Use Of Non-prescribed Antibiotics Research Articles

Non-Prescription Antibiotics Use and Associated Factors Among Drug Retail Outlets in Ambo, Ethiopia: A Cross-Sectional Study.

PurposeTo assess the non-prescription use of antibiotics and associated factors in Ambo Town, West Shoa, Oromia, Ethiopia.MethodsAn institutional-based cross-sectional study design supported with the qualitative study was conducted in Ambo Town from February 1 to March 1, 2020. Data were collected using a pretested semi-structured questionnaire and in-depth interview guide questions. Simple random sampling was used to select retail outlets and systematic random sampling to select study participants. The data analysis was done using SPSS and univariate and multivariate binary logistic regression analysis was performed to identify factors associated with non-prescription use of antibiotics. Thematic framework analysis was applied for the qualitative data.ResultsFrom the 421 study sample, a total of 399 participants were interviewed with a 94.8% response rate. Among the study participants, 214 (53.6) were males, 228 (57.1%) were married, 191 (47.9%) were orthodox by religion, and 343 (86%) were Oromo by ethnicity. One hundred seventy-two (43.1%; 95% CI: 38.6, 48.1) of the participants had used non-prescribed antibiotics. Being male [AOR=2.21 95% CI: 1.276, 3.835], residing in rural area [AOR=3.659, 95% CI: 1.479, 9.054], holding diploma [AOR=0.120, 95% CI: 0.025, 0.591], and hold BSC degree [AOR=0.050, 95% CI: 0.007, 0.378], and being farmer [AOR=0.034, 95% CI: 0.004, 0.285] showed significant association with the non-prescription use of antibiotics.ConclusionThis study concluded that the non-prescription use of antibiotics 172 (43.1%) was relatively high. Being male, residing in a rural area, holding a diploma, BSc degree, and being a farmer were significantly associated with non-prescription use of antibiotics. So, West Shoa Zone regulatory body should actively focus on the prevention of non-prescription use of antibiotics through health communication and public awareness on the demerits of non-prescription use of antibiotics.

Non-prescription antibiotic use for cough among Chinese children under 5 years of age: a community-based cross-sectional study

ObjectiveThis study aimed to investigate the non-prescription use of antibiotics for cough among children under 5 years in China.DesignA community-based cross-sectional survey.SettingA face-to-face interview based on a standard questionnaire in...

Parental self-medication with antibiotics in a Tunisian pediatric center

Self-medication of antibiotics among children is a very common problem in Tunisia. Its prevalence isn't well established. The aims of this study are to evaluate parents' knowledge concerning antibiotic use, and identify the factors associated with this problem. We conducted a cross-sectional study over a one year period (between August 2019 and July 2020). Data collection was performed using a questionnaire guided interview. We included parents of children consulting or hospitalized in the pediatric department of the university hospital Taher Sfar in Mahdia. A total of 354 parents were included with an average age of 36.4±9.2 years. The average knowledge score was 2±1.3 points. In fact, 61.6% of the parents had poor knowledge about antibiotics. The frequency of non-prescription antibiotics use among children was 20.6%. Amoxicillin was the most used antibiotic (72.6%). Sore throat, important fever and flu-like symptoms were the main symptoms justifying non-prescription antibiotic use among our pediatric population in 60.3%, 34.2% and 23.3% of cases respectively. The main reason of self-medication was the fact that the same antibiotic was once prescribed to treat the same symptoms (58.9%). The used antibiotic came from an old prescription for the same child in 57.5% of the cases and was recommended by the pharmacist in 39.7% of the cases. After multivariate analysis, the factors associated with parental self-medication with antibiotics were: the advanced parent's age, the ability to name an antibiotic and knowledge's score>2. Our study confirmed that parental knowledge about antibiotic use is low. In fact, the government should from one hand, organize antibiotic delivery and prohibit off the counter sells and in the other hand promote the education of the public through different procedures to stop this major health problem.

