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Background Antimicrobial self-medication is common in most low and middle income countries (LMICs). However there has been no systematic review on non-prescription antimicrobial use in these settings. This review thus intended to establish the burden, risk factors and effects of antimicrobial self-medication in Low and Middle Income Countries. Methods In 2012, we registered a systematic review protocol in PROSPERO (CRD42012002508). We searched PubMed, Medline, Scopus, and Embase databases using the following terms; “self-medication”, “non-prescription”, ‘self-treatment’, “antimicrobial”, “antimalarial”, “antibiotic”, “antibacterial” “2002-2012” and combining them using Boolean operators. We performed independent and duplicate screening and abstraction of study administrative data, prevalence, determinants, type of antimicrobial agent, source, disease conditions, inappropriate use, drug adverse events and clinical outcomes of antibiotic self-medication where possible. We performed a Random Effects Meta-analysis. Results A total of thirty four (34) studies involving 31,340 participants were included in the review. The overall prevalence of antimicrobial self-medication was 38.8 % (95 % CI: 29.5-48.1). Most studies assessed non-prescription use of antibacterial (17/34: 50 %) and antimalarial (5/34: 14.7 %) agents. The common disease symptoms managed were, respiratory (50 %), fever (47 %) and gastrointestinal (45 %). The major sources of antimicrobials included, pharmacies (65.5 %), leftover drugs (50 %) and drug shops (37.5 %). Twelve (12) studies reported inappropriate drug use; not completing dose (6/12) and sharing of medicines (4/12). The main determinants of antimicrobial self-medication include, level of education, age, gender, past successful use, severity of illness and income. Reported negative outcomes of antimicrobial self-medication included, allergies (2/34: 5.9 %), lack of cure (4/34: 11.8 %) and causing death (2/34: 5.9 %). The commonly reported positive outcome was recovery from illness (4/34: 11.8 %). Conclusion The prevalence of antimicrobial self-medication is high and varies in different communities as well as by social determinants of health and is frequently associated with inappropriate drug use.

More and more elderly people with cancer are treated in oncology clinics worldwide every year, many of whom have comorbid disorders treated with one or more drugs. Moreover, these patients might also take self-prescribed over-the-counter drugs or complementary and alternative medicines, which they might not tell their doctor about. Initiation of chemotherapy with one or more cytotoxic or targeted agents and drugs for treatment of cancer symptoms or toxic effects related to treatment can result in polypharmacy. We examine the clinical implications of polypharmacy. Challenges for the medical teams who treat elderly patients with cancer include identification of what drugs are actually being taken by the patient, avoidance or management of any adverse effects or drug interactions, and reassessing the patient's overall treatment. We address these issues and propose practical recommendations for management of treatment for elderly patients with cancer.

In much of the world antimicrobial drugs are sold without prescription or oversight by health-care professionals. The scale and effect of this practice is unknown. We systematically reviewed published works about non-prescription antimicrobials from 1970–2009, identifying 117 relevant articles. 35 community surveys from five continents showed that non-prescription use occurred worldwide and accounted for 19–100% of antimicrobial use outside of northern Europe and North America. Safety issues associated with non-prescription use included adverse drug reactions and masking of underlying infectious processes. Non-prescription use was common for non-bacterial disease, and antituberculosis drugs were available in many areas. Antimicrobial-resistant bacteria are common in communities with frequent non-prescription use. In a few settings, control efforts that included regulation decreased antimicrobial use and resistance. Non-prescription antimicrobial and antituberculosis use is common outside of North America and northern Europe and must be accounted for in public health efforts to reduce antimicrobial resistance.

