Self-medication is a human behavior in which an individual uses a substance or any exogenous influence to self-administer treatment for physical or psychological ailments.
The most widely self-medicated substances are over-the-counter drugs used to treat common health issues at home, as well as dietary supplements. These don't require a doctor's prescription to obtain.Excessive and not always proper use of antibiotic is a serious problem, of which antimicrobial resistance, currently cause for worldwide concern, is the major one. How can we reduce self-medication with antibiotics?
Key messages for the general public: Self-medication with antibiotics
Antibiotic-resistant bacteria are a danger to us all because they cause infections that are difficult to treat.
If we take antibiotics repeatedly and improperly, we contribute to the increase in antibiotic-resistant bacteria, one of the world’s most pressing health problems [1-6].
So if at some point in time you, your children or other family members need antibiotics, they may no longer work [7].
Self-medication with antibiotics is not a responsible use of antibiotics [8].
Self-medication is when you take (or want to take) antibiotics without first consulting a medical doctor by:
- using leftover antibiotics from previous treatments; or,
- getting antibiotics at the pharmacy without a prescription.
Note: With the word “antibiotics”, ECDC means antibacterial agents or antibacterials.
1. Antibiotics can only be prescribed by a medical doctor who has examined you
Many winter illnesses can cause the same symptoms, but they might not require the same treatment. If you have been prescribed an antibiotic for a previous illness and have recovered well, it is tempting to want to use the same antibiotic if you have similar symptoms. However, only a medical doctor who has examined you can ascertain if a winter illness requires treatment with antibiotics.
- Never try to buy antibiotics without a prescription.
- Never save antibiotics for later use.
- Never use leftover antibiotics from previous treatments.
- Never share leftover antibiotics with other people.
Do not keep leftover antibiotic treatments [8]. If you received more antibiotic doses (e.g. tablets, gel caps) than you were prescribed, ask your pharmacist about how to dispose of the remaining doses.
2. Antibiotics are not painkillers and cannot cure every illness
Antibiotics do not work like painkillers and cannot relieve headaches, aches, pains or fevers.
Antibiotics are only effective against bacterial infections and cannot help you recover from infections caused by viruses such as the common cold or the flu [9–12, 14].
Up to 80% of winter illnesses affecting your nose, ears, throat and lungs are of viral origin, so taking antibiotics will not make you feel better [11, 12].
3. Taking antibiotics for wrong reasons, such as against colds and flu, will not help you feel better faster, and may cause side-effects
Taking antibiotics against a cold or the flu has no benefit for you: antibiotics simply do not work against viral infections [9-12]. In addition, antibiotics may cause several unpleasant side effects such as diarrhoea, nausea or skin rashes [9, 10, 13-15].
Taking antibiotics to fight mild bacterial infections, such as rhinosinusitis, sore throats, bronchitis or earaches, is often unnecessary [15-19] since, in most cases, your own immune system is able to deal with such mild infections.
Most symptoms can be alleviated with over-the-counter medicines. Taking antibiotics will not reduce the severity of your symptoms and will not help you feel better faster [10, 12, 15, 17].
If your symptoms persist or if you have any concern, it is important that you see your doctor. If you really have a severe infection such as bacterial pneumonia, your doctor will prescribe antibiotics. Seek help more quickly than other people :
- if you are over 65 years old;
- if you have asthma or diabetes;
- if you have lung disease (e.g. chronic bronchitis, emphysema, chronic obstructive pulmonary disease);
- if you have heart problems (e.g. previous heart attack, angina, chronic heart failure);
- if you have a medical problem where your immune system is suppressed; or
- if you are taking drugs that suppress the immune system (e.g. steroids, chemotherapy for cancer, some drugs used to suppress thyroid gland functions).
List adapted from ‘Genomics to combat resistance against antibiotics in community-acquired LRTI in Europe’, a project funded by the European Commission’s Directorate-General for Research and Innovation.
4. Take the time to get better
Meeting life’s demands while being ill can be a source of stress, especially if you are experiencing certain symptoms for the first time. Finding an appropriate time to visit the doctor can be difficult, expensive and time-consuming. Knowing how to manage your symptoms can help you cope better with your illness. Learn how you can take care of yourself without antibiotics.