Non-prescriptionxx antibiotic use for people aged 15\xa0years or older for cough in China: a community-based survey

BackgroundNon-prescription antibiotic use at community is a main driver of antimicrobial resistance. Cough is a common condition and prevalent in all townships, including China. This study aims to investigate the non-prescription antibiotic use for cough in China and explore to which extent antibiotic use knowledge was correctly instructed in communities.MethodsA probability-proportionate-to-size sampling method was adopted to survey from all 14 townships in Yiwu city, China. All participants were investigated by face-to-face interview on Portable Android Devices. The continuous variables were presented by mean and standard deviation or medium and inter-quartile range (IQR). The categorical variables were presented using percentage or constituent ratio. Chi-square test for univariate analysis and logistic regression for multivariate analysis were conducted to assess the odds ratios and 95% confidence intervals, respectively.ResultsA total of 3034 respondents across all the 14 townships and the 50 natural villages/streets completed all key items of the questionnaire. Of 2400 (79.10%) respondents stated that they experienced cough in the past 12 months with the medium age of 36.5 (IQR: 26–49) and 12.21% (293/2400) respondents had the non-prescription antibiotic use behavior. Among those 293 respondents, the proportion of non-prescription antibiotic use for cough peaked at around 16% among people aged 30–39 years old. The major sources of antibiotics were pharmacy (77.70%) and/or family storage (43.92%).ConclusionsNon-prescription antibiotics use for cough is prevalent in the community, especially among people in their thirties. Strengthened drug purchase regulation and well-trained professional pharmacists would be promising alternatives to ameliorate AMR. Moreover, penetrating antibiotics knowledge to common citizens and is an urgent task to alleviate antimicrobial resistance. Therefore, proactive policies and regulations should be made to improve current situations.

Prevalence of and Risk Factors for Nonprescription Antibiotic Use among Individuals Presenting to One Hospital in Saudi Arabia after the 2018 Executive Regulations of Health Practice Law: A Cross-Sectional Study.

Antibiotic resistance is a worldwide public health emergency. Nonprescription antibiotic use is a chief cause of antibiotic resistance. The Saudi Government, as a consequence, imposed in 2018 executive regulations to prevent the distribution of antibiotics without a prescription. Herein, we aimed to investigate the prevalence of and risk factors for nonprescription antibiotic use among individuals presenting to one hospital in Saudi Arabia after enacting these regulations. This cross-sectional study was conducted on people, aged ≥18 years, who presented to the primary healthcare clinics of King Khalid University Hospital in Riyadh during the period between 1/1/2019 and 28/2/2019. Participants were asked to fill out a self-administrated questionnaire assessing their nonprescription antibiotic use during the past year in addition to sociodemographic information. Then, logistic regression analyses were performed to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for age, sex, education, and nationality of any nonprescription antibiotic use compared with no use within the past year. Out of 463 participants, 62.9% were females, 67.4% were <40 years, and 93.7% were Saudi citizens. Overall, 30.5% of participants reported nonprescription antibiotic use during the past year (19.7% one to two times and 10.8% more than two times). Male and non-Saudi participants were more likely to report any nonprescription antibiotic use, with HRs (95% CIs) of 1.99 (1.30, 3.04) and 3.81 (1.73, 8.35), respectively. The main reasons behind nonprescription antibiotic use were having previous experience with a health condition (69.2%), inaccessibility of healthcare (26.6%), and recommendation from a relative or a friend (16.1%). A major limitation of this study was that it included individuals attending one hospital. Individuals who seek medical consultation could be dissimilar to those who do not see doctors regarding nonprescription antibiotic use.

