Table_1_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：抗生素的自我用药，包括多种形式[例如，剩余药品或非处方药(OTC)的使用]，由于往往以非审慎的方式进行，从而导致了抗微生物耐药性的增加。为了应对这一持续的公共卫生问题，有必要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，识别抗生素自我用药的决定因素。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我用药决定因素的研究进行了全面检索。检索范围不受语言和研究的类型限制，但仅限于欧洲和盎格鲁-撒克逊国家。由成对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个国家的54篇出版物，其中大多数识别了与患者相关的决定因素。重要的决定因素包括在家储存抗生素、医疗服务获取困难以及有自我用药的意图。当医疗机构为需求旺盛且社会易受伤害的患者提供服务时，医疗保健专业人员会促进自我用药的实践。与医疗保健体系相关的决定因素包括整包装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）发现了相互矛盾的结果。结论：抗生素的自我用药是由患者、医疗保健专业人员和体系层面的多种决定因素驱动的。政策制定者应认识到自我用药的复杂性，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。