Background Although over the counter (OTC) drugs are believed to be relatively safe, their inappropriate use could have serious implications. The aim of the study was to assess the practice of self-medication, prevalence of risky practice and its associated factors in pharmacy outlets of Asmara, Eritrea. Methods A descriptive cross-sectional study was conducted among 609 customers in 20 pharmacy outlets in Asmara between August and September, 2017. Two-stage cluster sampling was employed and data were collected using a structured questionnaire through face to face exit interviews. Descriptive statistics and multivariate logistic regression were performed using SPSS (version 22). Results Of the 609 customers, 93.7% had practiced self-medication with OTC drugs; of which 81.8% were at risky practice. On average, each participant was using OTC drugs at least once a month (Median = 1, IQR = 3.67). Educational level ( p  < 0.0001), religion ( p  = 0.047), occupation ( p  = 0.027) and knowledge regarding OTC drugs ( p  = 0.019) were significantly associated with risky practice. Respondents with elementary and below educational level were fifteen times (AOR = 15.49, CI: 1.97, 121.80) at higher risk compared to those with higher education, and students were almost three times (AOR = 2.96, CI: 1.13, 7.73) at higher risk than governmental employees. Furthermore, respondents with below average score in knowledge were more likely to be engaged in risky practice (AOR = 1.83, CI: 1.11, 3.04) compared to those with above average score. The most frequently preferred OTC drug group was analgesics (34.3%) followed by antipyretics (15.7%) and cough and cold preparations (14.2%). About 14% of the respondents admitted that they had taken more than the recommended dose and 6.9% had experienced drug related problems following the consumption of OTC drugs. Always, 35% of the respondents read package insert(s) and 73.9% check expiry dates while purchasing OTC drugs. Refrigerating OTC drugs, where it is not recommended, was also one of the prominent risky practices. Conclusions This study revealed that inappropriate self-medication practice with OTC drugs was prevalent requiring early intervention to minimize the risks.

Access to medicines without prescription is a major contributing factor for self-medication practices. This study was designed to examine the ratio of non-prescribed medicines sales and self-medication practices in Punjab, Pakistan. This study also evaluates the reasons for self-medication within its communities. An observational study was conducted in 272 systemically selected pharmacies to analyze medicines-related sales, with or without prescription. A cross-sectional survey was performed between June 2015 and November 2016. Consumers were interviewed about their self-medication practices. Of the pharmacies surveyed, 65.3% participated in the study. A total of 4348 medicines were purchased for self-medication by 3037 consumers (15.2% of all study participants), of which 873 (28.7%) participated in an interview. Majority (81.2%) medicine purchaser, (90.9%) interview participants, and (59.4%) drug users were male. On average, each community pharmacy sold 7.9 medicines without prescription each day, to an average of 5.5 customers. Many participants (28.9%) had matriculation in their formal education. The medicines most often sold for self-medication were analgesics and antipyretics(39.4%). More than 25% of participants reported fever symptoms and 47.8% assumed their illness was too trivial to consult a doctor. Media advertisements were the most common source of information for participants (46.7%). Many types of medicines were often sold without prescription from community pharmacies. Self-medication was common practice for a wide range of illnesses. Pakistan also needs effective implementation of policies to monitor medication sales. Public education about rational medication and limits to advertising medicine are very necessary.

Analgesics and anti-inflammatory drugs represent the largest segment of over-the-counter (OTC) medicines. This observational study involved 247 patients treated for pain in outpatient physiotherapy. Using Transcutaneous Electrical Nerve Stimulation (TENS) sensitivity threshold was measured together with subjective sensation (hedonic rating), investigating the impact of OTC analgesic intake on sensory sensitivity and subjective perception. Additionally, the influence of sex, age, height, and body mass index (BMI) on sensitivity threshold was assessed. Sensory threshold was significantly affected by age (B = 0.04, % variance = 5.84, p  < 0.001), BMI (B = 0.22, % variance = 5.71, p  = 0.001), and use of OTC analgesics up to 8 h beforehand (B = 0.83, % variance = 3.87, p  = 0.001). The OTC drugs with the strongest effect on sensory threshold were Ibuprofen 400 mg (B = 0.91, % variance = 3.01, p  = 0.003). Compared to individuals who did not use pain medication and predominantly experienced the stimulus as pleasant (53.37%), those who had taken analgesics more frequently reported a neutral perception of TENS stimulation (65.22%) and exhibited higher sensory thresholds. These findings suggest that OTC analgesics may alter neurosensory responses, highlighting a potential interaction not previously considered in standard pharmacological information. Further double-blind controlled trials are warranted to validate these observations and elucidate underlying mechanisms.