A Cross-Sectional Survey of Community Pharmacist's Knowledge, Behavior and Attitude Toward Antibiotic Dispensation, Southern Karnataka, India

Aim: The study was conducted to determine the knowledge, attitude/perceptions, and behavior of the community pharmacists in the Southern Karnataka district. Settings and Design: The study was a cross-sectional survey conducted with the help of a questionnaire containing open and close-ended questions and Likert-scale-based response items. Materials and Methods: Questionnaires were distributed to pharmacists by simple random sampling. Statistical Analysis: The data were analyzed by Fisher's test and Chi-square test for association between knowledge, attitude, and practices and sociodemographic categories. Results: Majority of the pharmacists considered the use of antibiotics in livestock and agriculture as the reason for antibiotic resistance. All of the pharmacists agreed that refusing to dispense antibiotics without prescription will negatively hit sales. Conclusion: It is imperative to educate pharmacists about rules and regulations regarding antibiotic dispensation. They need to be sensitized about the negative impact of nonprescription antibiotic use on antibiotic resistance and public health.

Hubungan Tingkat Pengetahuan Tentang Antibiotik dengan Sikap dan Tindakan Penggunaan Antibiotik Tanpa Resep pada Mahasiswa/i Universitas HKBP Nommensen Medan

Introduction: Antibiotics are drugs that are used to prevent and treat infections caused by bacteria. Inappropriate use of antibiotics can cause various problems, such as bacterial resistance to antibiotics. One of the causes of bacterial resistance to antibiotics is the irrational in non prescription use of antibiotics. Aims: to determine the association of knowledge level about antibiotics with attitude and action level in non prescription use of antibiotics in Universitas HKBP Nommensen students. Method: There was 210 active students of Universitas HKBP Nommensen were included as respondents in this cross sectional study. The level of knowledge, attitudes and actions of respondents were measured using a questionnaire. Chi Square test was used to analyzed the association of knowledge with attitude and action of respondents. Result: There was no significant association of knowledge level about antibiotics with attitude and action level in non prescription use of antibiotics in Universitas HKBP Nommensen students (p &gt; 0,005). Conclusion: Knowledge is not a dominant factor influencing both attitude and action in non prescription use of antibiotics.

140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

BackgroundUse of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics.MethodsWe surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription.ResultsWe interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1).The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant.Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently ConclusionNon-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice.Disclosures All Authors: No reported disclosures

Identifying the commonly used antibiotics for self-medication in urban Mozambique: a qualitative study

ObjectivesThe study aimed at identifying the commonly used non-prescribed antibiotics (NPAs) and the main health conditions leading to the practices of self-medication with antibiotics (SMAs) in Maputo city, Mozambique.DesignCross-sectional qualitative...

A Conceptual Framework for Understanding How and Why People Take Antibiotics Without a Prescription

Background: The reported prevalence of nonprescription antibiotic use in the United States varies from 5% among socioeconomically and ethnically diverse primary care patients to 66% among Latino migrant workers. Reports indicate that people obtain and take antibiotics from stores or flea markets in the United States, friends or relatives, and leftover antibiotics from previous prescriptions. This unsafe practice may lead to unnecessary and inappropriate antibiotic use and increases the risk of antibiotic resistance. As groundwork to develop an intervention to decrease nonprescription antibiotic use, we mapped reported drivers of nonprescription use to the Kilbourne conceptual framework for advancing health disparities research. Methods: The Kilbourne framework consists of 3 phases: (1) detection of health disparities and identification of vulnerable populations, (2) understanding why disparities exist, and (3) reducing or eliminating disparities through interventions. We focused on the first 2 phases and mapped the identified drivers of nonprescription antibiotic use onto the key domains of the Kilbourne conceptual framework: patient, healthcare system, and clinical encounter factors. We also conducted brief field research to explore anecdotal reports regarding availability of nonprescription antibiotics in our community. Results: We found 8 studies addressing factors related to nonprescription antibiotic use in the United States. These studies were primarily qualitative and included Spanish-speaking Hispanic and Latino immigrants. Figure 1 shows the proposed factors that may directly or indirectly predict nonprescription antibiotic use. Key potential factors are individual factors, psychosocial factors, resources, healthcare system factors, and clinical-encounter factors. For example, patients with inadequate health literacy may have poor access to care because of difficulty finding providers and choosing or navigating insurance plans; thus, they may be at risk for nonprescription use. At the same time, patients with inadequate health literacy may be at risk for using nonprescription antibiotics for a viral infection because of difficulty understanding medication labels or package inserts. The relevance of resources (availability) to nonprescription antibiotic use was supported by our research team’s purchase of amoxicillin, tetracycline, and metronidazole without prescriptions from a flea market in Houston, Texas. Conclusions: The Kilbourne conceptual framework provides a strong, comprehensive basis for research and intervention in the challenging problem of nonprescription antibiotic use. Ongoing research will test the proposed relationships between patient, healthcare system, and clinical-encounter factors and nonprescription antibiotic use outcomes. We are conducting a survey among both indigent and insured patient populations to identify the relative importance of these factors and to validate our proposed conceptual framework of nonprescription antibiotic use.Funding: This project was supported by grant number R01HS026901 from the Agency.Disclosures: None

