• Larissa Grigoryan, George Germanos, Roger Zoorob, Shivanki Juneja, Jean L Raphael, Michael K Paasche-Orlow, and Barbara W Trautner.
• Baylor College of Medicine, Houston, Texas (L.G., G.G., R.Z.).
• Ann. Intern. Med. 2019 Aug 20; 171 (4): 257-263.

BackgroundUse of antibiotics without a prescription may increase unnecessary and inappropriate drug use or doses as well as global risk for antimicrobial resistance.PurposeTo perform a scoping review of research on the prevalence of nonprescription antibiotic use in the United States and to examine the factors that influence it.Data SourcesSearches of PubMed, EMBASE, CINAHL, Scopus, and relevant Web sites without language restrictions from January 2000 to March 2019.Study SelectionStudies reporting nonprescription use of antibiotics, storage of antibiotics, intention to use antibiotics without a prescription, and factors influencing nonprescription use.Data ExtractionTwo reviewers independently screened citations and full texts and performed data abstraction.Data SynthesisOf 17 422 screened articles, 31 met inclusion criteria. Depending on population characteristics, prevalence of nonprescription antibiotic use varied from 1% to 66%, storage of antibiotics for future use varied from 14% to 48%, and prevalence of intention to use antibiotics without a prescription was 25%. Antibiotics were obtained without a prescription from various sources, including previously prescribed courses, local markets or stores, and family or friends. Reported factors contributing to nonprescription use included easy access through markets or stores that obtain antibiotics internationally for under-the-counter sales, difficulty accessing the health care system, costs of physician visits, long waiting periods in clinics, and transportation problems.LimitationScarce evidence and heterogeneous methods and outcomes.ConclusionNonprescription antibiotic use is a seemingly prevalent and understudied public health problem in the United States. An increased understanding of risk factors and pathways that are amenable to intervention is essential to decrease this unsafe practice.Primary Funding SourceNone.

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