Our results showed that the prevalence of self-medication with antibiotics in rural population in southern Greece was high. Our results are comparable to those of Jordan were 46% of patients reported antimicrobial self-medication . However, antimicrobial drug self-medication prevalence varies widely among different European regions. Studies in Denmark and Spain showed that self drug consumption was 3% and 11% respectively [14, 15]. In Malta and Lithuania the prevalence of self-medication was 19% and 22% respectively [7, 16]. A prospective survey of emergency department patients in the USA established that 17% of patients had taken leftover antibiotics without consulting a physician, most commonly for a cough (11%) or sore throat (42%) . A recent study in Europe reported that Greece had one of the highest outpatient antibiotic uses in Europe with cephalosporins and macrolides being the most frequently used antibiotics .
Substantial variation in the prevalence rates of antimicrobial drug self-medication among the European regions suggests that socioeconomic factors play a role, as do disparities in health care systems such as reimbursement policies, access to health care, and drug dispensing policies . Another factor is the acquisition of antimicrobial drugs from pharmacies without prescription, which occurred most frequently in eastern and southern European countries .
Although most of the responsibility regarding inappropriate antibiotic use belongs to the physicians' prescribing practices, several studies found that patients, too, contribute to inappropriate antibiotic usage [15, 18]. Self-medication with antibiotics is possible via several sources: a) they are legally available over the counter, b) antibiotics initially prescribed by physicians are saved and subsequently used without medical consultation, c) antibiotics are obtained through friends or relatives, and d) they can be acquired via Internet [15, 18].
In the present study the major source of self-medication was the pharmacy. It must be mentioned that in Greece law still allows patients to obtain antibiotics from the pharmacists without any medical prescription. A study by Contopoulos-Ioannidis et al., reported that 77% of Greek pharmacists offered antibiotics without a medical prescription . The same study showed that most of pharmacists offered expensive broad-spectrum antibiotics. Antibiotics were most frequently offered for treatment of patients with symptoms that were suggestive of a common cold .