title: Patterns and determinants of inappropriate antibiotic use in injection drug users.
abstract: BACKGROUND
  Inappropriate antibiotic use contributes to the emergence and spread of drug resistant infections. Though injection drug users are at increased risk for drug resistant infections, few studies have examined antibiotic use in this population.
  
  
  OBJECTIVE
  To understand patterns and determinants of antibiotic use among injection drug users.
  
  
  METHODS
  Five focus groups were conducted with 28 current injection drug users recruited from a syringe exchange program in Philadelphia and analyzed using the constant comparative method to identify emergent themes. Twenty-six participants also completed a written survey instrument.
  
  
  RESULTS
  Injection drug users reported frequent antibiotic exposure, with 12 of 26 participants reporting use of antibiotic medications at least once in the previous 30 days. Participants reported several patterns of antibiotic use that were potentially harmful, including delays in seeking medical care, failing to fill prescriptions, obtaining antibiotics from non-provider sources, and poor adherence to prescribed regimens. The major determinants of inappropriate antibiotic use were delayed recognition of severity of illness, reluctance to wait to be seen, previous mistreatment by providers, lack of insurance, prioritizing purchasing drugs of abuse over antibiotics, forgetting to take antibiotics because of distractions that accompany drug use, concerns about interactions between antibiotics and other substances, and an irregular diet. Additionally, injection drug users commonly misunderstood the concept of antibiotic resistance and equated it with tolerance.
  
  
  CONCLUSIONS
  Injection drug users reported potentially dangerous antibiotic use behaviors and described determinants of these behaviors. Outreach and educational interventions to improve antibiotic use should target high-risk populations, such as injection drug users, and consider their distinct antibiotic use behaviors and determinants.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. jostarre@montefiore.org
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Starrels
authors.forename: Frances K
authors.initials: FK
authors.lastname: Barg
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D004352:Drug Resistance, Microbial / Q000502:physiology; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D012309:Risk-Taking; D012651:Self Medication / Q000009:adverse effects / Q000191:economics; D015819:Substance Abuse, Intravenous / Q000191:economics / Q000453:epidemiology* / Q000523:psychology
chemical_list: D000900:Anti-Bacterial Agents