gms | German Medical Science

Introduction: Although using antibiotics is an established part of fighting bacterial infections it has also led to resistant pathogens, which pose a major threat to public health. Among others, one reason for the rising resistance is misuse by patients via self-medication (left-overs from previous prescriptions) or obtaining drugs without prescriptions, e.g. during travel. The German National Cohort (NAKO) is the largest German cohort aiming to investigate common diseases like cancer, diabetes, infections, and cardiovascular diseases. NAKO also collects data on drug treatments, including antibiotic use. We used data from NAKO to estimate how much antibiotic intake without prescription by a medical doctor can be detected.

Methods: We used a sample of 101,629 NAKO participants (approx. 50%) from 2014-2019 to analyze, how many individuals reported antibiotic intake and a visit to a physician in the last 12 months. And how many participants that reported an antibiotic intake in the last two months have been seen by a physician in the same time-frame, to estimate the proportion of antibiotics taken without recent prescription.

We linked physician visits in the last twelve respective two months, with antibiotic use in the last twelve or last two months respectively. We used Stata/BE 18.0.

Results: Out of the 101,629 NAKO participants, 81,514 participants answered the questions on physician visits and antibiotic use in the last 12 months and 5,047 for the last two months.

If investigating reports for the last 12 months, 71,590 participants (87.8%) reported a physician visit in this period, and 30,544 participants (37.5%) reported having taken antibiotics. Of note, 5.3% (1,619/30,544) reported having taken antibiotics but no visit to a physician.

If investigating reports for the last two months, 3,202 (63.4%) reported at least one physicians visit and 389 participants (7.7%) reported having taken antibiotics. Of these, 40 participants (10.3%) reported not having seen a physician during this period.

Conclusions: The NAKO’s large, population-based sample is suited for identification of trends in health care. The results show a widespread use of healthcare services and antibiotics. Our analysis points to possible cases of self-medication. These results emphasize the need for further research on antibiotic use and align with those of the Eurobarometer report, which indicates that in the last 12 months 5% of individuals took antibiotics without a prescription by a physician in 2016. Further investigations should include assessment of determinants of these behaviours and include routine data linked to population-based data.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.