Table_3_Determinants of Self-Medication With Antibiotics in European and Anglo-Saxon Countries: A Systematic Review of the Literature.DOCX

Background: Self-medication with antibiotics, which comes in different forms [e.g., leftover or over-the-counter (OTC) use], contributes to antimicrobial resistance as it often happens in a non-prudent manner. In order to tackle this persistent public health problem, its drivers need to be known. The aim of this study was therefore to identify determinants of self-medication with antibiotics via a systematic literature review.Methods: A comprehensive search on determinants of self-medication with antibiotics in the ambulatory care was conducted in PubMed, Scopus, and Embase for studies published between January 2000 and March 2017. There was no limit on the language nor on the type of study. The search was restricted to European and Anglo-Saxon countries. Pairs of reviewers independently screened the abstracts and full texts and performed a quality assessment.Results: From the initial 664 abstracts, 54 publications that included 44 countries were retrieved of which most identified patient related determinants. Important determinants include storing antibiotics at home, poor access to healthcare, and having the intention to self-medicate. Healthcare professionals contribute to the practice of self-medication when catering for demanding and socially vulnerable patients. Healthcare system related determinants include dispensing antibiotics in whole packages and the lack of enforcement of medicine regulations. For some determinants (e.g., patients' age) contradictory results were found.Conclusion: Self-medication with antibiotics is driven by a variety of determinants on the patient, healthcare professional, and system levels. Policy makers should recognise the complexity of self-medication in order to develop multifaceted interventions that target healthcare professionals and patients simultaneously.

背景：抗生素的自行用药，其形式多样（例如，剩余药物或非处方药（OTC）使用），由于通常以非审慎的方式发生，从而导致了抗菌药物的耐药性。为了应对这一持续的公共卫生问题，必须了解其背后的驱动因素。因此，本研究旨在通过系统文献综述来识别抗生素自行用药的决定因素。方法：在PubMed、Scopus和Embase数据库中，对2000年1月至2017年3月间发表的关于门诊护理中抗生素自行用药决定因素的研究进行了全面检索。检索未对语言或研究类型设限，仅限于欧洲和盎格鲁-撒克逊国家。由成对的审稿人独立筛选摘要和全文，并进行了质量评估。结果：从最初的664篇摘要中，检索到包括44个国家在内的54篇出版物，其中大部分识别了与患者相关的决定因素。重要的决定因素包括家庭储存抗生素、医疗保健获取困难以及具有自行用药的意图。医疗保健专业人员在对需求迫切且社会脆弱的患者提供服务时，会促成自行用药的实践。与医疗保健体系相关的决定因素包括整包分发抗生素以及药品法规执行不力。对于某些决定因素（例如，患者的年龄）存在矛盾的结果。结论：抗生素的自行用药受到患者、医疗保健专业人员和体系层面上的多种决定因素的驱动。政策制定者应认识到自行用药的复杂性，以便制定旨在同时针对医疗保健专业人员和患者的多方面干预措施。