Non-prescription antimicrobial use worldwide: a systematic review
Open accessAbstract
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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In most LMICs, antibiotics can be purchased at drug stores without a prescription.
“In most LMICs, antibiotics can be purchased at drug stores without a prescription 20 and are used both for treatment and prophylaxis 21,22 .”
From Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. (2020) · cites this paper as [20]
Cites
Costelloe, C., Metcalfe, C., Lovering, A., Mant, D., & Hay, A. D. (2010) · BMJ · doi:10.1136/bmj.c2096 · Cited by 1,981 · see citing works
The spread of CTX-M-type extended-spectrum β-lactamases
Rossolini, G. M., D'Andrea, M. M., & Mugnaioli, C. (2008) · Clinical Microbiology and Infection · doi:10.1111/j.1469-0691.2007.01867.x · Cited by 487 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis
Murray, C. J. L., Ikuta, K. S., Sharara, F., Swetschinski, L., Robles Aguilar, G., Gray, A., Han, C., Bisignano, C., Rao, P., Wool, E., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02724-0 · Cited by 16,316 · see citing works
Antibiotic resistance-the need for global solutions
Laxminarayan, R., Duse, A., Wattal, C., Zaidi, A. K. M., Wertheim, H. F. L., Sumpradit, N., Vlieghe, E., Hara, G. L., Gould, I. M., Goossens, H., et al. (2013) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(13)70318-9 · Cited by 4,439 · see citing works
Self-citationAntimicrobial resistance: a global multifaceted phenomenon
Prestinaci, F., Pezzotti, P., & Pantosti, A. (2015) · Pathogens and Global Health · doi:10.1179/2047773215y.0000000030 · Cited by 3,296 · see citing works
Llor, C., & Bjerrum, L. (2014) · Therapeutic Advances in Drug Safety · doi:10.1177/2042098614554919 · Cited by 2,079 · see citing works
Ocan, M., Obuku, E. A., Bwanga, F., Akena, D., Richard, S., Ogwal-Okeng, J., & Obua, C. (2015) · BMC Public Health · doi:10.1186/s12889-015-2109-3 · Cited by 504 · see citing works
Members of the human gut microbiota involved in recovery from Vibrio cholerae infection
Hsiao, A., Ahmed, A. M. S., Subramanian, S., Griffin, N. W., Drewry, L. L., Petri, W. A., Haque, R., Ahmed, T., & Gordon, J. I. (2014) · Nature · doi:10.1038/nature13738 · Cited by 387 · see citing works
Antimicrobial resistance in the environment: The Indian scenario
Taneja, N., & Sharma, M. (2019) · Indian Journal of Medical Research · doi:10.4103/ijmr.ijmr_331_18 · Cited by 317 · see citing works
Self-medication with Antibiotics in WHO Southeast Asian Region: A Systematic Review
Nepal, G., & Bhatta, S. (2018) · Cureus · doi:10.7759/cureus.2428 · Cited by 272 · see citing works
“It is a form of healthcare practiced in most parts of the world and overall 50% of total antibiotics used are purchased over-the-counter [4-5].”
BackgroundNadimpalli, M. L., Marks, S. J., Montealegre, M. C., Gilman, R. H., Pajuelo, M. J., Saito, M., Tsukayama, P., Njenga, S. M., Kiiru, J., Swarthout, J., et al. (2020) · Nature microbiology · doi:10.1038/s41564-020-0722-0 · Cited by 223 · see citing works
Self-medication practice in Ethiopia: a systematic review
Ayalew, M. B. (2017) · Patient Preference and Adherence · doi:10.2147/ppa.s131496 · Cited by 182 · see citing works
“48 This practice poses great risks, like antibiotic resistance.”
Godman, B., Haque, M., McKimm, J., Abu Bakar, M., Sneddon, J., Wale, J., Campbell, S., Martin, A. P., Hoxha, I., Abilova, V., et al. (2020) · Current Medical Research and Opinion · doi:10.1080/03007995.2019.1700947 · Cited by 171 · see citing works
Antibiotic effectiveness: Balancing conservation against innovation
Laxminarayan, R. (2014) · Science · doi:10.1126/science.1254163 · Cited by 170 · see citing works
Self-citationSakeena, M. H. F., Bennett, A. A., & McLachlan, A. J. (2018) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2018.09.022 · Cited by 157 · see citing works
Aslam, A., Gajdács, M., Zin, C. S., Ab Rahman, N. S., Ahmed, S. I., Zafar, M. Z., & Jamshed, S. (2020) · Antibiotics · doi:10.3390/antibiotics9090597 · Cited by 142 · see citing works
Chang, J., Ye, D., Lv, B., Jiang, M., Zhu, S., Yan, K., Tian, Y., & Fang, Y. (2017) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkw519 · Cited by 128 · see citing works
Horumpende, P. G., Sonda, T. B., van Zwetselaar, M., Antony, M. L., Tenu, F. F., Mwanziva, C. E., Shao, E. R., Mshana, S. E., Mmbaga, B. T., & Chilongola, J. O. (2018) · PLOS ONE · doi:10.1371/journal.pone.0207465 · Cited by 124 · see citing works
Irrational use of antibiotics in the Moshi Municipality Northern Tanzania: a cross sectional study
Mboya, E. A., Sanga, L. A., & Ngocho, J. S. (2018) · Pan African Medical Journal · doi:10.11604/pamj.2018.31.165.15991 · Cited by 117 · see citing works
