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Kunz Coyne AJ, Holger D, Kennedy E, Connell M, Binienda J, Giuliano C, Bailey EM. Penicillin allergy reassessment for treatment improvement: A dental office tool to support appropriate penicillin allergy labeling. J Am Dent Assoc 2024:S0002-8177(24)00055-2. [PMID: 38520419 DOI: 10.1016/j.adaj.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 03/25/2024]
Abstract
BACKGROUND Dental appointments offer an opportunity to evaluate a documented penicillin (PCN) allergy and determine whether the patient might be a candidate for medical reassessment of their allergy. The authors gathered feedback on the Penicillin Allergy Reassessment for Treatment Improvement (PARTI) tool, designed to enhance dentist-patient communications regarding PCN allergies. METHODS From January 2022 through May 2023, the authors conducted a mixed-methods study, collecting focus group data from patients with PCN allergies and surveying health care workers (HCWs) regarding the PARTI tool. Feedback focused on reassessment procedures, patient-centered allergy information, and medical records updates. Thematic analysis was used for focus group data. RESULTS The study included 15 patients in focus groups and 50 HCW survey respondents representing diverse US regions. Patient demographic characteristics included varied races, the mean age was 52 years, and most of the patients were female (53.3%). Most patients had health care interactions within the preceding year, at which 86.6% of patients were asked about drug allergies. HCW respondents primarily consisted of pharmacists (30%) and dentists, dental hygienists, and dental assistants (28%). Feedback on the PARTI tool was constructive, with both patients and HCWs recognizing its potential benefits and providing insights for improvement. Many HCWs (68%) highlighted the importance of step 3 of the PARTI tool, that is, the section on PCN allergy testing. Feedback from participants was incorporated into the final PARTI tool. CONCLUSIONS Patient and HCW feedback on the PARTI tool was used to finalize a tool for the dental office to provide to patients who are candidates for PCN allergy reassessment. The feedback will also be used to inform an upcoming pilot study in US dental offices, focused on the process for PCN allergy reassessment and health record documentation. PRACTICAL IMPLICATIONS Deploying the PARTI tool in dental offices is pivotal, as mislabeling patients with PCN allergies could have severe consequences, such as hindering the prescription of lifesaving antibiotics for conditions like endocarditis, in the future. This implementation not only enhances communication between dentists and patients, but it is also crucial for ensuring improved patient safety and maintaining accurate medical records among health care settings.
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Korkmaz P, Mıstanoğlu-Özatağ D, Paşalı-Kilit T, Toka O, Onbaşı K. Knowledge and Attitudes of Patients About the Rational Use of Antibiotics. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2024; 6:11-21. [PMID: 38633436 PMCID: PMC11019724 DOI: 10.36519/idcm.2024.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/14/2024] [Indexed: 04/19/2024]
Abstract
Objective Antimicrobial resistance can lead to morbidity and mortality in serious infections. Therefore, this study aimed to evaluate the knowledge and attitudes of patients admitted to the outpatient clinics of our hospital about the rational use of antibiotics. Materials and Methods Patients who applied to Infectious Diseases and Internal Diseases Polyclinics between August 01, 2021 and February 01, 2022 were included. After obtaining written consent from those who agreed to participate in the study, a face-to-face questionnaire was applied to evaluate their knowledge and attitudes about antibiotic use. Results A total of 735 patients were included in the study; 64.1% were women, and the mean age was 40±15 years. The median of the total correct score on the scale measuring the patients' knowledge level in the study was 5. It was determined that individuals who scored 5 or less did not have sufficient knowledge, and those who scored above 5 had sufficient knowledge. Female gender, being single, being a university graduate, and having a middle income were associated with sufficient knowledge level (p<0.05). The rates of self-starting or using antibiotics until the complaints subsided were higher in the group with insufficient knowledge (p<0.05). Conclusion The knowledge level of our patients regarding antibiotic use provided better results in all parameters, such as the number of visits to the doctor, self-starting antibiotics, using the antibiotic in the appropriate indication, and complying with the duration. The knowledge level was found to be associated with the appropriate antibiotic use.
