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JAC Advance Access originally published online on November 22, 2006
Journal of Antimicrobial Chemotherapy 2007 59(1):152-156; doi:10.1093/jac/dkl457
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Is self-medication with antibiotics in Europe driven by prescribed use?

Larissa Grigoryan1,*, Johannes G. M. Burgerhof2, Flora M. Haaijer-Ruskamp1, John E. Degener3, Reginald Deschepper4, Dominique L. Monnet5, Antonella Di Matteo6, Elizabeth A. Scicluna7, Ana-Claudia Bara8, Cecilia Stålsby Lundborg9, Joan Birkin10 and on behalf of the SAR group

1 Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands 2 Department of Epidemiology, University Medical Center Groningen, University of Groningen Groningen, The Netherlands 3 Department of Medical Microbiology, University Medical Center Groningen The Netherlands 4 Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel Brussels, Belgium 5 National Center for Antimicrobials and Infection Control, Statens Serum Institut Copenhagen, Denmark 6 Laboratory of Pharmacoepidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro (Chieti) Italy 7 Infection Control Unit, St Luke's Hospital G'Mangia, Malta 8 National Institute of Research and Development in Health Bucharest, Romania 9 Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm and Nordic School of Public Health and Apoteket AB Göteborg, Sweden 10 Health Protection Agency East Midlands, Nottingham City Hospital Nottingham, UK

Received 23 August 2006; returned 11 September 2006; revised 29 September 2006; accepted 12 October 2006


*Corresponding author. Tel: +31-50-3636858; Fax: +31-50-3632812; E-mail: l.grigoryan{at}med.umcg.nl

Background: Self-medication with antibiotics may increase the risk of inappropriate use and the selection of resistant bacteria. One of the triggers for using self-medication may be past experience with antibiotics prescribed by health professionals. We examined the association between prescribed use and self-medication with antibiotics.

Methods: A population survey was conducted in 19 European countries, covering 15 548 respondents. Multinomial logistic regression analysis was used to study the relationship between prescribed use and self-medication for all symptoms/diseases and for upper respiratory tract infections (URTIs).

Results: The association between prescribed use and self-medication was modified by source of self-medication, region in Europe and education. This association was consistently stronger for self-medication from leftovers than from other sources, primarily directly from a pharmacy. It was stronger also for respondents from Northern/Western Europe than respondents from Eastern Europe and Southern Europe and those with low education. Prescribed use for URTIs (minor ailments such as throat symptom, influenza, etc.) increased the likelihood of self-medication with leftover antibiotics for these symptoms/diseases in all European regions.

Conclusions: Our study shows consistent associations between prescribed use and self-medication with antibiotics from leftovers, but has not been able to support the hypothesis that self-medication from other sources than leftovers is triggered by earlier prescribed use. Preventing leftovers may be one effective way of preventing self-medication. This can be achieved by ensuring that the amount dispensed corresponds to the amount prescribed, by educating patients and by making doctors aware that prescribing for minor ailments may increase the risk of self-medication for such ailments.

Keywords: antibacterial agents , drug prescribing , drug resistance , bacterial


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