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Antibiotics “Like Gold” for Some Patients: Personal Beliefs and Health Care Barriers Drive Inappropriate Antibiotic Use


•    Personal beliefs and health care system barriers drive antibiotic use without a prescription, according to a new qualitative study.
•    Overuse and misuse of antibiotics contribute to antimicrobial resistance, where bacteria and viruses become less susceptible to treatments.
•    The findings can inform community-level education efforts on inappropriate use of antibiotics and help shape policies to promote antibiotic stewardship.

Patients report using antibiotics without a prescription for two primary reasons: personal beliefs based on past treatment experiences and health care system barriers, suggesting the need for antibiotic stewardship education and access efforts, according to a new study presented at IDWeek 2023.

Researchers conducted in-depth interviews to identify patients’ motivations to use antibiotics without a prescription. Nonprescription antibiotic use among study participants included using antibiotics leftover from a prior prescribed course, obtained from social networks and purchased over-the-counter in other countries or illegally in United States-based stores and markets. 

Interviewees primarily reported using antibiotics for symptoms of COVID-19, the flu and the common cold, as well as for pain management, allergies and even wounds. Patients used antibiotics to treat symptoms they previously had or because they believed they understood their illnesses and which medications would be the most effective for their bodies. Some patients used antibiotics as an alternative to over-the-counter medications they perceived as ineffective. One participant described antibiotics as being “like gold,” indicating that they should be kept on hand because getting a prescription from their doctor is challenging, but antibiotics effectively treat all kinds of “infections.”

Participants documented barriers to health care and treatment access, including long wait times to schedule appointments and to see the doctor while at their appointments. Interviewees struggled with getting transportation to appointments, paying for parking and affording the associated costs of doctor visits. Many patients opted to use nonprescription antibiotics because they are more convenient than visiting a clinician and are easier to obtain and afford.

Antibiotic misuse is understudied and may represent a fraction of the problem of misuse and antimicrobial resistance, study authors caution.

“Improper use of antibiotics contributes to the growing threat of antimicrobial resistance, where bacteria and viruses evolve genetically to counter drugs,” said Lindsey A. Laytner, PhD, MPH, presenting author from the Baylor College of Medicine Department of Family and Community Medicine. “Clinicians, pharmacists and community leaders must establish education efforts on safe antibiotic use, provide alternative treatment options for everyday symptoms and work to improve access to health care and related services.”

Already, the findings are being used to design a patient-provider communication tool for clinicians, pharmacists and patients on safe antibiotic use and alternative nonantibiotic treatment options based on common symptoms patients experience. The tool is currently being piloted and tested at the Baylor College of Medicine and the Harris Health System clinics.

In addition to Dr. Laytner, the study co-authors include: Patricia Chen, PhD; Susan G. Nash, PhD; Juanita Salinas, MA; Kiara Olmeda, MS; Roger Zoorob, MPH, MD; Michael Paasche-Orlow, MD, MA, MPH; Barbara Trautner, MD, PhD; and Larissa Grigoryan, MD, PhD.

About IDWeek
IDWeek is the joint annual meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. IDWeek is a recognized forum for peer-reviewed presentations of new research on scientific advances and bench-to-bedside approaches in prevention, diagnosis, treatment and epidemiology of infectious diseases, including HIV, across the lifespan. For more information, visit

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