Patterns and Determinants of Inappropriate Antibiotic Use in Injection Drug Users
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Inappropriate antibiotic use contributes to the emergence and spread of drug resistant infections. Though injection drug users are at increased risk for drug resistant infections, few studies have examined antibiotic use in this population.
To understand patterns and determinants of antibiotic use among injection drug users.
Five focus groups were conducted with 28 current injection drug users recruited from a syringe exchange program in Philadelphia and analyzed using the constant comparative method to identify emergent themes. Twenty-six participants also completed a written survey instrument.
Injection drug users reported frequent antibiotic exposure, with 12 of 26 participants reporting use of antibiotic medications at least once in the previous 30 days. Participants reported several patterns of antibiotic use that were potentially harmful, including delays in seeking medical care, failing to fill prescriptions, obtaining antibiotics from non-provider sources, and poor adherence to prescribed regimens. The major determinants of inappropriate antibiotic use were delayed recognition of severity of illness, reluctance to wait to be seen, previous mistreatment by providers, lack of insurance, prioritizing purchasing drugs of abuse over antibiotics, forgetting to take antibiotics because of distractions that accompany drug use, concerns about interactions between antibiotics and other substances, and an irregular diet. Additionally, injection drug users commonly misunderstood the concept of antibiotic resistance and equated it with tolerance.
Injection drug users reported potentially dangerous antibiotic use behaviors and described determinants of these behaviors. Outreach and educational interventions to improve antibiotic use should target high-risk populations, such as injection drug users, and consider their distinct antibiotic use behaviors and determinants.
- Tenover FC. Mechanisms of antimicrobial resistance in bacteria. Am J Med. 2006;119(6 Suppl 1):S3–10. discussion S62-70. CrossRef
- World Health Organization. Drug resistance threatens to reverse medical progress. Press Release. 2000;41.
- Grundmann H, Aires-de-Sousa M, Boyce J, Tiemersma E. Emergence and resurgence of meticillin-resistant Staphylococcus aureus as a public-health threat. Lancet. 2006;368(9538):874–85. CrossRef
- Kunin CM. Resistance to antimicrobial drugs–a worldwide calamity. Ann Intern Med. 1993;118(7):557–61.
- Weber SG, Gold HS, Hooper DC, Karchmer AW, Carmeli Y. Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients. Emerg Infect Dis. 2003;9(11):1415–22.
- Gonzales R, Wilson A, Crane LA, Barrett PH Jr. What’s in a name? Public knowledge, attitudes, and experiences with antibiotic use for acute bronchitis. Am J Med. 2000;108(1):83–5. CrossRef
- Corbett KK, Gonzales R, Leeman-Castillo BA, Flores E, Maselli J, Kafadar K. Appropriate antibiotic use: variation in knowledge and awareness by Hispanic ethnicity and language. Prev Med. 2005;40(2):162–9. CrossRef
- Mangione-Smith R, McGlynn EA, Elliott MN, McDonald L, Franz CE, Kravitz RL. Parent expectations for antibiotics, physician-parent communication, and satisfaction. Arch Pediatr Adolesc Med. 2001;155(7):800–6.
- Gonzales R, Corbett KK, Leeman-Castillo BA, et al. The “minimizing antibiotic resistance in Colorado” project: impact of patient education in improving antibiotic use in private office practices. Health Serv Res. 2005;40(1):101–16. CrossRef
- Steinman MA, Ranji SR, Shojania KG, Gonzales R. Improving antibiotic selection: a systematic review and quantitative analysis of quality improvement strategies. Med Care. 2006;44(7):617–28. CrossRef
- Metlay JP, Camargo CA Jr., MacKenzie T, et al. Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments. Ann Emerg Med. 2007;50(3):221–30. CrossRef
- Allison DC, Miller T, Holtom P, Patzakis MJ, Zalavras CG. Microbiology of upper extremity soft tissue abscesses in injecting drug abusers. Clin Orthop Relat Res. 2007;461:9–13.
- Miller M, Cespedes C, Vavagiakis P, Klein RS, Lowy FD. Staphylococcus aureus colonization in a community sample of HIV-infected and HIV-uninfected drug users. Eur J Clin Microbiol Infect Dis. 2003;22(8):463–9. CrossRef
- Charlebois ED, Bangsberg DR, Moss NJ, et al. Population-based community prevalence of methicillin-resistant Staphylococcus aureus in the urban poor of San Francisco. Clin Infect Dis. 2002;34(4):425–33. CrossRef
- Charlebois ED, Perdreau-Remington F, Kreiswirth B, et al. Origins of community strains of methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2004;39(1):47–54. CrossRef
- Saravolatz LD, Markowitz N, Arking L, Pohlod D, Fisher E. Methicillin-resistant Staphylococcus aureus. Epidemiologic observations during a community-acquired outbreak. Ann Intern Med. 1982;96(1):11–6.
