Determinants of antibiotic self-medication A systematic review and meta-analysis

Background: Decreasing the prevalence of antibiotic self-medication among the public requires proper under-standing of the risk factors involved. However, the determinants of antibiotic self-medication are not well defined.Objectives: To identify patient and health system-related determinants of antibiotic self-medication among the public. Methods: A systematic review of quantitative observational studies and qualitative studies was undertaken. PubMed, Embase, and Web of Science were searched to identify studies on determinants of antibiotic self -medication. The data were analyzed using meta-analysis, descriptive analysis, and thematic analysis.Results: Sixty-eight studies were included in the review. From meta-analyses, male sex (pooled odds ratio [POR]: 1.52, 95% confidence interval [CI]: 1.19-1.75), lack of satisfaction with healthcare services/physicians (POR: 3.53, 95% CI: 2.26-4.75) were associated with antibiotic self-medication. In subgroup analysis, lower age was directly associated with self-medication in high-income countries (POR: 1.61, 95% CI: 1.10-2.36). In low-and middle-income countries, people with greater knowledge of antibiotics were less likely to self-medicate (POR: 0.2, 95% CI: 0.08-0.47). Patient-related determinants identified from descriptive and qualitative studies included previous experience with antibiotics and similar symptoms, perceived low severity of disease, intention to save time and get better quickly, cultural beliefs about curative power of antibiotics, advice from family/ friends, and having home stock of antibiotics. Health system-related determinants included high cost of consulting physicians and low cost of self-medication, lack of access to physician/medical care, lack of trust/ confidence in physicians, greater trust in pharmacists, long distance of physicians/healthcare facilities, long waiting time at healthcare facilities, easy access to antibiotics from pharmacies, and convenience associated with self-medication.Conclusions: Patient and health system-related determinants are associated with antibiotic self-medication. In-terventions to decrease antibiotic self-medication should incorporate community programs along with appro-priate policies and healthcare reforms targeting these determinants with specific attention to population at high risk of self-medication.