title: Non-prescription antimicrobial use worldwide: a systematic review.
abstract: In much of the world antimicrobial drugs are sold without prescription or oversight by health-care professionals. The scale and effect of this practice is unknown. We systematically reviewed published works about non-prescription antimicrobials from 1970-2009, identifying 117 relevant articles. 35 community surveys from five continents showed that non-prescription use occurred worldwide and accounted for 19-100% of antimicrobial use outside of northern Europe and North America. Safety issues associated with non-prescription use included adverse drug reactions and masking of underlying infectious processes. Non-prescription use was common for non-bacterial disease, and antituberculosis drugs were available in many areas. Antimicrobial-resistant bacteria are common in communities with frequent non-prescription use. In a few settings, control efforts that included regulation decreased antimicrobial use and resistance. Non-prescription antimicrobial and antituberculosis use is common outside of North America and northern Europe and must be accounted for in public health efforts to reduce antimicrobial resistance.
authors.affiliation: University of Maryland, School of Medicine, Baltimore, MD, USA. dmorgan@epi.umaryland.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Morgan
authors.forename: Iruka N
authors.initials: IN
authors.lastname: Okeke
authors.forename: Ramanan
authors.initials: R
authors.lastname: Laxminarayan
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
authors.forename: Scott
authors.initials: S
authors.lastname: Weisenberg
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D006801:Humans; D038622:Internationality; D004366:Nonprescription Drugs / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D004366:Nonprescription Drugs