Recreational use of psychoactive substances among secondary school students in North-Central Nigeria

ABSTRACT Background: In the West African sub-region, the recreational use of psychoactive substances has increased. Adolescent substance use is commonly found among students. This study was aimed at determining the prevalence and pattern of substance use among secondary school students in Ilorin, Nigeria. Methods: Using a multistage sampling technique, data from 2,001 students was analyzed. Instruments used were a sociodemographic questionnaire and a modified WHO Students’ Drug Use Survey Questionnaire. Results: The overall lifetime use of substances was 83.7%, while overall current use was 62.4%. Non-prescription use of antibiotics and analgesics was prevalent (53% and 15.8%, respectively). The psychoactive substances most commonly used were stimulants, alcohol and organic solvents, with a current use of 7.1%, 3.5% and 3.5% respectively (N = 2001). The overall mean age at first use was 13.45 ± 1.49, while many organic solvent users started at age 10. Conclusions: The recreational use of psychoactive substances is common among school children in Ilorin. The age of onset is in early adolescence, or earlier for substances like organic solvents that are easily accessible. The prevalent use of alcohol, a gateway drug, is a call for action.

Faktor-Faktor Yang Mempengaruhi Perilaku PenggunaanAntibiotik Tanpa Resep Pada Mahasiswa/I Universitas HKBP Nommensen Medan

Background : Antibiotics are drugs that work to prevent and treat infection caused by bacteria. However, improper use of antibiotics can cause antibiotic resistance. Antibiotic resistance occurs due to irrational used without a prescription. The aim of this study is to determine the predisposition factors of non prescription use of antibiotics in Universitas HKBP Nommensen students. &#x0D; Methods: This research is descriptive study. Sample of this study were 210 active students of Universitas HKBP Nommensen, who were selected by using purposive sampling technique. The predisposition factors of non prescription use of antibiotics obtained from quetionnaire. &#x0D; Results: The predisposition factors of non prescription use of antibiotics in Universitas HKBP Nommensen students were poor knowledge of antibiotics, the suggestion of relatives or neighbors and the experience of consuming antibiotics to cure the same disease before. Financial problem was not a dominant factor.&#x0D; Conclusion: Poor knowledge of antibiotics, the suggestion of relatives or neighbors and the experience of consuming antibiotics before are the dominant predisposition factors of non prescription use of antibiotics.&#x0D;

A case report of self-medication with over-the-counter fish antibiotic: Implications for pharmacists

ObjectiveThe human use of over-the-counter antibiotics intended for the treatment of pet animals has been recognized as a potential barrier to antibiotic stewardship efforts. The objective of this report is to describe a case of self-medication with a fish antibiotic resulting in delayed medical treatment and provide recommendations for pharmacists practicing in outpatient settings on how to best identify and manage nonprescription antibiotic use. Case summaryA 24-year-old man experienced dental pain and “flu-like” symptoms for which he attempted self-treatment with oral amoxicillin 250 mg daily purchased by a family member from a pet store. The amoxicillin was marketed for the treatment of bacterial infection in pet fish. After several days of increasing tooth pain despite the self-medication, the patient presented to an outpatient clinic where he was found to have a molar abscess requiring tooth extraction. The patient responded well to therapy and was counseled to discontinue antibiotic self-treatment. Practice implicationsUndocumented use of nonprescription antibiotics represents a threat to patient safety. Potential deleterious outcomes include resistance, adverse drug events, and delays in definitive infection treatment. Pharmacists should screen patients for nonprescription antibiotic use, provide them counseling on appropriate antibiotic use, and educate other health care professionals on underrecognized sources of nonprescription antibiotics to increase awareness of this growing issue. Furthermore, antibiotic resistance should be considered when recommending an antibiotic agent for the treatment of infections.