Chang, J., Xu, S., Zhu, S., Li, Z., Yu, J., Zhang, Y., Zu, J., Fang, Y., & Ross-Degnan, D. (2019) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(19)30324-x · Cited by 108 · see citing works
Gebretekle, G. B., & Serbessa, M. K. (2016) · Antimicrobial Resistance & Infection Control · doi:10.1186/s13756-016-0101-z · Cited by 102 · see citing works
Alrasheedy, A. A., Alsalloum, M. A., Almuqbil, F. A., Almuzaini, M. A., Aba Alkhayl, B. S., Albishri, A. S., Alharbi, F. F., Alharbi, S. R., Alodhayb, A. K., Alfadl, A. A., et al. (2020) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2020.1705156 · Cited by 102 · see citing works
Hoxha, I., Malaj, A., Kraja, B., Bino, S., Oluka, M., Marković-Peković, V., & Godman, B. (2018) · Journal of Global Antimicrobial Resistance · doi:10.1016/j.jgar.2018.01.019 · Cited by 73 · see citing works
Irrational use and non-prescription sale of antibiotics in Nigeria: A need for change
Faculty of Health, S. A. S., Akinyandenu, O., Akinyandenu, A., & Department of Pharmacology, C. O. M. (2014) · Journal of Scientific and Innovative Research · doi:10.31254/jsir.2014.3222 · Cited by 65 · see citing works
Erku, D. A., & Aberra, S. Y. (2018) · Antimicrobial Resistance & Infection Control · doi:10.1186/s13756-018-0389-y · Cited by 55 · see citing works
Asghar, S., Atif, M., Mushtaq, I., Malik, I., Hayat, K., & Babar, Z.-U.-D. (2020) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2019.09.003 · Cited by 53 · see citing works
Wang, X., Xuan, Z., Storella, T. H., & Zhou, X. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113035 · Cited by 40 · see citing works
Parental self‐medication of antibiotics for children in Jordan
Mukattash, T. L., Alkhatatbeh, M. J., Andrawos, S., Jarab, A. S., AbuFarha, R. K., & Nusair, M. B. (2020) · Journal of Pharmaceutical Health Services Research · doi:10.1111/jphs.12331 · Cited by 36 · see citing works
Gebrekirstos, N. H., Workneh, B. D., Gebregiorgis, Y. S., Misgina, K. H., Weldehaweria, N. B., Weldu, M. G., & Belay, H. S. (2017) · Antimicrobial Resistance & Infection Control · doi:10.1186/s13756-017-0227-7 · Cited by 38 · see citing works
Antimicrobial-Resistant Bacteria in Infected Wounds, Ghana, 20141
Janssen, H., Janssen, I., Cooper, P., Kainyah, C., Pellio, T., Quintel, M., Monnheimer, M., Groß, U., & Schulze, M. H. (2018) · Emerging Infectious Diseases · doi:10.3201/eid2405.171506 · Cited by 36 · see citing works
“indiscriminate use of antimicrobial drugs contributes to this factor (14).”
BackgroundCortez, J., Rosário, E., Pires, J. E., Taborda Lopes, J., Francisco, M., Vlieghe, E., & Brito, M. (2017) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2017.05.011 · Cited by 26 · see citing works
Raju, R., Srinivas, S. C., Siddalingegowda, S. M., Vaidya, R., Gharat, M., & Kumar, T. M. P. (2024) · Journal of Pharmacy & Pharmaceutical Sciences · doi:10.3389/jpps.2024.12721 · Cited by 25 · see citing works
Farooqui, H. H., Selvaraj, S., Mehta, A., & Mathur, M. R. (2020) · JAC-Antimicrobial Resistance · doi:10.1093/jacamr/dlaa076 · Cited by 16 · see citing works
Sale of Antibiotics without Prescriptions in Alexandria, Egypt
Kotb, M., & ElBagoury, M. (2018) · Journal of Pure and Applied Microbiology · doi:10.22207/jpam.12.1.34 · Cited by 15 · see citing works
Wanyama, H., Akhtar, T. S., & Abbas, S. (2025) · Gastroenterology Review · doi:10.5114/pg.2025.148486 · Cited by 8 · see citing works
- Authors
- Morgan, D. J., Okeke, I. N., Laxminarayan, R., Perencevich, E. N., & Weisenberg, S.
- Affiliations
- University of Maryland, Baltimore (US)
- Haverford College (US)
- Center for Disease Dynamics, Economics & Policy (US)
- University of Iowa (US)
- Alta Bates Summit Medical Center (US)
- Corresponding author
- Morgan, Daniel J
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2011-09
- Volume
- 11
- Issue
- 9
- Pages
- 692-701
- ISSN
- 1473-3099 (ISSN-L)
- PMC
- PMC3543997
- OpenAlex
- W2100353213
- Cited by
- 947
- References
- 2
- Citations by year
- 2026: 44 · 2025: 64 · 2024: 71 · 2023: 92 · 2022: 76 · 2021: 99 · 2020: 126 · 2019: 81 · 2018: 88 · 2017: 65 · 2016: 40 · 2015: 29 · 2014: 34 · 2013: 15 · 2012: 20
- FWCI
- 2.61
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The Lancet Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (K08HS018111, 1 K08 HS18111-01)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Physical Sciences › Environmental Science › Pollution › Pharmaceutical and Antibiotic Environmental Impacts
- Keywords
- antimicrobial resistance, antitubercular agents, adverse drug reactions, antimicrobial use regulation, community survey
- MeSH terms
- Anti-Bacterial Agents, Drug Resistance, Microbial, Nonprescription Drugs, Humans, Internationality
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