The Italian COPD Patient Association (Associazione Pazienti BPCO) conducted an online survey among its 2814 members with COPD to investigate the reasons for the widespread use of mucolytic therapies by patients, often including self-prescription using over the counter (OTC) alternatives. After consulting with several respiratory specialists, the Association's steering committee developed a list of nine questions with possible answers that was posted on the website of the Association. The survey was open to all members of the Association, with responses to be e-mailed to the Association. Approximately 78% the 502 participants surveyed reported having used mucolytics in the previous six months, with 54.5% using prescribed medications and 23.5% opting for OTC medications. Usage patterns revealed that 43.4% utilized mucolytics during episodes of excessive mucus, while 35.5% used them regardless of the presence of mucus. In terms of formulation preferences, water-soluble granulated sachets (34.9%) and effervescent/dispersible tablets (22.8%) were the most preferred, followed by capsules (14.1%) and aerosol ampoules (11.2%). The factors influencing these preferences were the hydration benefits of sachets and tablets, the portability and taste advantages of capsules, and the swallowing difficulties of aerosol formulations. The data showed that 26.5% of survey participants consumed the entire contents of the prescribed or OTC package, while 19.9% utilised it for a minimum of 10 days, 31.5% for a period between 5 and 10 days, and 10.2% for less than 5 days. Cost was cited as a reason for discontinuation by 8.3% of participants. Notably, 29.5% of respondents believed that mucolytic efficacy was dependent on the amount of mucus. Most patients (66.3%) used mucolytics at home, and 57.4% took the medication once daily and 24.3% twice daily. Additionally, 41.8% were aware of the dual antioxidant and mucolytic properties of the medication. These findings emphisise the need for a patient-centred approach, encouraging healthcare providers to consider individual preferences and offer personalised advice that has the potential to improve adherence and overall outcomes for COPD patients.

The availability of over-the-counter (OTC) proton pump inhibitors (PPIs) for the short-term (2 weeks) management of frequent heartburn (≥2 days/week) has increased markedly, yet evidence-based recommendations have not been developed. A panel of nine international experts in gastroesophageal reflux disease developed consensus statements regarding the risks and benefits of OTC PPIs using a modified Delphi process. Consensus (based on ≥80% approval) was reached through multiple rounds of remote voting and a final round of live voting. To identify relevant data, the available literature was searched and summarized. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system terminology was used to rate the quality of evidence and strength of recommendations; consensus was based on ≥2/3 agreement. After 4 rounds of review, consensus was achieved for 18 statements. Notably, the available data did not directly reflect OTC use, but instead, prescription use; therefore, extrapolations to the OTC setting were often necessary. This limitation is regrettable, but it justifies performing this exercise to provide evidence-based expert opinion on a widely used class of drugs. The panel determined that using OTC PPIs according to label instructions is unlikely to mask the symptoms of esophageal or gastric cancer or adversely impact the natural history of related precursor conditions. OTC PPIs are not expected to substantially affect micronutrient absorption or bone mineral density or cause community-acquired pneumonia, Clostridium difficile infection, or cardiovascular adverse events. However, OTC PPI use may be associated with slightly increased risks for infectious diarrhea, certain idiosyncratic reactions, and cirrhosis-related spontaneous bacterial peritonitis. The available evidence does not suggest that OTC PPI use consistent with label instructions is associated with substantial health risks. To minimize potential risks, healthcare professionals and consumers must actively participate in decision making when managing reflux-related symptoms in the self-care setting.

