Background Antibiotic resistance is a growing problem worldwide. It has considerable implications on societies’ health and resources. However, there has been no systematic review on non-prescription antibiotics in Middle Eastern (ME) countries.

Purpose To review relevant studies published in ME countries to establish the prevalence, possible causes and clinical outcomes of self-medication with antibiotics (SMA) and identify recommendations to reduce irrational use of antibiotics.

Material and methods Databases (PubMed, Scopus, ProQuest, Web of Science) were searched for peer reviewed research published between January 2000 and June 2016 on SMA among adults aged ≥18 years living in the ME. A hand search for relevant citations and key journals was also performed. Articles were scrutinised for country of origin, sample size, recall period, prevalence rate, determinants and possible causes of SMA, type of antibiotic, source of supply, indication for SMA, inappropriate use, source of drug information, clinical outcomes and recommendations to address the problem where possible.

Results 22 studies were found. The prevalence of SMA ranged from 19% to 82%. Age, gender, educational and income levels were the main determinants of SMA. The reasons for SMA varied across studies. Sociocultural, economic and regulatory factors were the most commonly cited reasons for SMA. Penicillins were the antibiotics most commonly used; the antibiotics were obtained mainly via stored leftover drugs at home, pharmacies/drug stores without prescriptions and friends/relatives. SMA was mainly for sore throat, fever and respiratory problems, such as cold/flu and cough. The primary sources of drug information and recommendations included relatives/friends and previous successful experience with the same antibiotic. Inappropriate drug use such as incorrect indication, short and long duration of treatment, exchange/sharing of antibiotics, and storing antibiotics at home for use at a later time were reported. Negative and positive outcomes of SMA were identified. Some recommendations were made based on the problems that were found, but these were not evaluated.

Conclusion The prevalence of SMA is high in ME countries. Thus we have to understand the links between different factors promoting SMA and assess the changing trend in order to help us derive strategies aimed at reducing drug related health risks among the ME population.

No conflict of interest