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Affiliation(s)
- Pınar Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Kütahya Health Sciences University School of Medicine, Kütahya, Türkiye
| | - Duru Mıstanoğlu-Özatağ
- Department of Infectious Diseases and Clinical Microbiology, Kütahya Health Sciences University School of Medicine, Kütahya, Türkiye
| | - Türkan Paşalı-Kilit
- Department of Internal Medicine, Kütahya Health Sciences University School of Medicine, Kütahya, Türkiye
| | - Onur Toka
- Department of Bioistatics, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Kevser Onbaşı
- Department of Internal Medicine, Kütahya Health Sciences University School of Medicine, Kütahya, Türkiye
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Raihan MA, Islam MS, Islam S, Islam AFMM, Ahmed KT, Ahmed T, Islam MN, Ahmed S, Chowdhury MS, Sarker DK, Lamisa AB. Knowledge, attitudes, and practices regarding antibiotic use in Bangladesh: Findings from a cross-sectional study. PLoS One 2024; 19:e0297653. [PMID: 38346032 PMCID: PMC10861050 DOI: 10.1371/journal.pone.0297653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Escalating antibiotic resistance presents a notable worldwide dilemma, pointing a large involvement of general population. The objective of this study was to assess knowledge, attitudes, and practices regarding the utilization of antibiotics among Bangladeshi residents. METHODS A cross-sectional study, conducted from January 01 to April 25, 2022, included 1,947 Bangladeshi adults with a history of antibiotic use, via online surveys and face-to-face interviews using a pretested semi-structured questionnaire. Descriptive statistics, Chi-square tests, and multivariate linear regression models were employed. RESULTS Mean scores for knowledge, attitudes, and practices were 6.59±1.20, 8.34±1.19, and 12.74±2.59, with correct rates of 73.22%, 92.67%, and 57.91%. Positive predictors for knowledge included being unmarried (β = 0.10, p = 0.001), higher education (College: β = 0.09, p = 0.025; Bachelor: β = 0.22, p<0.001; Master or above: β = 0.14, p<0.001), various professions (student: β = 0.57, p<0.001; housewife: β = 0.33, p<0.001; employee: β = 0.53, p<0.001; businessman: β = 0.31, p<0.001; unemployed: β = 0.15, p<0.001), and residing in semi-urban (β = 0.32, p<0.001) or urban areas (β = 0.15, p<0.001). Positive predictors for attitudes included being married (β = 0.18, p<0.001), specific professions (student: β = 1.06, p<0.001; housewife: β = 0.33, p<0.001; employee: β = 0.86, p<0.001; businessman: β = 0.37, p<0.001; unemployed: β = 0.47, p<0.001), higher SES (Lower-middle: β = 0.22, p<0.001; Middle: β = 0.26, p<0.001), and residing in semi-urban areas (β = 0.18, p<0.001); negative predictors included higher education (College: β = -0.12, p = 0.001; Master or above: β = -0.09, p = 0.008) and being rich (β = -0.13, p<0.001). Positive predictors for practices included being married (β = 0.18, p<0.001), specific professions (student: β = 0.32, p<0.001; employee: β = 0.43, p<0.001; businessman: β = 10, p = 0.034; unemployed: β = 0.11, p = 0.009), and higher SES (Lower-middle: β = 0.14, p = 0.009; Middle: β = 0.38, p<0.001; Higher-middle: β = 0.15, p = 0.008); negative predictors included higher education (College: β = -0.21, p<0.001), being rich (β = -0.12, p<0.001), residing in semi-urban (β = -0.14, p<0.001) or urban areas (β = -0.16, p<0.001). CONCLUSIONS Participants exhibited adequate knowledge and positive attitudes but lagged behind in proper practice of antibiotic use. Proper initiatives should be tailored to enhance prudent antibiotic use and mitigate the risk of antimicrobial resistance.