Objectives To compare the efficacy and safety of single versus combination non-prescription oral analgesics in community-derived people aged 40 years and older with chronic knee pain. Methods A randomised, double-blind, four-arm, parallel-group, active controlled trial investigating short-term (day 10) and long-term (week 13) benefits and side-effects of four regimens, each taken three times a day: ibuprofen (400 mg); paracetamol (1000 mg); one fixed-dose combination tablet (ibuprofen 200 mg/paracetamol 500 mg); two fixed-dose combination tablets (ibuprofen 400 mg/paracetamol 1000 mg). Results There were 892 participants (mean age 60.6, range 40–84 years); 63% had radiographic knee osteoarthritis and 85% fulfilled American College of Rheumatology criteria for osteoarthritis. At day 10, two combination tablets were superior to paracetamol (p<0.01) for pain relief (determined by mean change from baseline in WOMAC pain; n=786). At 13 weeks, significantly more participants taking one or two combination tablets rated their treatment as excellent/good compared with paracetamol (p=0.015, p=0.0002, respectively; n=615). The frequency of adverse events was comparable between groups. However, by 13 weeks, decreases in haemoglobin (≥1 g/dl) were observed in some participants in all groups. Twice as many participants taking two combination tablets had this decrease compared with those on monotherapy (p<0.001; paracetamol, 20.3%; ibuprofen, 19.6%; one or two combination tablets, 24.1%, 38.4%, respectively). Conclusions Ibuprofen/paracetamol combination analgesia, at non-prescription doses, confers modest short-term benefits for knee pain/osteoarthritis. However, in this population, paracetamol 3 g/day may cause similar degrees of blood loss as ibuprofen 1200 mg/day, and the combination of the two appears to be additive. Study no ISRCTN77199439

Professional guidelines advise against regular or long-term NSAID use in most patients with chronic kidney disease (CKD), heart failure (HF), and hypertension (HTN) due to risk of adverse events. Nevertheless, over-the-counter (OTC) NSAIDs are broadly accessible and frequently used among this population. Efforts to decrease high-risk OTC NSAID use have the potential to improve safety and reduce chronic disease burden. This randomized controlled trial evaluated the effectiveness of a brief, electronically-administered educational video in reducing high-risk OTC NSAID use. Adult participants with CKD, HF, and/or HTN who self-identified as regular NSAID users (≥3 times/week for 3 months) were invited to participate. Participants (n = 425) were randomized to either view an electronically-administered educational video informed by the COM-B behavioral change model (VIDEO, n = 223) or the FDA Drug Facts label for NSAIDs (CONTROL, n = 202). Intent to decrease OTC NSAIDs was evaluated via 11-point contemplation ladder immediately and 4 weeks post-intervention, with self-reported NSAID Exposure assessed at 4 weeks. We also evaluated current and recent pain levels at baseline and 4 weeks. Intent to decrease OTC NSAID use (4.28 (SD: 3.45) ladder rungs) and NSAID exposure (20.14 (SD: 13.66) dose-days per month) did not differ between groups at baseline. Intent to decrease OTC NSAID use increased more from baseline to immediately post-intervention in VIDEO vs. CONTROL (1.32 (SD: 2.80) vs. 0.55 (SD: 1.99) rungs, p < 0.001), with greater improvements for those with lower baseline intent. VIDEO and CONTROL were associated with a similar rise in intent to decrease OTC NSAID use (1.92 (SD: 4.41) vs. 1.36 (SD: 3.46), p = 0.150) and a similar decrease in NSAIDs exposure (−32.8% in VIDEO and −36.5% in CONTROL, p = 0.520) 4 weeks post-intervention. Pain levels did not differ between groups. Results suggest that a low-burden, electronically-administered intervention reduce high-risk medication use among patients with CKD, HF, and/or HTN.