International Journal of Clinical Pharmacy

, Volume 36, Issue 1, pp 86–91 | Cite as

Non-adherence to antibiotic therapy in patients visiting community pharmacies

  • Milene Fernandes
  • Andreia Leite
  • Maria Basto
  • Miguel Araújo Nobre
  • Nuno Vieira
  • Rui Fernandes
  • Paulo Nogueira
  • Paulo Jorge
Short Research Report


Background Patient non-adherence to antibiotic therapy may lead to therapeutic failure, re-infection, and bacterial resistance. Assessing the factors associated with this problem is important for promoting rational use of antibiotics. Objective This study aimed to measure prevalence and reasons for non-adherence to antibiotic treatment and to identify associated factors. Method Patients were recruited for the study in community pharmacies in Lisbon, Portugal, from February to April, 2009. Data from prescriptions for oral antibiotics were collected for adult subjects. Adherence to treatment was assessed with a modified Portuguese version of the Morisky scale. Factors associated with non-adherence were identified through bivariate analysis and logistic regression models. Results A total of 243 patients were included in the study. They had a mean age 46.5 ± 16.6 years and 74.5 % of the sample was female. The prevalence of non-adherence was 57.7 % and was related to delays and failures in taking the prescribed medicine. Increasing age (OR 0.97), difficulty in buying the antibiotic (OR 2.34), duration of treatment (OR 1.28), difficulty with ingestion (OR 3.08), and satisfaction with the information given by physician (OR 0.33) were identified as independent factors associated with non-adherence. Conclusion Non-adherence to antibiotics is common in the community setting. Factors related to the antibiotic, the patient, and the patient-physician relationship should be addressed to promote adherence. Pharmacists should provide information to patients about correct use of antibiotics and address barriers to adherence.


Antibiotics Bacterial resistance Community pharmacies Patient adherence Portugal 



Thanks are due to the participants and to the pharmacies that collaborated in the study, to the interviewers Inês Simões, Verónica Delgado and Maria Freitas, to Luís Caldeira and Fernando Fernandez-Llimos for additional comments on the article and to Yonah Yaphe for editorial assistance.


The study received a grant from the Merck, Sharp & Dohme Foundation (Portugal), with no influence on study design or data analysis.

Conflicts of interest

None to declare.


  1. 1.
    European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2011. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2012. ISBN 978-92-9193-398-3.Google Scholar
  2. 2.
    Goossens H, Ferech M, Vander Stichele R, Elseviers M, ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579–87.PubMedGoogle Scholar
  3. 3.
    Kardas P. Patient compliance with antibiotic treatment for respiratory tract infections. J Antimicrob Chemother. 2002;49:897–903.PubMedCrossRefGoogle Scholar
  4. 4.
    Pechere JC, Hughes D, Kardas P, Cornaglia G. Non-compliance with antibiotic therapy for acute community infections: a global survey. Int J Antimicrob Agents. 2007;29:245–53.PubMedCrossRefGoogle Scholar
  5. 5.
    Pechere JC. Patients’ interviews and misuse of antibiotics. Clin Infect Dis. 2001;33:S170–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Adriaenssens N, Coenen S, Versporten A, Muller A, Minalu G, Faes C, ESAC Project Group. European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe (1997–2009). J Antimicrob Chemother. 2011;66(Suppl 6):vi3–12.PubMedGoogle Scholar
  7. 7.
    Ramalhinho I, Ribeirinho M, Vieira I, Cabrita J. Evolution of outpatient antibiotic use in Portugal mainland 2000–2009. Acta Med Port. 2012;25(1):20–8.PubMedGoogle Scholar
  8. 8.
    Branco MJ, Nogueira PJ, Marinho Falcão JC, Melo M, Martins AP. Uses, misuses and abuses… Patient utilization of antibiotics. Lisboa: ONSA; 2000.Google Scholar
  9. 9.
    André M, Vernby A, Berg J, Lundborg CS. A survey of public knowledge and awareness related to antibiotic use and resistance in Sweden. J Antimicrob Chemother. 2010;65(6):1292–6.PubMedCrossRefGoogle Scholar
  10. 10.
    WHO. Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment, 2013. Oslo, 2012. ISBN: 978-82-8082-525-4.Google Scholar
  11. 11.
    WHO. International statistical classification of diseases and related health problems. 10th revision ed, 2010. Geneva; 2010. ISBN: 978-92-4-154834-2.Google Scholar
  12. 12.
    Delgado AB, Lima ML. Contribution to the concurrent validity of a measure of adherence to treatment. Psic Saúde Doenças. 2001;2(2):81–100.Google Scholar
  13. 13.
    Morisky DE, Lawrence WG, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74.PubMedCrossRefGoogle Scholar
  14. 14.
    Cals JW, Hopstaken RM, Le Doux PH, Driessen GA, Nelemans PJ, Dinant GJ. Dose timing and patient compliance with two antibiotic treatment regimens for lower respiratory tract infections in primary care. Int J Antimicrob Agents. 2008;31:531–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Vrijens B, Urquhart J. Patient adherence to prescribed antimicrobial drug dosing regimens. J Antimicrob Chemother. 2010;55:616–27.CrossRefGoogle Scholar
  16. 16.
    R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, 2012. ISBN: 3-900051-07-0,
  17. 17.
    Morris AB, Li J, Kroenke K, Bruner-England TE, Young JM, Murray MD. Factors associated with drug adherence and blood pressure control in patients with hypertension. Pharmacotherapy. 2006;26(4):483–92.PubMedCrossRefGoogle Scholar
  18. 18.
    Rolnick SJ, Pawloski PA, Hedblom BD, Asche SE, Bruzek RJ. Patient characteristics associated with medication adherence. Clin Med Res. 2013;11(2):54–65.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Lindenmeyer A, Hearnshaw H, Vermeire E, Van Royen P, Wens J, Biot Y. Interventions to improve adherence to medication in people with type 2 diabetes mellitus: a review of the literature on the role of pharmacists. J Clin Pharm Ther. 2006;31(5):409–19.PubMedCrossRefGoogle Scholar
  20. 20.
    Rubio-Valera M, Serrano-Blanco A, Magdalena-Belío J, Fernández A, García-Campayo J, Pujol MM, et al. Effectiveness of pharmacist care in the improvement of adherence to antidepressants: a systematic review and meta-analysis. Ann Pharmacother. 2011;45(1):39–48.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Milene Fernandes
    • 1
  • Andreia Leite
    • 1
  • Maria Basto
    • 1
    • 2
  • Miguel Araújo Nobre
    • 1
  • Nuno Vieira
    • 3
  • Rui Fernandes
    • 1
  • Paulo Nogueira
    • 1
    • 4
  • Paulo Jorge
    • 1
  1. 1.Faculty of Medicine, Institute of Preventive MedicineUniversity of LisbonLisbonPortugal
  2. 2.Medical DepartmentRottapharm|MadausLisbonPortugal
  3. 3.Internal Medicine DepartmentCentro Hospitalar do Barlavento AlgarvioPortimãoPortugal
  4. 4.General-Directorate of Health (DGS)LisbonPortugal

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