A systematic review and meta-analysis of misuse of antibiotic therapies in the community

doi:10.1016/j.ijantimicag.2005.04.017

International Journal of Antimicrobial Agents

Volume 26, Issue 2, August 2005, Pages 106-113

https://doi.org/10.1016/j.ijantimicag.2005.04.017 Get rights and content

Abstract

Misuse of antibiotic therapy can have a profound negative impact both on individuals and on the community. The objective of this meta-analysis was to estimate the prevalence of antibiotic misuse in terms of non-compliance with therapy or reuse of leftover antibiotics in the community. Of 2848 screened articles, 46 contained the required information on the number of participants, the number compliant/using leftovers and the measurement technique. Mean compliance with antibiotics was 62.2% (95% confidence interval (CI), 56.4–68.0%) and mean use of leftover antibiotics was 28.6% (95% CI, 21.8–35.4%). Although variation in the methods resulted in substantial heterogeneity in the estimates, results were generally consistent by region and measurement technique. Patient education and simpler antibiotic regimens should be encouraged to promote responsible use of antibiotic therapy.

Introduction

Misuse of antibiotic therapy, including failure to complete therapy, skipping of doses, or reuse of leftover antibiotics, can potentially expose patients to suboptimal doses of antibiotic therapy. Such antibiotic-taking behaviour can result in insufficient antibiotic exposure for eradicating infectious bacteria and potentially create an environment that promotes antibiotic resistance. Misuse of antibiotic therapy has ramifications on healthcare costs, antibiotic resistance, treatment failure, hospitalisation time, wasted medication and increased return visits to the physician [1], [2], [3].

Patients frequently report discontinuing antibiotic therapy when they begin to feel better or when adverse events occur [2]. In a large community survey of antibiotic compliance, 10–47% of patients in nine countries surveyed reported not finishing a course of antibiotic therapy and 4–41% reported saving leftover antibiotics for future use [4]. Poorer compliance with antibiotic therapy has been associated with the use of longer courses of therapy and regimens having more daily doses [5]. Although many individual studies have examined the misuse of antibiotics in the community, the prevalence of antibiotic misuse has not been systematically reviewed.

Therefore, we conducted a systematic review of observational studies to estimate the prevalence of antibiotic misuse in the community setting. The objective was to review and summarise estimates of non-compliance with antibiotic therapy and use of unused leftover antibiotics by outpatients. We also summarised differences in estimates of misuse by region, treatment condition, age and method of assessment.

Section snippets

Methods

We searched PubMed, EmBASE, Web of Science, International Pharmaceutical Abstracts (IPA) and the Cochrane Library to identify studies that measured misuse of acute antibiotic therapy in the community. Search terms were identified through a pilot review of the literature and were used to identify articles through a systematic, standardised process. MeSH terminology was used to maintain common terms across search databases. The search strategy is outlined in Table 1. Frequently used terms such as

Literature review

Of 2848 published reports screened, 181 required a full-text review. It was not possible to locate four articles, which were therefore excluded. Two articles that reported combined results from multinational telephone interviews were excluded to avoid duplication of data and to minimise the heterogeneity of compliance estimates between countries [14], [15]. Following full-text review, 46 unique articles were identified that contained the required information for meta-analysis [4], [16], [17],

Discussion

Antibiotics are among the most commonly used medications worldwide and are of tremendous value to public health. Despite their importance, the continued efficacy of antibiotic therapies is threatened by the emergence of resistance. Much of this resistance has been attributed to indiscriminate overuse of antibiotics [62]. However, the effectiveness of antibiotics in the community and the risk of resistance may also be influenced by how antibiotics are used by the patient [23].

In this review,

Acknowledgments

This study was supported by Pfizer Inc., New York, NY. We would also like to thank employees at the University of North Carolina, Chapel Hill Health Sciences Library, for their assistance in the literature review and article retrieval process.

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A systematic review and meta-analysis of misuse of antibiotic therapies in the community

Abstract

Introduction

Section snippets

Methods

Literature review

Discussion

Acknowledgments

Control Clin Trials

Am J Geriatr Psychiatry

Int J Antimicrob Agents

Int J Antimicrob Agents

Soc Sci Med

J Pediatr

Soc Sci Med

J Clin Epidemiol

Am J Emerg Med

Aten Primaria

Control Clin Trials

Lancet

J Clin Epidemiol

Revista de Calidad Asistencial

Adherence to physicians’ instructions as a factor in managing streptococcal pharyngitis

Pediatrics

Parameters important in short antibiotic courses

J Int Med Res

Overview of issues related to medical compliance with implications for the outpatient management of infectious diseases

Infect Agents Dis

Patients’ interviews and misuse of antibiotics

Clin Infect Dis

Patient compliance with antibiotic treatment for respiratory tract infections

J Antimicrob Chemother

Quantitative methods in the review of epidemiologic literature

Epidemiol Rev

Measurement of patient compliance

Pharm World Sci

Compliance assessed by the Medication Event Monitoring System

Arch Dis Child

Pharmacists’ interventions using an electronic medication-event monitoring device's adherence data versus pill counts

Ann Pharmacother

Compliance with short-term antibiotic therapy among patients attending primary health centres in Riyadh, Saudi Arabia

J R Soc Health

Pattern of drug use in Addis Ababa community

East Afr Med J

Compliance with doxycycline therapy in sexually transmitted diseases clinics

Sex Transm Dis

Measured versus self-reported compliance with doxycycline therapy for chlamydia-associated syndromes: high therapeutic success rates despite poor compliance

Sex Transm Dis

Failure of children to receive penicillin by mouth

N Engl J Med

Measuring treatment compliance of men with non-gonococcal urethritis receiving oxytetracycline combined with low dose phenobarbitone

Genitourin Med

Pan-European survey of patients’ attitudes to antibiotics and antibiotic use

J Int Med Res

Medical prescription and treatment compliance in acute infectious diarrhea: indirect impact of an educational intervention

Salud Publica Mex

Compliance with doxycycline therapy for outpatient treatment of pelvic inflammatory disease

South Med J

Determinants of non-compliance with short term antibiotic regimens

Br Med J (Clin Res Ed)

Variation in acceptance of common oral antibiotic suspensions

Pediatr Infect Dis J

The extent of parental compliance with timing of administration of their children's antibiotics

J Adv Nurs

Adherence to cotrimoxazole treatment for acute lower respiratory tract infections in rural Bangladeshi children

Ann Trop Paediatr

General practice compliance study: is it worth being a personal doctor?

Br Med J (Clin Res Ed)

Relationship between the prescriber's instructions and compliance with antibiotherapy in outpatients treated for an acute infectious disease

J Clin Pharmacol