Most studies of antibiotic use rely on information from prescriptions written in primary care settings, therefore the actual use of antibiotics within households (a community perspective) may be under-reported. A survey among inner city predominately Hispanic households of one neighborhood was conducted to determine self-reported illness symptoms, prevalence, and factors associated with antibiotic use. Eligible households had at least three members and at least one preschool child. One member, usually the mother, participated in a one-hour interview in Spanish (at the participant’s choice). Trained interviewers had to verify reported antibiotic use with the specific name of the product or inspection of the container.

Among the 2743 household members in the 631 households, one-third experienced symptoms associated with infection within the past month.  The most common symptoms were respiratory (69% - runny nose, cough, or sore throat), gastrointestinal (15% - vomiting or diarrhea), fever (13%), and skin infections (3%).  About half (48%) sought medical care, and 39% used an antibiotic. Those with respiratory symptoms or fever were more likely to seek care and take antibiotics.  Those who spent more time out of the house (40 or more hours/week) were less likely to have infection symptoms.

In order to prevent underreporting, this survey did not inquire if an antibiotic was prescribed.  Some respondents reported sharing medication among family or friends, and some were not able or willing to produce a container; interviewers could tell from available containers that some were not prescribed for the person/condition. The neighborhood had shops which sold over-the-counter antibiotics.  The prevalence of antibiotic use for symptoms usually associated with viral infections suggests continuing overuse despite increased education of providers and the public about the risks of developing antibiotic resistance.  Public health education on appropriate use of antibiotics must be distributed in the language of the community, especially for persons from countries where such are available without prescription.

(Larson E, Lin S and Gomez-Duarte C. Emerg Infect Dis 2003;9(9):1096-1102.)

Comment:  What a terrific topic for back-to-school health information to orient families who are recent immigrants to safer health care practices. --J.O.