For most winter illnesses, your condition will improve after two weeks.
Indicative duration n of symptoms for common winter illnesses in adults
Ear infection up to 4 days
Sore throat up to 1 week
Common cold up to 1 ½ weeks
Flu up to 2 weeks
Runny or congested nose up to 1 ½ weeks
Sinus infection up to 2 ½ weeks
Cough (which often happens after a cold) up to 3 weeks
5. Ask your pharmacist for advice: other medicines can help relieve your symptoms
Your pharmacist may recommend over-the-counter medicines to help alleviate your symptoms.
Always ask for advice, especially if you are taking medicines for any other condition.
Painkillers relieve aches, pains and fevers.
Anti-inflammatory medicines, such as throat sprays or pastilles, help you swallow more easily.
Oral expectorants clear secretions in your airways.
Nasal sprays and decongestants help you breathe more comfortably.
Antihistamines alleviate stuffy, sneezy and itchy noses.
Drinking plenty of fluids and getting some rest will help improve any winter illness.
References
[1] Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis 2014;14:13. [open access link]
[2] Chung A, Perera R, Brueggemann AB, Elamin AE, Harnden A, Mayon-White R, et al. Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study. BMJ 335(7617):429. [open access link]
[3] Donnan PT, Wei L, Steinke DT, et al. Presence of bacteriuria caused by trimethoprim resistant bacteria in patients prescribed antibiotics: multilevel model with practice and individual patient data. BMJ 2004;328(7451):1297-301. [open access link]
[4] London N, Nijsten R, Mertens P, van den Bogaard A, Stobberingh E. Effect of antibiotic therapy on the antibiotic resistance of faecal Escherichia coli in patients attending general practitioners. J Antimicrob Chemother 1994;34(2):239-46. [link]
[5] Malhotra-Kumar S, Lammens C, Coenen S, Van Herck K, Goossens H. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study. Lancet 2007;369(9560):482-90. [open access link]
[6] Nasrin D, Collignon PJ, Roberts L, Wilson EJ, Pilotto LS, Douglas RM. Effect of β lactam antibiotic use in children on pneumococcal resistance to penicillin: prospective cohort study. BMJ 2002; 324(7328):28-30. [open access link].
[7] Daneman N, McGeer A, Green K, Low DE; for the Toronto Invasive Bacterial Diseases Network. Macrolide resistance in bacteremic pneumococcal disease: implications for patient management. Clin Infect Dis 2006;43(4):432-8. [open access link]
[8] Grigoryan L, Burgerhof JG, Haaijer-Ruskamp FM, et al. Is self-medication with antibiotics in Europe driven by prescribed use? J Antimicrob Chemother 2007;59(1):152-6. [open access link]
[9] Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Systematic Reviews 2013 Jun 4;6:CD000247. [open access link]
[10] Arroll B, Kenealy T, Falloon K. Are antibiotics indicated as an initial treatment for patients with acute upper respiratory tract infections? A review. NZ Med J 2008;121(1284):64-70. [link]
[11] Heikkinen T, Järvinen A. The common cold. Lancet 2003;361(9351):51-9. [open access link]
[12] Mäkelä MJ, Puhakka T, Ruuskanen O, et al. Viruses and bacteria in the etiology of the common cold. J Clin Microbiol 1998;36(2):539-42. [open access link]
[13] Keeney KM, Yurist-Doutch S, Arrieta MC, Finlay BB. Effects of antibiotics on human microbiota and subsequent disease. Annu Rev Microbiol 2014 Jun 2. [Epub ahead of print]
[14] Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis 2008;47(6):735-43. [open access link]
[15] Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD000245. [link]
[16] Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA 2010;304(19):2161-9. [open access link]
[17] Spinks A, Glasziou P, Del Mar CB. Antibiotics for sore throat. Cochrane Database Systematic Reviews 2013 Nov 5;11:CD000023. [link]
[18] Young J, De Sutter A, Merenstein D, et al. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet 2008;371(9616):908-14. [open access link]
[19] Van Vugt SF, Butler CC, Hood K, et al. Predicting benign course and prolonged illness in lower respiratory tract infections: a 13 European country study. Fam Pract 2012;29(2):131-8. [open access link]
- See more at: http://ecdc.europa.eu/en/eaad/antibiotics-get-informed/key-messages/Pages/self-medication-general-public.aspx#sthash.IR8jhIUq.dpuf
Have a nice day
Ali
http://ecdc.europa.eu/en/eaad/antibiotics-get-informed/key-messages/Pages/self-medication-general-public.aspx
Dear Nader,
maybe the following papers will help you:
