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