Non-prescription antimicrobial use worldwide: a systematic review

Abstract

In much of the world antimicrobial drugs are sold without prescription or oversight by health-care professionals. The scale and effect of this practice is unknown. We systematically reviewed published works about non-prescription antimicrobials from 1970-2009, identifying 117 relevant articles. 35 community surveys from five continents showed that non-prescription use occurred worldwide and accounted for 19-100% of antimicrobial use outside of northern Europe and North America. Safety issues associated with non-prescription use included adverse drug reactions and masking of underlying infectious processes. Non-prescription use was common for non-bacterial disease, and antituberculosis drugs were available in many areas. Antimicrobial-resistant bacteria are common in communities with frequent non-prescription use. In a few settings, control efforts that included regulation decreased antimicrobial use and resistance. Non-prescription antimicrobial and antituberculosis use is common outside of North America and northern Europe and must be accounted for in public health efforts to reduce antimicrobial resistance.

Figure 1. Flowchart of study selection

Some articles were classified as fitting into more than one type of study (eg, simulated client pharmacy surveys and potential or proven harm).

Figure 2. Frequency of non-prescription use of antimicrobials in the general population based on published works

In small areas, countries with similar frequency of non-prescription antimicrobial use have been grouped.