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. 2025 Apr 15;26(1):111.
doi: 10.1186/s12875-025-02811-3.

A screening question to assess risk of using antibiotics without a prescription: a diagnostic study

Ashley Collazo  1 , Eva Amenta  2   3 , Kiara Olmeda  4 , Marissa Valentine-King  4 , Lindsey Laytner  4   3 , Azalia Mancera  4 , Roger Zoorob  4 , Michael K Paasche-Orlow  5 , Richard L Street Jr  6 , Barbara W Trautner  3   7 , Larissa Grigoryan  4   3
Affiliations

A screening question to assess risk of using antibiotics without a prescription: a diagnostic study

Ashley Collazo et al. BMC Prim Care. .

Abstract

Objectives: Non-prescription antibiotic use (using antibiotics without medical advice) is potentially unsafe and promotes antimicrobial resistance. We studied predictors of prior non-prescription use and whether screening for prior non-prescription antibiotic use predicted intention of future non-prescription antibiotic use.

Methods: The survey was performed from January 2020 - June 2021 in six public primary care clinics and two private emergency departments. Prior non-prescription users were respondents who reported taking oral antibiotics for symptoms without contacting a clinician. Intended use was defined by answering yes to the question, "would you use antibiotics without contacting a doctor/nurse/dentist/clinic." We examined predictors for prior non-prescription use. We also calculated the sensitivity, specificity, and positive and negative predictive value (PPV, NPV) of (a) any prior non-prescription antibiotic use and (b) prior use in the past 12 months - for future intended non-prescription use.

Results: Of 564 survey respondents, 246 (43.6%) reported non-prescription use; 91 (37.0%) of these respondents, 16.1% overall, reported doing so in the past 12 months. Approximately 63% of non-prescription antibiotic use was in those with a previous prescription of the same antibiotic for similar symptoms/illnesses. The screening characteristics of non-prescription use in the past 12 months to identify intention to use of antibiotics without a prescription in the future were: sensitivity 75.9% (95% CI: 65.3-84.6), specificity 91.4% (95% CI: 87.8-94.2), Bayes' PPV 74.5% (95% CI: 66.7-80.9), and Bayes' NPV 93.7% (95% CI: 90.5-96.1).

Conclusions: This study proposed a method to screen for future use of non-prescription antibiotics, which may have implications on antimicrobial stewardship efforts in primary care settings.

Keywords: Anti-bacterial agents; Antibiotic stewardship; Bacterial drug resistance; Predictive value of tests; Primary health care.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and approved by the Baylor College of Medicine Institutional Review Board (protocol #: H-45709). Informed consent was obtained from all participants in the study. Consent for publication: Not applicable. Disclaimer: This work is the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the United States Government. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Symptoms and Sources of Non-Prescription Antibiotic Use
See this image and copyright information in PMC

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