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Affiliation(s)
- Md. Abu Raihan
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Md. Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, Bangladesh
| | - Shariful Islam
- Department of Microbiology, Noakhali Science & Technology University, Noakhali, Bangladesh
| | | | | | - Tania Ahmed
- Department of Pharmacy, Gono Bishwabidyalay, Savar, Dhaka, Bangladesh
| | - Md. Nahidul Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Shamsunnahar Ahmed
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | | | - Dipto Kumar Sarker
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Anika Bushra Lamisa
- Department of Biochemistry and Microbiology, School of Health and Life Science, North South University, Dhaka, Bangladesh
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Firdaus S, Sadaf F, Sharma SK, Prakash V, Tanweer MK, Kibria T. Examining the Perspectives and Attitudes Towards Antibiotic Use and Resistance Among the General Public in Muzaffarpur in Bihar, India. Cureus 2024; 16:e53938. [PMID: 38468979 PMCID: PMC10925818 DOI: 10.7759/cureus.53938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
Objective This study aimed to examine the current understanding and perspectives about the use of antibiotics among the general public living in the city of Muzaffarpur, Bihar, and the surrounding areas. Methodology A cross-sectional study was carried out from March 2023 to August 2023 in Muzaffarpur. Data was obtained through interviews based on a standardized questionnaire derived from a prior study. The findings were summarized using descriptive statistics, frequencies, and percentages, and then presented in tabular form. Results This study recruited 384 participants in total; the majority of them (n=200, 52.1%) were females, while the remaining 184 (47.9%) participants were males. Our findings revealed that 368 (96%) participants agreed on the necessity of prescribing distinct antibiotics for the treatment of various ailments. Nevertheless, the participants held divergent perspectives regarding the efficacy of antibiotics in treating coughs and colds, as well as their effectiveness against viruses and bacteria. Overall, 354 (92.1%) participants agreed with the importance of finishing the prescribed antibiotic regimen, and 335 (87.2%) agreed that people should refrain from retaining drugs for future use. Of note, 90% of the participants (n=346) stated that they did not think it was advisable to get antibiotics from friends and family without first consulting a doctor. Conclusion The current study documented a prevalent utilization of antibiotics among the study participants, with a significant proportion of these medications being obtained without a prescription. The respondents demonstrated a general lack of understanding, particularly concerning the significance of antibiotics in treating mild viral illnesses.
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Affiliation(s)
- Soofia Firdaus
- Department of Microbiology, Sheikh Bhikhari Medical College, Hazaribagh, IND
| | - Fnu Sadaf
- Department of Pathology, Nalanda Medical College, Patna, IND
| | - Sushant K Sharma
- Department of General Surgery, Sri Krishna Medical College, Muzaffarpur, IND
| | - Vishal Prakash
- Department of Pathology, Nalanda Medical College, Patna, IND
| | | | - Tauseef Kibria
- Department of General Surgery, Sri Krishna Medical College, Muzaffarpur, IND
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Sinuraya RK, Wulandari C, Amalia R, Puspitasari IM. Understanding Public Knowledge and Behavior Regarding Antibiotic Use in Indonesia. Infect Drug Resist 2023; 16:6833-6842. [PMID: 37908781 PMCID: PMC10614649 DOI: 10.2147/idr.s427337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/19/2023] [Indexed: 11/02/2023] Open
Abstract
Background Inappropriate use of antibiotics is a prominent factor contributing to the development of antibiotic resistance, which subsequently increases healthcare costs and heightens mortality rates. Objective This study sought to evaluate the level of knowledge and behavior pertaining to antibiotic usage within the Indonesian population. Methods This observational study was conducted in Indonesia between December 2019 and June 2020 and employed a validated questionnaire to survey 582 respondents. A comparative analysis was performed to investigate the differences in mean scores across various respondent characteristics, specifically related to their knowledge and practice regarding antibiotic usage. Regression analysis was used to identify the factors influencing the adoption of appropriate behavior in antibiotic utilization. Results Study participants comprised 68.2% males and 31.8% females. Participants achieved an average score of 4.86 ± 2.40 out of eight points for knowledge and behavior with an average score of 5.29 ± 1.85 out of seven points. Approximately 57.7% and 56.0% of the respondents have knowledge and behavior scores above the average score of the total population, respectively. The findings indicated notable variations in average knowledge scores associated with educational attainment and employment status regarding antibiotic use. Similarly, differences were observed in gender and employment status concerning behavior. Regression analysis highlighted that employment status, trust in physicians, and possessing sound knowledge of antibiotic usage were significant predictors of good behavior in utilizing antibiotics. Some misconceptions were identified, such as using antibiotics to kill viruses and believing antibiotics are effective for any kind of disease. Conclusion Less than 60% of the respondents have knowledge and behavior scores above the average score of the total population; however, there are some misconceptions regarding antibiotic utilization. This underscores the importance of implementing targeted strategies, such as health education and public health campaigns, to improve the population's understanding of the correct antibiotic use.