Self-care habits among people who inject drugs with skin and soft tissue infections: a qualitative analysis

BackgroundInjection drug use is on the rise in the USA, and skin and soft tissue infections (SSTI) are a common complication, resulting in significant morbidity and mortality. Due to structural barriers to care-seeking, many people who inject drugs avoid formal care and resort to self-care techniques, but little is known about the nature of these techniques, or more generally about the accuracy or breadth of this population’s knowledge of SSTIs.MethodsSemi-structured qualitative interviews were conducted with 12 people who inject heroin in two metropolitan areas: Sacramento and Boston, USA.ResultsThese interviews reveal a robust and accurate knowledge base regarding skin infections, including the progression from simple cellulitis to an abscess, and acknowledgment of the possibility of serious infections. Nonetheless, there remains a reticence to seek care secondary to past traumatic experiences. A step-wise approach to self-care of SSTI infections was identified, which included themes of whole-body health, topical applications, use of non-prescribed antibiotics, and incision and drainage by non-medical providers.ConclusionsThe reported SSTI self-care strategies demonstrate resilience and ingenuity, but also raise serious concerns about inappropriate antibiotic consumption and complications of invasive surgical procedures performed without proper training, technique, or materials. Harm reduction agencies and health care providers should work to obviate the need for these potentially dangerous practices by improving healthcare access for this population. In the absence of robust solutions to meet the needs of this population, education materials should be developed to optimize the efficacy and minimize the harms of these practices, while empowering and supporting the autonomy of people who use drugs and providing clear guidance on when self-care should be abandoned in favor of formal medical care.

2063. Using Twitter Data and Machine Learning to Identify Outpatient Antibiotic Misuse: A Proof-of-Concept Study

BackgroundOutpatient antibiotic misuse is common, yet it is difficult to identify and prevent. Novel methods are needed to better identify unnecessary antibiotic use in the outpatient setting.MethodsThe Twitter developer platform was accessed to identify Tweets describing outpatient antibiotic use in the United States between November 2018 and March 2019. Unique English-language Tweets reporting recent antibiotic use were aggregated, reviewed, and labeled as describing possible misuse or not describing misuse. Possible misuse was defined as antibiotic use for a diagnosis or symptoms for which antibiotics are not indicated based on national guidelines, or the use of antibiotics without evaluation by a healthcare provider (Figure 1). Tweets were randomly divided into training and testing sets consisting of 80% and 20% of the data, respectively. Training set Tweets were preprocessed via a natural language processing pipeline, converted into numerical vectors, and used to generate a logistic regression algorithm to predict misuse in the testing set. Analyses were performed in Python using the scikit-learn and nltk libraries.Results4000 Tweets were included, of which 1028 were labeled as describing possible outpatient antibiotic misuse. The algorithm correctly identified Tweets describing possible antibiotic misuse in the testing set with specificity = 94%, sensitivity = 55%, PPV = 75%, NPV = 87%, and area under the ROC curve = 0.91 (Figure 2).ConclusionA machine learning algorithm using Twitter data identified episodes of self-reported antibiotic misuse with good test performance, as defined by the area under the ROC curve. Analysis of Twitter data captured some episodes of antibiotic misuses, such as the use of non-prescribed antibiotics, that are not easily identified by other methods. This approach could be used to generate novel insights into the causes and extent of antibiotic misuse in the United States, and to monitor antibiotic misuse in real time. Disclosures All authors: No reported disclosures.

