In the past ten years, the number of bacterial pathogens resistant to multiple antibiotics has dramatically increased. The emergence of resistant microorganisms is a direct product of the excessive use of antibiotics, as exposure to multiple antibacterial agents provides the selective pressure for the rise and spread of these pathogens.1 Studies have shown that the overuse of antibiotics is a consequence of the increased worldwide availability of these agents and the overprescription of antimicrobials when they are not necessary.1 This issue is particularly relevant in Latin American countries, where the use of antimicrobials is encouraged due to systematic and cultural factors.2 Given the increase in the numbers of Latino immigrants, it is important to examine their perceptions of medicine and antibiotic use in order to devise better strategies to control the rise of antimicrobial resistant pathogens—a major global public health problem.
Latin American countries have fewer restrictions on the sale of antimicrobial agents, and the existing laws regulating the prescription or retailing of these drugs are poorly enforced.3 This enables the self-diagnosing and self-medicating practices that many members of the Latino community are accustomed to. Furthermore, cultural beliefs and misconceptions regarding the purpose and function of antibiotics play a major role in their misuse among the Latino population. For example, a study showed that Latinos are more likely than non-Latino whites to believe that antibiotics are necessary for the treatment of their child’s illness, regardless of the disease process.4 Moreover, many patients fail to recognize the impact of self-medication with antibiotics on antibiotic resistance and how it can reduce the effectiveness of these treatments over the long term.2
These factors influence the way patients from the Latino population perceive the American medical system. A study evaluating the experiences of Latino adults in treating common infections in South Carolina described how many participants expressed frustration with the US health care system because it requires medical visits to obtain prescriptions for seemingly low-risk illnesses.2 The same study reported that patients believed that it was not worth the time and expense to obtain antibiotics through physician visits, as it was possible to acquire antibiotics through other means, including purchasing them at local stores without prescriptions and importing them from relatives.2 Another study investigating past and present behaviors of Latino immigrants regarding non-prescribed antibiotics conducted in South Carolina confirmed that health beliefs and practices instilled in their country of origin appeared to be maintained even after living in the US.3 Up to 30% of the participants believed that antimicrobial drugs should be available in the US without prescription.3 Furthermore, the study showed that 16% of the participants were able to import antibiotics into the US and 19% had purchased antibiotics in local stores without prescriptions.3
These findings are worrisome, as they demonstrate that Latino patients are vulnerable to misdiagnosis and mismanagement, since they are less likely to present to clinic for appropriate diagnosis and treatment.
Better strategies and interventions must be implemented in order to reduce self-medication with antibiotics in the Latino community if we want to control the growing epidemic of multidrug resistant pathogens worldwide. It is important to take into consideration the background preconceptions, beliefs, and practices that our patients bring to our offices, as they can affect their own health and the health of the community as a whole.
Daniela Rebollo Salazar is a 3rd-year medical student at NYU Langone Health
Peer reviewed by Michael Tanner, MD, Associate Editor, Clinical Correlations
Image courtesy of Wikimedia Commons
- Roca I, Akova M, Baquero F, et al. The global threat of antimicrobial resistance: science for intervention.New Microbes New Infect.2015;6:22-29. https://www.ncbi.nlm.nih.gov/pubmed/26029375
- Mainous AG 3rd, Diaz VA, Carnemolla M. Factors affecting Latino adults’ use of antibiotics for self-medication.J Am Board Fam Med. 2008;21(2):128-134. https://www.ncbi.nlm.nih.gov/pubmed/18343860
- Mainous AG 3rd, Cheng AY, Garr RC, Tilley BC, Everett CJ, McKee MD. Nonprescribed antimicrobial drugs in Latino community, South Carolina. Emerging Infect Dis. 2005:11(6):883-888. https://www.ncbi.nlm.nih.gov/pubmed/15963283
- Mangione-Smith R, Elliott MN, Stivers T, McDonald L, Heritage J, McGlynn EA. Racial/ethnic variation in parent expectations for antibiotics: implications for public health campaigns.Pediatrics. 2004;113(5):e385-e394. https://www.ncbi.nlm.nih.gov/pubmed/15121979