Lack of Health Insurance, Younger Age Predicts Nonprescription Antibiotic Use

Individuals with no health insurance are more likely to use antibiotics without a prescription, potentially increasing antimicrobial resistance and patient harm. These study results were published in Clinical Infectious Disease.

Study participants were surveyed about nonprescription antibiotic use between January 2020 and June 2021. The survey was conducted among individuals receiving care at 6 primary care clinics and 2 emergency departments in Texas. Antibiotics obtained without a prescription in the United States, abroad, from a friend or relative, or any of these 3 sources was considered nonprescription use. Data were adjusted to indicate whether participants completed the survey prior to vs during the COVID-19 pandemic. Researchers used t-testing, Mann Whitney, chi-square, and fisher exact testing to assess the effect of patient-, health care system-, and clinical encounter-related factors on nonprescription antibiotic use.

Among 564 participants included in the analysis, 198 completed the survey prior to the COVID-19 pandemic and 366 completed the survey during the pandemic. For the overall study population, the mean age was 49.7 years, and most participants were women and Hispanic (72.2% and 46.6%, respectively). A total of 150 (26.7%) participants reported long waiting times as a barrier to medical care within the previous 12 months, and 16.6% reported the high cost of medical appointments as a barrier to care.

Overall, 247 (43.8%) participants reported use of nonprescription antibiotics. The rate of nonprescription antibiotic use was significantly higher among patients who received care at publicly- vs privately-funded clinics (48.4% vs 31.6%; P <.001). Of note, penicillins — particularly amoxicillin — represented 50% of all reported instances of nonprescription antibiotic use.

Intent to use nonprescription antibiotics from any source was indicated by 177 (31.4%) participants. Stratified by individual sources, 126 (22.3%) participants indicated intent to obtain antibiotics from a friend or relative. The remaining participants indicated intent to obtain antibiotics in the US or abroad (19.1% vs 17.9%, respectively).

Significant factors that predicted the use of nonprescription antibiotics from any source included lack of health insurance, perceived high cost of medical visits, and younger age.

The researchers found that the COVID-19 pandemic had no significant confounding effect on the survey results.

Limitations of this study include the observational design, the use of self-reported data, and the influence that concerns regarding the legality of nonprescription antibiotic use may have had on participants’ responses. The researchers also noted that the survey was performed in a health care setting among individuals who were prone to seek medical care.

According to the researchers, "[P]olicy to ensure basic insurance coverage of all residents could have the added benefit of reducing unsafe use of non-prescription antibiotics, thus supporting the cause of antibiotic stewardship."

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Grigoryan L, Paasche-Orlow MK, Alquicira O, et al. Antibiotic use without a prescription: a multisite survey of patient, health system, and encounter characteristics. Clin Infect Dis. Published online April 24, 2023. doi:10.1093/cid/ciad241