Knowledge, attitudes and practices regarding antibiotic use in Maputo City, Mozambique.

BackgroundIrrational use of antibiotics is a major driver of antimicrobial resistance (AMR) worldwide. Sub-Saharan Africa, where the risk of spread of AMR is highest, lacks data on the knowledge, attitudes and practices regarding antibiotic prescription and use. This is the first study in Mozambique to address this gap.MethodsA cross-sectional study was conducted in 2016 in 1091 adults (age ≥18 years) living in five districts in peri-urban areas of Maputo City. Three stage cluster sampling was used to select the households. A semi-structured questionnaire was used to collect information on the knowledge, attitudes and practices regarding antibiotics and their use and socio-demographic data.ResultsOf the 1091 participants, 20.9% (228/1091) had used non-prescribed antibiotics. Most of the non-prescribed antibiotics were purchased in pharmacies (199/228; 87.3%). The proportion of use of non-prescribed antibiotics was higher in those who purchased from informal markets (82.6%; 14/17) and home stores (66.7%; 12/18), compared to pharmacies (24.6%; 199/810) (p = 0.000). Variables significantly associated with use of non-prescribed antibiotics were male gender (p = 0.004), living in the Central A (p<0.001), Aeroporto B (p<0.001) or 25 de Junho (p<0.001) neighborhoods, purchase of antibiotics in informal markets (p<0.002) or obtaining from home stores (p = 0.026), not completing the course (p<0.001) and having poor knowledge on the use of antibiotics (p<0.001). Main reasons for use of non-prescribed antibiotics were a perception that there was no need to attend a health facility (26.8%), followed by someone else’s advice (7.7%), symptoms similar to a previous episode (6.2%) and poor quality of care in health facilities (6.7%).ConclusionsOur study shows for the first time that knowledge regarding antibiotics is poor in Maputo City. Purchase of non-prescribed antibiotics is a common practice and most are sold in pharmacies, indicating deficient inspection. Interventions to reinforce adherence by pharmacies to current legislation for dispensing antibiotics, combined with community education are urgently needed.

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

Use of antibiotics without a prescription may increase unnecessary and inappropriate drug use or doses as well as global risk for antimicrobial resistance. 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. Searches of PubMed, EMBASE, CINAHL, Scopus, and relevant Web sites without language restrictions from January 2000 to March 2019. Studies reporting nonprescription use of antibiotics, storage of antibiotics, intention to use antibiotics without a prescription, and factors influencing nonprescription use. Two reviewers independently screened citations and full texts and performed data abstraction. Of 17422 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. Scarce evidence and heterogeneous methods and outcomes. 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. None.

\u201cAntibiotics kill things very quickly\u201d - consumers\u2019 perspectives on non-prescribed antibiotic use in Saudi Arabia

BackgroundIn recent decades, the Kingdom of Saudi Arabia has seen an exponentially growing antibiotic resistance, which is exacerbated by the use of antibiotics without a prescription and other various factors. However, no published data are available on factors influencing non-prescription use of antibiotics among the general public in Saudi Arabia using an in-depth interview technique.MethodsSemi-structured interviews were carried out with 40 Saudi participants from the Eastern Province of Saudi Arabia, selected via snowball sampling technique. Participants were enrolled based on the following inclusion criteria: 18 years of age or older and had self-medicated themselves with antibiotics in the past two years. Data collection was continued until data saturation was attained. Interviews were audiotaped, transcribed verbatim and analysed using NVivo 10 software.ResultsParticipants (80% female) had a mean (SD) age of 30 years (10.2). Self-medication with antibiotics was associated with various inappropriate antibiotic use behaviours and negative outcomes such as antibiotic resistance, treatment failures and adverse events. Interviews revealed that different reasons contribute to the rise of self-medication with antibiotics, ranging from difficulty accessing healthcare services, participant’s cultural beliefs and practices, lack of knowledge about antibiotics and antibiotic resistance, and weak regulatory enforcement.ConclusionsThe findings of the present study will aid in generating data that may provide an insight when designing future interventions to promote public health awareness regarding safe and effective use of antibiotics.

