Antibiotic use Without a Prescription Highlights Health Inequities

Reviewed by Erica Stohs, MD, MPH, University of Nebraska 

Investigators administered a survey to 564 patients from 6 publicly funded primary care clinics and 2 private EDs in Katy, Texas between in Jan 2020-June 2021 inquiring about use or intended use of antibiotics without a prescription. Non-prescription antibiotic use was defined as use of antibiotics without a prescription; intended use was a professed intention for future nonprescription antibiotic use. Authors describe a rigorous survey instrument development process, including a review by an assembled community advisory board.

Of the 564 respondents, 246 (44%) reported prior use of antibiotics without a prescription, and 177 (31.4%) reported intent to use unprescribed antibiotics. Antibiotic sources were friends/relatives (22% of 564 surveyed), purchase in the US without a prescription (19%) and purchase abroad (18%). Respondents were 33% Black and 47% Hispanic/Latino. Predictors of intended use were younger age, lack of health insurance, perceived high cost of healthcare visits, lack of transportation, language barrier, Hispanic/Latino ethnicity, and Spanish-speakers.

Results demonstrate health inequities surrounding outpatient antibiotic use, likely exacerbated during the COVID-19 pandemic which overlapped with most of the study period. Indications for antibiotic use were not sought, but suspected self-diagnosis and self-prescribing raises important safety implications. Generalizing this data to different regions of the country is a major limitation, but readers may acknowledge that nonprescription antibiotic use is a phenomenon in the US to address. Even more challenging for outpatient antibiotic stewards: tracking non-prescription antibiotic use.

Grigoryan L, et al. “Antibiotic use without a prescription: a multisite survey of patient, health system, and encounter characteristics. Clinical Infectious Diseases 2023;77(4):510-17.

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