When you get sick and feel like you need an antibiotic, do you drive to urgent care or call your doctor?

Or do reach into your medicine cabinet for leftover medication or find your favorite online pharmacy?

If it’s the latter, you’re not alone.

Many people hoard their extra medications, saving them for a rainy day, or order them online to avoid a costly trip to the doctor.

But taking antibiotics without a prescription is dangerous.

It’s not only a hazard for the people taking the medications, but it also encourages the development of antibiotic-resistant superbugs.

The reasons people save some of their antibiotics or take nonprescription ones is the subject of a new analysis published in the journal Annals of Internal Medicine.

By the numbers

If you go to a clinic or your doctor, you’re not likely to use a nonprescription antibiotic.

Only about 1 percent of people studied in the recent analysis were likely to do so, according to the researchers from the Baylor College of Medicine.

Meanwhile, other various studies have found people who store antibiotics for future use ranged from 14 to 48 percent of the population.

“Nonprescription antibiotic use is a seemingly prevalent and understudied public health problem in the United States,” the researchers wrote in a press release. “An increased understanding of risk factors and pathways that are amenable to intervention is essential to decrease this unsafe practice.”

Supercharging the superbugs

The most well-known danger of using unprescribed antibiotics is the hastening of the development of antibiotic-resistant “superbugs” which could limit the ability to treat even benign infections.

“Leftover antibiotics shouldn’t exist in the first place,” Dr. Alexis Halpern, an emergency medicine physician at NewYork-Presbyterian/Weill Cornell Medical Center, told Healthline. “Any prescribed antibiotic should be taken in its entirety. Otherwise, the bacteria that is being treated can develop resistance to it.”

“Think of it like you’re killing something with a poison and you think it’s dead, but it’s not yet,” she added. “Now that it’s become exposed to that poison, or antibiotic, it can grow stronger and might not be killed by it next time. This is how resistance happens.”

The cost of that resistance is high.

“In 2013, the U.S. Centers for Disease Control and Prevention (CDC) estimated that each year, 2 million infections caused by antimicrobial-resistant pathogens occur in the United States, resulting in 23,000 deaths,” said Dr. Ayo Moses, a family physician with CareMount Medical in New York.

But there are personal costs as well.

For instance, without a prescription you might not be sure that you’re taking the right antibiotic for a particular infection.

You also might be taking antibiotics when what you have isn’t an infection but a virus. Those can’t be treated with antibiotics.

“Antibiotics can cause a wide range of side effects,” said Christopher Hanifin, chair of the department of physician assistant, and assistant professor at Seton Hall University in New Jersey.

“These can include serious allergic reactions and even other infections, as antibiotics can kill off the population of beneficial bacteria in the body,” he told Healthline.

“When you receive a prescription from a provider, they will have discussed this possibility with you, and you have someone to call if you have questions. If you take leftover antibiotics, you may be on your own,” he said.

Ineffective antibiotics

Even if you do store antibiotics for future use, they might not work anyway.

“A stockpile of unused antibiotics around may lose potency fairly quickly,” Hanifin said. “This is especially true of many liquid antibiotics given to children which must be refrigerated and used promptly. Even antibiotic tablets may degrade fairly quickly given that people often store them in a medicine cabinet in a hot, humid bathroom.”

The problem of online or gray market antibiotics is similar. Without regulation and oversight, you can’t be sure that what you’re taking contains the ingredients it says it does.

“Gray market antibiotics are often expired, less effective, unregulated, use non-standard dosing, or aren’t manufactured for human use — all of which further drives antibiotic resistance,” said Dr. J.D. Zipkin, the associate medical director of GoHealth Urgent Care and a board-certified doctor of internal medicine and pediatrics.

“The right drug is needed for the right bug. When a patient guesses which antibiotic will help them, there’s a high likelihood that they will not get the correct treatment,” he told Healthline.

A local problem

If taking nonprescription antibiotics is ineffective and potentially dangerous, why do people do it?

In the United States it’s likely a combination of factors, including self-diagnosis, access to care, and the high cost of healthcare, experts say.

First is the “Dr. Google” problem, Dr. Halpern said. That is, people using the internet to determine their diagnosis and looking to treat it without a doctor’s consultation.

“Taking medication without the expertise to understand why specific medications are chosen or not is really dangerous and can cause other medical problems,” she said.

Then there’s cost and access. Whether you can afford a visit to the doctor, take the time off work, travel to a medical facility, and the cost of the prescription itself are all factors.

“A large portion of the cost of healthcare comes from the visit itself, not the antibiotics,” Dr. Zipkin said. “As a result, many patients can face large financial burdens compared to trying to diagnose and treat themselves. Patients, therefore, have an incentive to discontinue their course of antibiotics as soon as symptoms resolve and save the remainder, even though partial treatments can increase antibiotic resistance.”

A global problem

The issue of antibiotic misuse isn’t confined to the United States.

“Antibiotic resistance is a worldwide threat,” Zipkin said. “Many countries have no limitations on open-access antibiotics whatsoever, which drives inappropriate overuse and resistance. Other countries, like the United States, restrict access via prescriptions, but pressures on healthcare providers still allow for ongoing inappropriate prescribing habits.”

Ultimately, consumers may need better education and alternatives, and doctors might need to change some of their own habits.

Halpern agreed, but added that doctors should share some of the responsibility.

“Among many reasons, I believe lack of awareness on all sides takes the biggest fault in the upward trend of antibiotic misuse,” Dr. Moses said. “As a result of this, the CDC has instituted its ‘Be Antibiotics Aware‘ campaign, which is a national effort to help fight antibiotic resistance and improve antibiotic prescribing and use.”

“As a society, somehow we’ve also grown to think that any infection requires antibiotics,” Halpern said. “This is a complex issue. As a medical community, we seem to be stuck in a difficult cycle of overprescribing and worrying about under-treating.”

This article was originally published on Healthline.com