- Miller LG, Perdreau-Remington F, Rieg G, et al. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med. 2005;352(14):1445–53. CrossRef
- Pan ES, Diep BA, Charlebois ED, et al. Population dynamics of nasal strains of methicillin-resistant Staphylococcus aureus–and their relation to community-associated disease activity. J Infect Dis. 2005;192(5):811–8. CrossRef
- Huang H, Cohen SH, King JH, Monchaud C, Nguyen H, Flynn NM. Injecting drug use and community-associated methicillin-resistant Staphylococcus aureus infection. Diagn Microbiol Infect Dis. 2008;60(4):347–50.
- Cherubin CE, Sapira JD. The medical complications of drug addiction and the medical assessment of the intravenous drug user: 25 years later.[see comment]. Ann Intern Med. 1993;119(10):1017–28.
- Gordon RJ, Lowy FD. Bacterial infections in drug users. N Engl J Med. 2005;353(18):1945–54. CrossRef
- Centers for Disease Control and Prevention. Soft tissue infections among injection drug users– San Francisco, California, 1996-2000. MMWR. 2001;50:381–4.
- Spijkerman IJ, van Ameijden EJ, Mientjes GH, Coutinho RA, van den Hoek A. Human immunodeficiency virus infection and other risk factors for skin abscesses and endocarditis among injection drug users. J Clin Epidemiol. 1996;49(10):1149–54. CrossRef
- Binswanger IA, Kral AH, Bluthenthal RN, Rybold DJ, Edlin BR. High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco. Clin Infect Dis. 2000;30(3):579–81. CrossRef
- Paydar KZ, Hansen SL, Charlebois ED, Harris HW, Young DM. Inappropriate antibiotic use in soft tissue infections. Arch Surg. 2006;141(9):850–854. discussion 855-6. CrossRef
- Lucas GM, Gebo KA, Chaisson RE, Moore RD. Longitudinal assessment of the effects of drug and alcohol abuse on HIV-1 treatment outcomes in an urban clinic. AIDS. 2002;16(5):767–74. CrossRef
- Carrieri MP, Chesney MA, Spire B, et al. Failure to maintain adherence to HAART in a cohort of French HIV-positive injecting drug users. Int J Behav Med. 2003;10(1):1–14. CrossRef
- Arnsten JH, Demas PA, Grant RW, et al. Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. J Gen Intern Med. 2002;17(5):377–81.
- Howard AA, Arnsten JH, Lo Y, et al. A prospective study of adherence and viral load in a large multi-center cohort of HIV-infected women. AIDS. 2002;16(16):2175–82. CrossRef
- Gebo KA, Keruly J, Moore RD. Association of social stress, illicit drug use, and health beliefs with nonadherence to antiretroviral therapy. J Gen Intern Med. 2003;18(2):104–11. CrossRef
- Berg KM, Demas PA, Howard AA, Schoenbaum EE, Gourevitch MN, Arnsten JH. Gender differences in factors associated with adherence to antiretroviral therapy. J Gen Intern Med. 2004;19(11):1111–7. CrossRef
- Neale J, Allen D, Coombes L. Qualitative research methods within the addictions. Addiction. 2005;100(11):1584–93. CrossRef
- Charmaz K. Grounded theory: objectivist and constructivist methods. In: Denzin NK, Lincoln YS, eds. Handbook of qualitative research. Thousand Oaks: Sage; 2000:509–35.
- Glaser BG, Straus AL. The discovery of grounded theory: Strategies for qualitative research. New York: Aldine de Gruyter; 1999.
- Boeje H. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant. 2002;36:391–409. CrossRef
- Vanden Eng J, Marcus R, Hadler JL, et al. Consumer attitudes and use of antibiotics. Emerg Infect Dis. 2003;9(9):1128–35.
- Kardas P, Devine S, Golembesky A, Roberts C. A systematic review and meta-analysis of misuse of antibiotic therapies in the community. Int J Antimicrob Agents. 2005;26(2):106–13. CrossRef
- Richman PB, Garra G, Eskin B, Nashed AH, Cody R. Oral antibiotic use without consulting a physician: a survey of ED patients. Am J Emerg Med. 2001;19(1):57–60. CrossRef
- Porter J, Metzger D, Scotti R. Bridge to services: drug injectors’ awareness and utilization of drug user treatment and social service referrals, medical care, and HIV testing provided by needle exchange programs. Subst Use Misuse. 2002;37(11):1305–30. CrossRef
- Neale J, Sheard L, Tompkins CNE. Factors that help injecting drug users to access and benefit from services: a qualitative study. Substance Abuse Treatment, Prevention, & Policy. 2007;2:31. CrossRef
- Carbon C. Costs of treating infections caused by methicillin-resistant staphylococci and vancomycin-resistant enterococci. J Antimicrob Chemother. 1999;44(Suppl A):31–6. CrossRef
- Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis. 2003;36(1):53–9. CrossRef
- Patterns and Determinants of Inappropriate Antibiotic Use in Injection Drug Users
Journal of General Internal Medicine
Volume 24, Issue 2 , pp 263-269
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- injection drug use
- Industry Sectors
- Author Affiliations
- 1. Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania School of Medicine, 1303-B Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- 2. Veterans Affairs Medical Center, Philadelphia, PA, USA
- 3. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- 7. Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
- 5. Department of Anthropology, University of Pennsylvania, Philadelphia, PA, USA
- 6. Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- 4. Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA