Objective: To estimate the extent, prevalence, and trends in non-prescription antibiotic use in Hungary between 2000 and 2004 at national and regional levels. To identify determinants of nonprescription antibiotic use.
Method: Data on non-prescription sales of systemic antibiotics (Anatomical Therapeutic Chemical (ATC) class J01) were analyzed over a five-year period. The 2004 version of the World Health Organisation ATC/defined daily dose (DDD) methodology was used to quantify antibiotic consumption. Non-prescription antibiotic sales were expressed as number of DDD per 1,000 inhabitants per day and as a percentage (%) of total antibiotic use. Further measurement units were introduced for better understanding of consumption and to seek an association between price, prescription antibiotic use, and non-prescription antibiotic use.
Results: During the study period nationwide non-prescription sales of antibiotics increased threefold and reached nearly 2% prevalence in 2004. Substantial interregional differences were detected in both the level and the share of non-prescription antibiotics sales. Ten drugs were responsible for 90% of non-prescription antibiotic sales in 2004 (doxycyline, co-amoxiclav, co-trimoxazole, penamecillin, ampicillin, amoxicillin, clindamycin, clarithromycin, norfloxacin, and cefuroxime); of these, doxycycline was the number one nonprescription antibiotic in all five years. A relationship was found between price and non-prescription antibiotic use (R = -0.732, P = 0.016).
Conclusion: Despite the prescription-only status of antibiotics in Hungary, non-prescription sales occur. A further increase in non-prescription sales of antibiotics could be prevented by strict law enforcement, price augmentation, and intervention focusing on pharmacist and the general public. More detailed studies are needed to identify other sources and causes of self-medication.