Gastelurrutia MA, Larrañaga B, Garay A, Echeveste Fde A, Fernandez-Llimos F. Impact of a program to reduce the dispensing of antibiotics without a prescription in Spain. Pharm Pract (Granada). 2013;11(4):185-90. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869633/pdf/pharmpract-11-185.pdf
Al Rasheed A, Yagoub U, Alkhashan H, Abdelhay O, Alawwad A, Al Aboud A, Al Battal S. Prevalence and Predictors of Self-Medication with Antibiotics in Al Wazarat Health Center, Riyadh City, KSA. Biomed Res Int. 2016;2016:3916874. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736398/pdf/BMRI2016-3916874.pdf
Best wishes from Germany, Martin
Dear Nader,
This is an increasingly important and urgent issue for the humanity. There are already monster bugs out there that are no longer treatable with the available antibiotics/drugs. There is urgent need for coordinated action world-wide. Education of public and doctors, as well as law enforcement for the antibiotic distribution. In many countries, antibiotics are still available as over the counter, with no requirement for prescription. Drug companies and pharmacists need to stop encouraging wide spread antibiotic use. Often doctors have also been prescribing antibiotics to their patients without a proper diagnosis. Unless we address this problem soon, the resistant bacteria and bugs will be causing a lot of damage.
best wishes, Refik
Self-medication is an important health issue especially in developing countries like India. In developing countries, where universal access to health care is yet to be achieved, self-medication is one of the common and preferred modes resorted by the patients. Various studies reported that self-medication may lead to delay in care seeking which results in paradoxical economic loss due to delay in the diagnosis of underlying conditions and appropriate treatment. Also, self-medication can lead to interaction between drugs which would be prevented, had the patient sought care from a licensed medical practitioner. Practising self-medication for drugs like antibiotics might lead to drug resistance; and hence, there needs to be a check on these practices.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3915367/
http://www.ajpcr.com/Vol4Issue3/346.pdf
Educational campaigns and better enforcement over the drug regulations is necessary in order to reduce self-medication and contribute to rational use of antibiotics.
https://www.google.rs/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwj4l9-30ovNAhWLPhQKHXNXAqwQFggaMAA&url=http%3A%2F%2Fmedicinadanas.info%2Findex.php%2Farhiva-publikacije%2F2011godina%2F201107-09-temp%2F79-samoleenje-antibioticima-kod-odraslih-u-srbiji&usg=AFQjCNE5t9yJX6YtXYt_PlaRJNLJoi5nGQ&sig2=Qj6kkPLXpcSF10Rl0Z4fNA&bvm=bv.123664746,d.bGs
This is a genuine question and as far as I concern, I believe that a person should be very careful regarding medicine intake. The medicine should be taken only if it is required and self medication should be avoided. Further the antibiotics are of major concern, the tendency of taking antibiotics in a general conditions should be avoided and these drugs should only be taken after a prescription however the providers should also take care in prescribing antibiotics.
"Recent analysis has shown that Serbia belongs to countries with high consumption of antibiotics. The Republic of Serbia is a South Eastern European country in socio-economic transition and in the process of harmonization with health laws of the European Union. Serbia has been an independent state since 2004 and is one of the few countries in Europe which has not joined the European Surveillance of Antimicrobial Consumption (ESAC) project yet. Worldwide data indicate that antibiotics are frequently used inappropriately. This inappropriate use may contribute to antibiotic resistance, which is reaching alarming levels in Southern and Eastern Europe. Disregarding the problem of antibiotic resistance leads not only to unfavourable medical consequences, but also to substantial ecological and economic consequences..."
http://apps.szu.cz/svi/cejph/archiv/2015-2-04-full.pdf
One of the major problems is that 70% (or more) antibiotics are used in food industry. Antibiotics in sub-therapeutic doses are applied for preventative measures and for growth stimulation in livestock and in aquacultures. The subtherapeutic doses are especially effective in promoting antibiotic resistance. These antibiotics eventually ends up in sewer system and our waters.