The Use of Antibiotics in the Treatment of Pediatric Varicella Patients: Evidence from the multi-country MARVEL study

Background: Varicella is a common infectious disease in childhood that can result in bacterial complications such as skin and soft tissue infections and pneumonias, among others. Although well-tolerated and effective varicella vaccines have been available for >20 years, only 40 countries around the world have implemented universal varicella vaccination (UVV) programmes. The objective of this study was to examine empiric data on the appropriate and inappropriate use of antibiotics in the treatment of pediatric varicella patients, based on data collected in five countries (Argentina, Hungary, Mexico, Peru, and Poland). Methods & Materials: Five primary data collection studies were conducted between 2014-2017 as part of MARVEL (Multi-country economic and epidemiological burden of varicella study). Detailed data were obtained on the treatment of primary varicella in both inpatients and outpatients aged 1-14 years between 2009-2016. We descriptively analyzed data on the type of complications, severity of disease (measured by number of lesions), and dosage and duration of both prescription and non-prescription antibiotic use, together with data on whether or not a confirmation of the presence of bacterial infections was available. These results were contrasted within countries to treatment guidelines for varicella and the use of antibiotics to assess appropriate and inappropriate use, and between countries to compare utilization patterns. Results: Across the 5 countries, 787 patient records were included (401 outpatients, 386 inpatients). The average number of antibiotics used per inpatient ranged from 0.9 in Poland to 1.9 in Peru, with an average duration of use of 7.2 days (Hungary) to 15.8 days (Mexico) among users. Among outpatients, this ranged from 0.03 antibiotics in Hungary to 0.4 antibiotics in Argentina, with an average duration of antibiotics used of 6.5 days (Peru) to 9.5 days (Argentina). The proportion of antibiotics prescribed without a probable or confirmed diagnosis of bacterial infection ranged from 44.3% (Hungary) to 89.9% (Peru). Conclusion: UVV could substantially reduce both inappropriate and appropriate use of antibiotics in pediatric varicella patients, and could be a valuable tool in an arsenal to combat antimicrobial resistance. Further studies on the gap between appropriate and inappropriate use of antibiotics in the treatment of varicella may be warranted.

Survey of Nonprescription Medication and Antibiotic Use in Patients with Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, and Overlap Syndrome.

Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and overlap syndrome (SJS-TEN) are rare, serious skin and mucosa break-down conditions frequently associated with antibiotic use. The role of nonprescription medications alone, or in combination with antibiotics in triggering SJS/TEN, is largely unknown. This study summarized data collected from patient surveys about nonprescription and antibiotic use prior to a SJS/TEN diagnosis. The survey was administered online to members of the U.S. SJS Foundation who had been diagnosed with SJS/TEN or were the parent of a child who had been diagnosed with SJS/TEN. Respondents were asked about nonprescription medications taken within the year before diagnosis, and the approximate point in time before diagnosis that they had taken them. They were also asked about specific prescription medications, including antibiotics, that they took before diagnosis. An estimated 4500 patients received an invitation to complete the survey. 251 patients completed it, resulting in a response rate of 5.6%. The mean age of respondents was 43 years (SD (standard deviation) = 17.3) and 70% were female. 32.3% of respondents indicated that a prescription antibiotic triggered their reaction. 14.1% indicated a nonprescription medication had triggered their SJS/TEN, and 18.1% said a nonprescription medication may have triggered their SJS/TEN. 85.5% of respondents said they took a nonprescription medication within three months of their SJS/TEN diagnosis. Of those respondents who reported that an antibiotic triggered their SJS/TEN, 35.2% reported taking a nonprescription medication within the three months prior to their diagnosis. This survey captured valuable information about nonprescription and antibiotic use in SJS/TEN patients. It is important for future studies to estimate the impact of antibiotics on SJS/TEN, and account for nonprescription medication use in that relationship.