Journal of General Internal Medicine

, Volume 24, Issue 2, pp 263–269 | Cite as

Patterns and Determinants of Inappropriate Antibiotic Use in Injection Drug Users

  • Joanna L. Starrels
  • Frances K. Barg
  • Joshua P. Metlay
Populations at Risk



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.


antibiotics adherence injection drug use self-medication 



The authors would like to thank Katrina Armstrong, MD, MS, and Sandy Schwartz, MD, for conceptual development; Caitlin Loomis, Emily Mannes, and A. Robinson Williams for research assistance; Casey Cook, Melanie Sisemore, and others at Prevention Point Philadelphia; and the study participants. This project was supported by a pilot grant from the Leonard Davis Institute for Health Economics at the University of Pennsylvania. Additional support was provided by the Department of Veterans Affairs and the Robert Wood Johnson Foundation Clinical Scholars Program. This project was previously presented at the Robert Wood Johnson Foundation Clinical Scholars Program national meeting on November 2, 2006 and the Society of General Internal Medicine annual meeting on April 11, 2008.

Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Joanna L. Starrels
    • 1
    • 2
    • 3
    • 7
  • Frances K. Barg
    • 5
    • 6
  • Joshua P. Metlay
    • 1
    • 2
    • 3
    • 4
  1. 1.Robert Wood Johnson Clinical Scholars ProgramUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  2. 2.Veterans Affairs Medical CenterPhiladelphiaUSA
  3. 3.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  5. 5.Department of AnthropologyUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.Department of Family Medicine and Community HealthUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  7. 7.Division of General Internal MedicineAlbert Einstein College of Medicine and Montefiore Medical CenterBronxUSA

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