Pharmaceutical industry is always interested to sell drugs over-the -counter (no prescription) as this promotes higher sales. Unfortunately, regulatory authorities as Health Canada or FDA, which make decisions about each medical product (sale with or without prescription ) should provide a better control over antibiotic products.
Self-medication with antibiotics in Europe: a case for action.
"Unlike most other drugs that only affect individual patients if used incorrectly for self-medication, misused antibiotics add to the global risk of increased spread of bacterial resistance. This review focuses on self-medication with antibiotics in Europe and its determinants. High prevalence of self-medication with antibiotics has been repeatedly found in Southern and Eastern European countries that also report high levels of antibiotic resistance. Despite being illegal, over the counter dispensation of systemic antibiotics occurs in several European Union Member States. A second major source of self-medication is the availability of "leftover" antibiotics which results from either patient non-compliance or dispensation of a larger number of tablets than needed for one single course. The potentially modifiable factors associated with self-medication are: availability of antibiotics without prescription, pack-based antibiotic dispensing system, misconceptions of the general public about the efficacy of antibiotics for minor illnesses and prescribing of antibiotics for minor ailments by physicians. Measures that may reduce and prevent self-medication include dispensation of exact tablet quantities in pharmacies as already implemented e.g. in the UK, Netherlands, the Czech Republic and the United States, and enforcement of existing laws prohibiting over-the-counter sales of antibiotics. Such measures should be embedded in a general policy to change the culture of antibiotic use by improving awareness of the general public and professionals about antibiotics and the risks associated with their use as well as reducing misconceptions about the need for antibiotics for minor ailments..."
http://www.ncbi.nlm.nih.gov/pubmed/20615180
It is an interesting and important question. In my opinion there are two main ways to solve this problem (at least to try to do this):
By improving the health care system – there is a need for better organization: medical specialists and patients need more time for discussion, people are too busy and do not want/have no chance to waste time in waiting, may be in the near future it will be possible to use smart phones also for medical purposes (consultations)…
By improving the health culture of the population, even the children have to be informed in an adequate way.
Gulliford MC, Moore MV, Little P et al. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ 2016; 354: i3410 (Published 04 July 2016). http://www.bmj.com/content/bmj/354/bmj.i3410.full.pdf
If you are interested more about the self medication with antibiotics in Serbia, please read the following article which is the only thorough study assessing the knowledge, behaviour and attitudes towards antibiotics conducted on a representative sample of the general population in Serbia. The results indicated a relatively adequate level of knowledge regarding antibiotics use. However, some areas of misconceptions and improper behavior were identified: respondents showed uncertainty as to whether antibiotics are effective against viruses as well as high percentage of self-medication with antibiotics was recorded. Article Is the level of knowledge a predictor of rational antibiotic...
There is another element to this. In resource-limited settings, many people cannot afford doctors' fees. So they consult their neighbourhood pharmacy, where the pharmacy owner is quite happy to suggest antibiotics and make a sale. Underpinning this is the weak regulatory framework in these settings. So while not strictly self-medication, it is still an unregulated sale of antibiotics which undermines the principles of antimicrobial stewardship.
Poverty and ignorance are the reasons of self-medication with antibiotics. A poor or illiterate person has no desire, motivation or time to learn. On the other hand, the cost of a doctor's visit is high and many people self-medicate due to their poverty. If poverty is eradicated in society, many problems will be solved later.
This world wide problem can largely be reduced when WHO and nation specific regulatory bodies are able to create and apply strict protection, make public awareness on the misuse of antibiotics. Visible warning labels are important in medicines, including antibiotics. It should direct a patient to read carefully the enclosed booklet. In this one, the fact that antibiotics should be used only in necessary cases should be included. But ultimately it can be impossible to stop our hypochondriac tendencies and our beliefs (convictions of faith) about medications. As this question rightly states, self medication is a human behavior. I know a lot of people who use OTCs just because they are available and they try them to prevent things they don't have but might develop, such as "arthritic" pain when they don't have a diagnostic of RA. Others take allergy medications every day to prevent allergic reactions which are not even present, as they interpret mild rhinoviruses as seasonal allergies. Among this type of patients, antibiotics can also be misused
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