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Affiliation(s)
- Rano K Sinuraya
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Chalisma Wulandari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Riezki Amalia
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Irma M Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
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Nampoothiri V, Mbamalu O, Surendran S, Bonaconsa C, Pennel T, Boutall A, Gopal K, Castro Sanchez E, Dhar P, Holmes A, Singh S, Mendelson M, Tarrant C, Charani E. The elephant in the room: Exploring the influence and participation of patients in infection-related care across surgical pathways in South Africa and India. Health Expect 2023; 26:892-904. [PMID: 36721315 PMCID: PMC10010088 DOI: 10.1111/hex.13715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The irrational use of antibiotics is a leading contributor to antibiotic resistance. Antibiotic stewardship (AS) interventions predominantly focus on prescribers. This study investigated the influence and participation of inpatients in infection-related care, including antibiotic decision-making, within and across two tertiary hospitals in South Africa (Cape Town) and India (Kerala). METHODS Through ethnographic enquiry of clinical practice in surgical pathways, including direct nonparticipant observation of clinical practices, healthcare worker (HCW), patient and carer interactions in surgical ward rounds and face-to-face interviews with participants (HCWs and patients), we sought to capture the implicit and explicit influence that patients and carers have in infection-related care. Field notes and interview transcripts were thematically coded, aided by NVivo 12® Pro software. RESULTS Whilst observational data revealed the nuanced roles that patients/carers play in antibiotic decision-making, HCWs did not recognize these roles. Patients and carers, though invested in patient care, are not routinely involved, nor are they aware of the opportunities for engagement in infection-related decision-making. Patients associated clinical improvement with antibiotic use and did not consider hospitalization to be associated with infection acquisition or transmission, highlighting a lack of understanding of the threat of infection and antibiotic resistance. Patients' economic and cultural positionalities may influence their infection-related behaviours. In the study site in India, cultural norms mean that carers play widespread but unrecognized roles in inpatient care, participating in infection prevention activities. CONCLUSION For patients to have a valuable role in AS and make informed decisions regarding their infection-related care, a mutual understanding of their role in this process among HCWs and patients is crucial. The observed differences between the two study sites indicate the critical need for understanding and addressing the contextual drivers that impact effective patient-centred healthcare delivery. PATIENT OR PUBLIC CONTRIBUTION Ethnographic observations and interviews conducted in this study involved patients as participants. Patients were recruited for interviews after obtaining signed informed consent forms. Patients' identities were completely anonymized when presenting the study findings.
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Affiliation(s)
- Vrinda Nampoothiri
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Oluchi Mbamalu
- Department of Medicine, Division of Infectious Diseases & HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Surya Surendran
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.,Division of Health System and Equity, The George Institute for Global Health, New Delhi, India
| | - Candice Bonaconsa
- Department of Medicine, Division of Infectious Diseases & HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Timothy Pennel
- Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Adam Boutall
- Colorectal Unit, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Kirun Gopal
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Enrique Castro Sanchez
- School of Health Sciences, Division of Nursing, University of London, London, UK.,National Institute for Health and Care Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Puneet Dhar
- All India Institute of Medical Sciences, Rishikesh, India
| | - Alison Holmes
- National Institute for Health and Care Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Sanjeev Singh
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Marc Mendelson
- Department of Medicine, Division of Infectious Diseases & HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Esmita Charani
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.,Department of Medicine, Division of Infectious Diseases & HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,National Institute for Health and Care Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK.,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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Smith SS, Caliendo A, Cheng BT, Kern RC, Holl J, Linder JA, Cameron KA. Patient Perspectives on the Drivers and Deterrents of Antibiotic Treatment of Acute Rhinosinusitis: a Qualitative Study. J Gen Intern Med 2023; 38:683-690. [PMID: 36258155 PMCID: PMC9971408 DOI: 10.1007/s11606-022-07811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/13/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Antibiotics are prescribed in >80% of outpatient acute rhinosinusitis (ARS) visits, despite the low incidence of bacterial infection. Previous studies have shown patient expectations are the most robust predictor of antibiotics prescription in ARS. However, patient perceptions are not well known or understood. OBJECTIVE To understand patient perceptions regarding what drives or deters them from wanting, seeking, and taking antibiotic treatment of ARS. DESIGN Iterative thematic analysis of semi-structured interviews. PARTICIPANTS Nineteen adults diagnosed with ARS within the prior 60 days at the Northwestern Medicine General Internal Medicine clinic in Chicago, IL. MAIN MEASURES Perceptions of patients with ARS. KEY RESULTS We interviewed 19 patients, identifying the following drivers of antibiotic use: (1) symptoms, especially discolored rhinorrhea, and seeking relief, (2) belief that antibiotics are a convenient and/or effective way to relieve/cure sinusitis, and (3) desire for tangible outcomes of a clinic visit. For deterrents, the following themes emerged: (1) concern about antibiotic resistance, (2) preference for other treatments or preference to avoid medications, and (3) desire to avoid a healthcare visit. Patients identified that a trustworthy physician's recommendation for antibiotics was a driver, and a recommendation against antibiotics was a deterrent to taking antibiotics; a delayed antibiotic prescription also served as a deterrent. Antibiotic side effects were viewed neutrally by most participants, though they were a deterrent to some. CONCLUSIONS Patients have misconceptions about the indications and effectiveness of antibiotics for ARS. Intimate knowledge of key antibiotic drivers and deterrents, from the perspective of patients with ARS, can be leveraged to engage and increase patients' knowledge, and set appropriate expectations for antibiotics for ARS.
