Use and self-medication with antibiotics among adults in the Brazilian Amazon: a panel of two cross-sectional studies, 2015 and 2019

ABSTRACT

Background

The aim of this study was to investigate the prevalence of antibiotics use and self-medication among adults living in Manaus, Amazonas in 2015 and 2019.

Research design and methods

Analysis of two cross-sectional studies conducted in Manaus in 2015 and 2019. Adults aged ≥18 years were interviewed at home following a three-phase probabilistic sampling (census tracts, household, and individual). Primary outcome was the use of antibiotics in the previous 15 days. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of antibiotics use adjusted by independent variables.

Results

The prevalence of antibiotics use in the previous fortnight was 3.7% (95%CI 3.1–4.4%; n=3,479) in 2015 and 8.0% (95%CI 6.7–9.3%; n=2,321) in 2019. Self-medication increased from 19.2% (95%CI 12.4–26.0%; n=130) in 2015 to 30.7% (95%CI 22.5–38.8%; n=187) in 2019. Beta-lactams were the most used (252/317) and self-medicated (60/317) antibiotics in both surveys. Use of antibiotics was higher in 2019 (PR=2.05; 95%CI 1.60–2.64) compared to 2015 and among women (PR=1.66; 95%CI 1.16–2.39) compared to men.

Conclusions

Antibiotics use and self-medication in Manaus increased from 2015 to 2019. Enforcement of health regulation is needed to improve compliance and minimize potential risks.

KEYWORDS:

• Anti-bacterial agents
• Brazil
• cross-sectional studies
• drug utilization
• pharmacoepidemiology
• self-medication

Article highlights

• In Brazil, few population-based studies have assessed the use and self-medication with antibiotics after the implementation of antibiotics regulations. This analysis of two cross-sectional studies investigated these practices among adults living in Manaus, Amazonas in 2015 and 2019.

• Use of antibiotics in the previous 15 days was observed in approximately 4 out of 100 adults from Manaus in 2015 and 8 out of 100 in 2019. Among those who used antibiotics, self-medication was found in one-fifth in 2015 and one-third in 2019.

• Beta-lactams were the most used antibiotics in both prescription and self-medication practices.

• After adjustment, use of antibiotics was twice higher in 2019 than in 2015 and 66% higher among women in comparison to men.

• Use and self-medication with antibiotics increased in Manaus from 2015 to 2019 and indicate the need to enforce compliance with the Brazilian antibiotics sales regulations.

Author contributions

Silva MT and Galvao TF designed the work, analyzed and interpreted the data, critically reviewed the work for important intellectual content and approved the final version of this manuscript. Tiguman GMB analyzed and interpreted the data and drafted the work. All authors agree to be accountable for all aspects of the work.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This research was funded by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (Grants No. 404990/2013-4 and 448093/2014-6).