The United States has a seemingly high prevalence of nonprescription antibiotic usage, with the medication obtained through friends and family, local markets, and previously prescribed antibiotic courses, according to study results published in the Annals of Internal Medicine.

The aim of this study was to systematically evaluate data from PubMed, CINAHL, Scopus, and Embase to assess the prevalence of nonprescription antibiotic medication usage, storage of antibiotics, intention to use antibiotics without a prescription, and factors leading to the use of nonprescription antibiotics. Studies were selected using the Population, Concept, and Context framework; articles were screened; and data were inserted into a data chart. Studies included were from January 2000 to March 2019.

A total of 31 articles met the inclusion criteria, and these articles were grouped by study population into patients or parents of patients outside healthcare settings, patients or parents of patients within healthcare settings, Hispanic/Latino populations, and injection drug users. The use of nonprescription antibiotic medication ranged between 1% of patients visiting clinics and 66% of patients who were Latino migrant workers.

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These nonprescribed antibiotics were sourced from family and friends (10 articles; n=22,427), the internet (1 article), under the counter (6 articles; n=9695), veterinary clinics (2 articles; n=400), or stored after a prior antibiotic prescription (9 articles; n=22,517). The prevalence of intention to use antibiotics without a prescription was 25%.

The main factors leading to the use of nonprescription antibiotic medication use were lack of insurance or healthcare access, cost of physician visits or medication, long waiting periods in clinics, embarrassment for needing antibiotic, concerns about mistreatment, previous response to antibiotic treatment, job maintenance, lack of transportation, and easily accessible availability of antibiotics from other sources.

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Limitations of this study include inadequate data available, potential publication bias, and heterogeneous methods and outcomes of the different articles included in this systematic review.

The researchers concluded, “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.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Grigoryan L, Germanos G, Zoorob R, et al. Use of antibiotics without a prescription in the U.S. population: a scoping review [published online July 23, 2019]. Ann Intern Med. doi:10.7326/M19-0505