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Affiliation(s)
- Stephanie Shintani Smith
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Anne Caliendo
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian T Cheng
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert C Kern
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane Holl
- Department of Neurology, Biological Sciences Division, University of Chicago, Chicago, IL, USA
- Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL, USA
| | - Jeffrey A Linder
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kenzie A Cameron
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Impact of the COVID-19 Outbreak on the Antibiotic Use Patterns among a Rural Community Population in Eastern China. Antibiotics (Basel) 2022; 11:antibiotics11111544. [PMID: 36358199 PMCID: PMC9686520 DOI: 10.3390/antibiotics11111544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
There are growing concerns that the coronavirus disease of 2019 (COVID-19) pandemic may change antibiotic use patterns and accelerate antibiotic resistance, but evidence from the community level is lacking. This study aims to estimate the impact of the COVID-19 outbreak on the antibiotic use patterns among a community population in Eastern China. A self-administered medicine diary was used to collect information on antibiotic use from July 2019 to June 2021 among a rural community in Eastern China. We analyzed the changes in antibiotic use patterns over five months from August to December 2019 and the corresponding months in 2020. The risk of antibiotic use and its changes were measured with the incidence rate (IR) and relative risk (RR). In total, 1111 participants were eligible for the final analysis (440 in 2019 and 671 in 2020). After the COVID-19 outbreak, antibiotic use increased by 137% (5.43 per 100 person months in the 2019 vs. 12.89 per 100 person months in the 2020), and after the adjustment of covariates, the adjusted RR was 1.72 (95% CI: 1.10~2.34). It was higher among those who were women (RR = 2.62), aged 35−59 years old (RR = 2.72), non-farmers (RR = 2.75), had less than six years of education (RR = 2.61), had an annual household income over CNY 100,000 (USD 14,940) (RR = 2.60), and had no history of chronic diseases (RR = 2.61) (all p < 0.05). The proportion of cephalosporins consumed increased from 54.29% in 2019 to 64.92% in 2020 (p = 0.011). Among those aged 35 years and older, the proportion of antibiotics obtained from medical facilities increased, while the proportion obtained from retail pharmacies, homes, and other sources decreased (all p < 0.05). The COVID-19 outbreak changed antibiotic use patterns in this study population (Eastern China) significantly. More efforts to monitor and enhance antibiotic stewardship activities at the community level are needed in future.
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Liu E, Linder KE, Kuti JL. Antimicrobial Stewardship at Transitions of Care to Outpatient Settings: Synopsis and Strategies. Antibiotics (Basel) 2022; 11:antibiotics11081027. [PMID: 36009896 PMCID: PMC9405265 DOI: 10.3390/antibiotics11081027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023] Open
Abstract
Inappropriate antibiotic use and associated consequences, including pathogen resistance and Clostridioides difficile infection, continue to serve as significant threats in the United States, with increasing incidence in the community setting. While much attention has been granted towards antimicrobial stewardship in acute care settings, the transition to the outpatient setting represents a significant yet overlooked area to target optimized antimicrobial utilization. In this article, we highlight notable areas for improved practices and present an interventional approach to stewardship tactics with a framework of disease, drug, dose, and duration. In doing so, we review current evidence regarding stewardship strategies at transitional settings, including diagnostic guidance, technological clinical support, and behavioral and educational approaches for both providers and patients.
