The reasons many people use antibiotics without a prescription in Harris County

Antibiotic resistance is a growing global health crisis driven primarily by the misuse and overuse of antibiotics. Using antibiotics without a prescription contributes to this problem and poses serious safety risks, such as adverse drug reactions and obscuring the diagnosis of underlying infections. But why do some people choose to use antibiotics without consulting a doctor?

To investigate this, our research team surveyed 564 patients from six safety-net primary care clinics and two private emergency departments in Texas. Most respondents were female (72%), Hispanic or Latinx (47%) and were enrolled in the county financial assistance program (56%). Alarmingly, 44% of these patients reported using antibiotics without a prescription. Key reasons for using antibiotics without a prescription included:

• Convenience and accessibility of non-prescription antibiotics: Surveyed patients mentioned the convenience of using leftover antibiotics from previous prescriptions, family/friends or purchasing non-prescription antibiotics locally or from other countries.
• Previous symptom relief with antibiotics: Many patients have used antibiotics for colds or flu, even though these viral conditions don’t require antibiotics. Half of the patients would use non-prescription antibiotics because “they got better by taking it before” and “their doctor prescribed this antibiotic for the same symptom before.” Patients said they took non-prescription antibiotics for symptom relief, especially when their illnesses lingered. They trusted antibiotics more than over-the-counter medications like ibuprofen and believed they knew their bodies well enough to self-prescribe.
• Facing barriers to a doctor visit or to filling prescriptions: Challenges getting to the doctor due to family responsibilities, high cost of a medical visit or prescriptions, problems taking time off work, and transportation to the doctor’s office were patient-reported barriers associated with non-prescription use.

In general, younger patients and those without health insurance were particularly likely to use antibiotics without a prescription. By understanding the motivations for this behavior, we can develop targeted interventions to reduce non-prescription antibiotic use and combat antibiotic resistance.

Implications for public health and strategies to tackle non-prescription antibiotic use:

• Patient-focused educational brochure: We need to raise awareness about the dangers of antibiotic resistance and educate patients on the importance of using antibiotics only when prescribed. To do this, our Baylor research team has created an educational brochure for patients focused on safe antibiotic use and alternative, non-antibiotic treatment options when appropriate (such as for viral illnesses).
• Improve access to healthcare: Making healthcare services more affordable and accessible can reduce the need for self-medication.
• Community engagement: Working with community leaders and organizations can be a means to spread accurate information and dispel myths about antibiotic use.

Addressing non-prescription antibiotic use requires a comprehensive approach that includes education, improved healthcare access, and community involvement. By understanding why patients turn to non-prescription antibiotics, we can develop more effective strategies to combat antibiotic resistance and safeguard public health.

By Kiara Olmeda, research coordinator, family and community medicine, Dr. Ashley Collazo, research postdoctoral fellow, family and community medicine, Dr. Barbara W. Trautner, infectious diseases clinician-investigator at Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, affiliated with the Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), professor, Dr. Larissa Grigoryan, associate professor, family and community medicine