Healthcare System Distrust and Non-Prescription Antibiotic Use: A Cross-Sectional Survey of Adult Antibiotic Users

Brooke A. Hawkes, Sana M. Khan, Melanie L. Bell, Jill Guernsey de Zapien, Kacey C. Ernst, Katherine D. Ellingson

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Antibiotic resistance is a major public health concern driven by antibiotic overuse. Antibiotic stewardship programs are often limited to clinical settings and do little to address non-prescription antibiotic use in community settings. This study investigates the association between non-prescription antibiotic use and healthcare system distrust in the United States and Mexico. An online survey was deployed in the United States and Mexico with enhanced sampling through in-person recruiting in the border region. Non-prescription antibiotic use was defined as having bought or borrowed non-prescription oral or injectable antibiotics within the last 3 years. The survey included a previously validated 10-item scale to measure healthcare system distrust. Logistic regression was used to model the use of non-prescription antibiotics by the level of healthcare system distrust, adjusted for demographic characteristics and antibiotic knowledge. In total, 568 survey participants were included in the analysis, 48.6% of whom had used non-prescription oral or injectable antibiotics in the last 3 years. In the fully adjusted regression model, the odds of using non-prescription antibiotics were 3.2 (95% CI: 1.8, 6.1) times higher for those in the highest distrust quartile versus the lowest. These findings underscore the importance of community-based antibiotic stewardship and suggest that these programs are particularly critical for communities with high levels of healthcare system distrust.

Original languageEnglish (US)
Article number79
Issue number1
StatePublished - Jan 2023


  • antimicrobial resistance
  • antimicrobial stewardship
  • non-prescription antibiotic use
  • trust in healthcare system

ASJC Scopus subject areas

  • General Pharmacology, Toxicology and Pharmaceutics
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)
  • Biochemistry
  • Microbiology


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