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Affiliation(s)
- Elaine Liu
- Department of Pharmacy Services, Hartford Healthcare, Hartford, CT 06106, USA; (E.L.); (K.E.L.)
| | - Kristin E. Linder
- Department of Pharmacy Services, Hartford Healthcare, Hartford, CT 06106, USA; (E.L.); (K.E.L.)
| | - Joseph L. Kuti
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT 06106, USA
- Correspondence:
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Chan AHY, Beyene K, Tuck C, Rutter V, Ashiru-Oredope D. Pharmacist beliefs about antimicrobial resistance and impacts on antibiotic supply: a multinational survey. JAC Antimicrob Resist 2022; 4:dlac062. [PMID: 36035318 PMCID: PMC9400174 DOI: 10.1093/jacamr/dlac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pharmacists have important antimicrobial stewardship (AMS) roles yet limited literature exists on pharmacists’ knowledge and beliefs about antimicrobial resistance (AMR) and antimicrobials and how these beliefs influence antimicrobial supply in different countries. Methods A cross-sectional survey was disseminated to pharmacists around the world via the Commonwealth Pharmacists’ Association and related networks. Data were collected on demographics, antibiotic supply practices, and knowledge and beliefs about AMR. Results A total of 546 pharmacists responded from 59 countries, most commonly from Africa (41%) followed by Asia (26%) and Oceania (22%). Respondents supplied a mean of 46 ± 81 antibiotic prescriptions/week, 73%±35% of which were given in response to a prescription. Overall, 60.2% dispensed antibiotics at least once without a prescription. Respondents had good knowledge (mean 9.6 ± 1.3 (out of 12), and held positive beliefs about AMR [mean 3.9 ± 0.6 (out of 5)]. Knowledge about antibiotics and beliefs about AMR were positively correlated. The odds of supplying antibiotics without a prescription were 7.4 times higher among respondents from lower income countries [adjusted odds ratio (AOR) = 7.42, 95% CI 4.16–13.24]. Conversely, more positive AMR beliefs were associated with a lower odds of supplying antibiotics without a prescription (AOR = 0.91, 95% CI 0.86–0.95). Conclusions Most pharmacists had the good knowledge about antibiotics and positive beliefs about AMR. These beliefs were influenced by knowledge, work setting, and country income. A proportion of respondents provided antibiotics without a prescription; the likelihood of this occurring was higher in those who held more negative beliefs about AMR.
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Affiliation(s)
- Amy Hai Yan Chan
- Commonwealth Pharmacists’ Association , London , UK
- School of Pharmacy, University of Auckland, Grafton , Auckland , New Zealand
- UCL School of Pharmacy, University College London , London , UK
| | - Kebede Beyene
- School of Pharmacy, University of Auckland, Grafton , Auckland , New Zealand
| | - Chloe Tuck
- Commonwealth Pharmacists’ Association , London , UK
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Pogurschi EN, Petcu CD, Mizeranschi AE, Zugravu CA, Cirnatu D, Pet I, Ghimpețeanu OM. Knowledge, Attitudes and Practices Regarding Antibiotic Use and Antibiotic Resistance: A Latent Class Analysis of a Romanian Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127263. [PMID: 35742513 PMCID: PMC9224212 DOI: 10.3390/ijerph19127263] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023]
Abstract
Considering the major limitations of the latest studies conducted in Romania on the knowledge, attitudes and practices (KAPs) of antibiotic use and antibiotic resistance, we conducted this study to assess this major public health threat. A cross-sectional survey based on a validated questionnaire was conducted among the general population of Romania for a period of 5 months, i.e., September 2021-January 2022. The questionnaire was distributed using Google Form and it covered demographic characteristics and KAP assessments consisting of 12 items on knowledge, 10 items on attitudes and 3 items on practices. Latent class analyses (LCAs) were conducted to group respondents based on their responses. The response rate was 77%, of which females responded in a greater number (n = 1251) compared to males (n = 674). For most of the respondents (67.32%, n = 1296), the education level was high school, while 23.58% (n = 454) of respondents were college graduates. One in three Romanians (33.3%) know the WHO predictions related to this topic. Overall, the Romanian population is less disciplined when it comes to completing antibiotic treatments, as 29.19% of the respondents stop the course of antibiotic administration if their symptoms improve. The key findings from the present study may help policy makers in designing targeted interventions to decrease confusion, ambiguity or misconceptions about antibiotic use.
