ABSTRACT
OBJECTIVE: Stewardship efforts within institutions are commonplace, but fewer programs exist in community health care settings. Existing efforts focus on improving appropriate prescribing; however, clinicians must consider the use of antibiotics without a prescription as a contributor to antibiotic resistance. The objective of this article is to report observed methods of antibiotic self-prescription within the United States. DATA SOURCES: A Medline search was conducted to identify stewardship efforts within the community health care setting. The authors visited nonpharmacy locations and performed Internet searches to assess the feasibility of acquiring antibiotics without a prescription. Nonpharmacy locations within Nashville, TN, were visited in 2016. SUMMARY: Published literature, patient interactions, experiences at markets and pet stores, and Internet searches confirmed the availability of antibiotics without a prescription. Thirteen antimicrobial agents were found locally, and 31 additional agents were available via Internet sources. Literature searches revealed a lack of any completed research specific to self-prescribing and acquisition of antibiotics in the community setting or its effect on antibiotic resistance. CONCLUSION: Combating antibiotic resistance in the community setting presents unique challenges. Further research is necessary to determine the impact of self-prescription on patients' outcomes. When designing a community stewardship program, patients' ability to self-prescribe antibiotics should be taken into account and addressed.