Use of Antibiotics Without a Prescription in the U.S. Population: A Scoping Review.

BACKGROUND

Use of antibiotics without a prescription may increase unnecessary and inappropriate drug use or doses as well as global risk for antimicrobial resistance.

PURPOSE

To perform a scoping review of research on the prevalence of nonprescription antibiotic use in the United States and to examine the factors that influence it.

DATA SOURCES

Searches of PubMed, EMBASE, CINAHL, Scopus, and relevant Web sites without language restrictions from January 2000 to March 2019.

STUDY SELECTION

Studies reporting nonprescription use of antibiotics, storage of antibiotics, intention to use antibiotics without a prescription, and factors influencing nonprescription use.

DATA EXTRACTION

Two reviewers independently screened citations and full texts and performed data abstraction.

DATA SYNTHESIS

Of 17 422 screened articles, 31 met inclusion criteria. Depending on population characteristics, prevalence of nonprescription antibiotic use varied from 1% to 66%, storage of antibiotics for future use varied from 14% to 48%, and prevalence of intention to use antibiotics without a prescription was 25%. Antibiotics were obtained without a prescription from various sources, including previously prescribed courses, local markets or stores, and family or friends. Reported factors contributing to nonprescription use included easy access through markets or stores that obtain antibiotics internationally for under-the-counter sales, difficulty accessing the health care system, costs of physician visits, long waiting periods in clinics, and transportation problems.

LIMITATION

Scarce evidence and heterogeneous methods and outcomes.

CONCLUSION

Nonprescription antibiotic use is a seemingly prevalent and understudied public health problem in the United States. An increased understanding of risk factors and pathways that are amenable to intervention is essential to decrease this unsafe practice.

PRIMARY FUNDING SOURCE

None.