Self-medication and self-prescription with antibiotics in the Middle East-do they really happen? A systematic review of the prevalence, possible reasons, and outcomes

Objectives: There has been no review on the prevalence, possible causes, and clinical outcomes of self-medication with antibiotics (SMA) in the Middle East. Methods: Databases were searched (January 2000 through June 2016) for articles on SMA among adults aged >= 18 years living in the Middle East. A hand search for relevant citations and key journals was also performed. Results: Twenty-two studies were found. The prevalence of SMA ranged from 19% to 82%. Age, sex, and educational and income levels were the main determinants of SMA. Socio-cultural, economic, and regulatory factors were the most commonly cited reasons for SMA. Penicillins were the antibiotics most commonly used; the antibiotics were obtained mainly via stored leftover drugs, pharmacies without prescriptions, and friends/relatives. SMA was mainly for upper respiratory tract problems. The primary sources of drug information included relatives/friends and previous successful experience. Inappropriate drug use such as wrong indication, short and long duration of treatment, sharing of antibiotics, and storing antibiotics at home for use at a later time were reported. Negative and positive outcomes of SMA were identified. Conclusions: It is important to understand the links between different factors promoting SMA and to assess the changing trends in order to derive strategies aimed at reducing drug-related health risks. (C) 2017 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.