relatives (group C) were included in the study. A questionnaire on demographic, socioeconomic, and
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healthcare-related items including health complaints and consumption of antibiotics was used. Logistic
regression was performed to determine the co-variables of antibiotic use.
RESULTS:
Of 2996 individuals interviewed, 486 (16%) had taken an antibiotic. Compared to group C (7%
consumption), groups B and A exhibited a three-fold and four-fold higher use of antibiotics, respectively.
Respiratory (80%) and gastrointestinal (13%) symptoms were most frequent. Aminopenicillins andtetracyclines accounted for 80% of the prescribed antibiotics. Similar antibiotics were self-medicated (17%
of users). Age less than 18 years and health insurance were independent determinants of antibiotic use.
Urban provenance, being adult, male, and having no health insurance were independent determinants of
self-medication.
CONCLUSIONS:
In addition to health complaints, other factors determined antibiotic consumption. In view of the likely viral
origin of respiratory complaints and the resistance of intestinal pathogens, most antibiotic use was
probably unnecessary or ineffective. Future interventions should be directed towards healthcare
providers.