1. Larissa Grigoryan, MD, PhD Family and Community Medicine
Non-Prescription Antimicrobial Use in a Primary Care Population: Evidence for Action
Larissa Grigoryan, MD, PhD
Family and Community Medicine

2. Acknowledgements Roger Zoorob, MD, MPH Susan Nash, PhD
Department of Family and Community Medicine
Baylor College of Medicine, Houston, TX
Barbara Trautner, MD, PhD
Section of Infectious Diseases
Department of Medicine and Surgery
Michael E. DeBakey Veterans Affairs Medical Center

3. Background
Non-prescription antibiotic use is common among Latin American immigrants to US*
19%-26% obtained non-prescription antibiotics in surveys
Non-prescription use of antibiotics may foster development of resistance
Very short courses, inappropriate drug and dose choice, and unnecessary therapy
Other potential problems
Adverse drug reactions, drug interactions, effect on microbiota, masking of underlying infectious processes and superinfection
*Mainous et al, Emerg Infect Dis 2005; Landers et al, J Am Acad Nurse Pract 2010

4. Objectives
To estimate the prevalence of non-prescription antibiotic use in adult patients from public and private primary care clinics.
To examine patient characteristics associated with non-prescription use

5. Methods Multistage sampling design: Sample size needed is 296
1 private and 2 public family practice clinics
Race/ethnicity stratified sampling to reflect racial/ethnic makeup of the population of Harris County, TX
Systematic random sampling of adults
Sample size needed is 296
94% response rate

6. Measures Self-administered standardized questionnaire
Use of antibiotics during the past 12 months (prescribed or non-prescribed)
Name of medicine, symptom or disease
Intended non-prescription use and storage of antibiotics
Demographic characteristics

7. Respondent characteristics (n= 400)
Results
Respondent characteristics (n= 400)
Age, years
48 ±15
Female sex
274 (68%)
Hispanic or Latino
168 (42%)
African American or Black
80 (20%)
Non-Hispanic
152 (38%)
Private insurance
177 (45%)
Medicare
50 (12%)
Medicaid
75 (19%)
Uninsured
90 (23%)
Self-pay
4 (1%)
Less than high education
43 (11%)
High school or GED
112(28%)
Some college and above
245 (61%)
Presence of a chronic disease
138(34%)

8. Respondent characteristics (n= 400)
Results
Respondent characteristics (n= 400)
Income
≤ $20,000
141/372 (38%)
> $20,000 but ≤ $40,000
73/372 (15%)
> $60,000 but ≤ $100,000
46 (12%)
> $100,000
55 (15%)
Employed
232/363 (64%)
Not working
111/363 (31%)
Retired
20/363 (5%)
Public clinic patients
200 (50%)
Private clinic patients
Completed in Spanish
80 (20%)

9. Antibiotic use stratified by race/ethnicity
* in the previous 12 months

10. Types of non-prescribed antibiotics taken, n=22
*including bactrim, tetracycline, ofloxacin, and amoxicillin clavulanate

11. Sources of non-prescribed antibiotics taken, n=22
A store or pharmacy in the US (40%)
Obtained from another country (24%)
From a relative or friend (20%)
“Leftover” from previous prescriptions (12%)
Veterinary antibiotics (4%)

12. Types of stored antibiotics, n=40
*including cephalexin, cefaclor, metronidazole, and nitrofurantoin

13. Intended non-prescription use5 10 15 20 25 30
Other infections/diseases
Diarrhea
Flu
Bronchitis
Runny nose/cold
Sinus infection
Fever
Cough
UTI
Ear infection/ear pain
Sore throat
Toothache
Would use non-prescription antibiotics - %

14. Predictors of intended non-prescription use
Multivariate analyses
OR (95% CI)
P value
Age, years
0.98 ( )
0.02
Education
0.057
Less than high school
1 (reference)
High school or GED
0.39 ( )
Some college and above
0.60 ( )
0.18
Private clinic patients
Public clinic patients
1.92 ( )
Sex, race/ethnicity, insurance status, presence of a chronic disease, employment status, income and survey language were not significant

15. European Commission Antimicrobial Project

16. Use of prescribed and non-prescribed antibiotics in Europe and the United States
Rates per 1000 respondents
Source: L. Grigoryan et al, Emerg Infect Dis Mar; 12(3):

17. Conclusions
The problem of non-prescription use is not confined to Latino communities in the US.
Community antimicrobial stewardship must include a focus on non-prescription antimicrobials.
An integrated approach involving policy makers, prescribers and the general public is needed using both educational and regulatory measures.

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