As we highlighted in our previous blog, antibiotic stewardship – the careful use of appropriate antibiotic administration – can have positive effects. A small change from a difference in clinical lab reporting led to less drug use, which led to fewer drug-resistant infections. When we think of antibiotic stewardship, the onus is often thought to be on those that work in the clinic – the scientists who determine isolate susceptibility, or the clinicians who decide which antibiotic should be prescribed to a patient. These individuals certainly have an essential role to play in proper antimicrobial drug use in a health-care setting.
But the general public also has an important role to play in antibiotic stewardship, as illustrated by a new study in Antimicrobial Agents and Chemotherapy. In the report, Roger Zoorob and the team of physician scientists conducted a survey of 400 individuals, asking them about their antibiotic use. 5% of respondents said they had used non-prescription antibiotics within the past year, some multiple times, and 25% said they would be willing to use antibiotics without talking to a health-care professional. Though acquiring antibiotics without a prescription is illegal, those that had used off-prescription antibiotics had access due to leftover stocks from previous prescriptions, purchase outside of the U.S., and even within the U.S., which accounted for a whopping 40% of off-prescription antibiotics.
Who uses drugs without a prescription? The survey was given to patients waiting in one of three primary care clinics (two public and one private), with diversity in income, ethnicity, and insurance status; those who would be willing to use non-prescription antibiotics were more likely to be surveyed from one of the public clinics, with less education and lower annual incomes. There was no correlation between antibiotic self-treatment and race or ethnicity.
The reason antibiotics were self-administered varied, but several patterns emerged among respondents. Those that had used non-prescribed antibiotics were treating including respiratory symptoms, urinary tract infection symptoms, tooth pain, and stomach pain (see chart, right). Unfortunately, many of the antibiotics used may not successfully treat the microbial source of the infection. “When people self-diagnose and self-prescribe antibiotics, it is likely that the therapy is unnecessary because most often these are upper respiratory infections that are mostly caused by viruses,” said corresponding author Larissa Grigoryan.
Self-prescribed drugs are not only possibly ineffective, but also add to the growing antibiotic resistance problem. Exposing one’s microbiome to antibiotics increases the possible selection for drug-resistant strains, especially if the drug dosing or timing isn’t properly determined. Stemming the use of non-prescription antimicrobials is the type of antibiotic stewardship effort that belongs to all community members. These results demonstrate a necessary role for public health communication and education to inform all citizens how their actions may impact their and others’ future health. The small gains from stewardship programs can accumulate to prolonged drug efficacy if we all work together toward this common goal.
-- Julie Wolf