JAC Advance Access published online on February 22, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn054
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Original research |
Determinants of self-medication with antibiotics in Europe: the impact of beliefs, country wealth and the healthcare system
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, Groningen, The Netherlands 4 Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Brussels, Belgium 5 Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden 6 Nordic School of Public Health and Apoteket AB, Göteborg, Sweden 7 National Center for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark 8 Infection Control Unit, St Luke's Hospital, G'Mangia, Malta 9 Health Protection Agency East Midlands, Nottingham City Hospital, Nottingham, UK
Received 28 August 2007; returned 18 January 2008; revised 16 November 2007; accepted 21 January 2008
* Corresponding author. Tel: +31-88-7555100; E-mail: l.grigoryan{at}umcutrecht.nl
Background: Self-medication with antibiotics occurs among the population in Europe, particularly in southern and eastern countries. We studied the impact of predisposing factors (e.g. attitudes and knowledge concerning antibiotic use and self-medication) and enabling factors (country wealth and healthcare system factors) on self-medication with antibiotics in Europe.
Methods: In this follow-up of a previous European survey, we interviewed a subsample of 1101 respondents. A multilevel analysis with two levels (respondent and country) was performed. Variables that were statistically significantly different between users and non-users of self-medication were considered for inclusion into the multilevel regression analyses.
Results: Predisposing factors included individual-level characteristics. High perceived appropriateness of self-medication with antibiotics for bronchitis and an attitude favouring antibiotic use for minor ailments were related to a higher likelihood of self-medication. Enabling factors included individual and country data. At the individual level, perceived availability of antibiotics without a prescription was related to increased probability of self-medication. At the country level, higher gross domestic product (wealth) and exact dispensation of prescribed tablet quantities by pharmacies were independently associated with lower likelihood of self-medication.
Conclusions: Interventions aimed at preventing self-medication should include public education, enforcing regulations regarding the sale of antibiotics, and implementing laws for dispensing exact prescribed tablet quantities in pharmacies. With the included determinants, we explained almost all the variance at the country level, but not at the individual level. Future studies to increase our understanding of determinants of self-medication with antibiotics should focus on individual-level factors such as doctor–patient relationships and patient satisfaction.
Key Words: antibacterial agents , epidemiological factors , drug resistance , bacterial
Present address. Scientific Advice Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden.
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