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Affiliation(s)
- Elena Narcisa Pogurschi
- Public Health and Food Safety Laboratory, Department Formative Science in Animal Breeding and Food Industry, Faculty of Animal Productions Engineering and Management, University of Agronomic Sciences and Veterinary Medicine of Bucharest, 011464 Bucharest, Romania;
| | - Carmen Daniela Petcu
- Department Animal Production and Public Health, Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine of Bucharest, 050097 Bucharest, Romania;
| | | | - Corina Aurelia Zugravu
- Department-Fundamental Disciplines, Faculty of Midwifery and Nursing, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
| | - Daniela Cirnatu
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, “Vasile Goldis” Western University of Arad, 310025 Arad, Romania;
| | - Ioan Pet
- Department of Biotechnologies, Bioengineering, Faculty of Animal Resources, Banat University of Agricultural Science and Veterinary Medicine “Regele Mihai I al Romaniei”, 300645 Timisoara, Romania;
| | - Oana-Mărgărita Ghimpețeanu
- Department Animal Production and Public Health, Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine of Bucharest, 050097 Bucharest, Romania;
- Correspondence: ; Tel.: +40-724529434
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Kalam MA, Shano S, Afrose S, Uddin MN, Rahman N, Jalal FA, Akter S, Islam A, Anam MM, Hassan MM. Antibiotics in the Community During the COVID-19 Pandemic: A Qualitative Study to Understand Users' Perspectives of Antibiotic Seeking and Consumption Behaviors in Bangladesh. Patient Prefer Adherence 2022; 16:217-233. [PMID: 35115769 PMCID: PMC8806049 DOI: 10.2147/ppa.s345646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/12/2022] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic is thought to have led to increased "inappropriate" or "unjustified" seeking and consumption of antibiotics by individuals in the community. However, little reference has been made to antibiotic seeking and using behaviors from the perspectives of users in Bangladesh during this health crisis. PURPOSE This study seeks to document how antibiotic medicines are sought and used during a complex health crisis, and, within different contexts, what are the nuanced reasons why patients may utilize these medicines sub-optimally. METHODS We used an exploratory, qualitative design. Forty semi-structured telephone interviews were conducted with people diagnosed with COVID-19 (n=20), who had symptoms suggestive of COVID-19 (n=20), and who had received care at home in two cities between May and June 2021 in Bangladesh. In this study, an inductive thematic analysis was performed. RESULTS The analysis highlighted the interlinked relationships of antibiotic seeking and consumption behaviors with the diversity of information disseminated during a health crisis. Antibiotic-seeking behaviors are related to previous experience of use, perceived severity of illness, perceived vulnerability, risk of infection, management of an "unknown" illness and anxiety, distrust of expert advice, and intrinsic agency on antimicrobial resistance (AMR). Suboptimal adherence, such as modifying treatment regimes and using medication prescribed for others, were found to be part of care strategies used when proven therapeutics were unavailable to treat COVID-19. Early cessation of therapy was found to be a rational practice to avoid side effects and unknown risks. CONCLUSION Based on the results, we highly recommend the take up of a pandemic specific antimicrobial stewardship (AMS) program in the community. To deliver better outcomes of AMS, incorporating users' perspectives could be a critical strategy. Therefore, a co-produced AMS intervention that is appropriate for a specific cultural context is an essential requirement to reduce the overuse of antibiotics during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Md Abul Kalam
- Bangladesh Country Office, Helen Keller International, Dhaka, 1212, Bangladesh
- Correspondence: Md Abul Kalam, Helen Keller International, Bangladesh Country Office, Dhaka, 1215, Bangladesh, Tel +8801912408148, Email
| | - Shahanaj Shano
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, 1212, Bangladesh
- EcoHealth Alliance, New York, NY, USA
| | | | - Md Nasir Uddin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, 1212, Bangladesh
| | - Nafis Rahman
- Department of Public Health, American International University of Bangladesh, Dhaka, 1212, Bangladesh
| | - Faruk Ahmed Jalal
- Handicap International - Humanity & Inclusion, Dhaka, 1212, Bangladesh
| | - Samira Akter
- Department of Anthropology, Jahangirnagar University, Savar, Dhaka, 1243, Bangladesh
| | - Ariful Islam
- EcoHealth Alliance, New York, NY, USA
- Centre for Integrative Ecology, School of Life and Environmental Science, Deakin University, Geelong Campus, Warrnambool, VIC, 3216, Australia
| | - Md Mujibul Anam
- Department of Anthropology, Jahangirnagar University, Savar, Dhaka, 1243, Bangladesh
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Wong LP, Alias H, Husin SA, Ali ZB, Sim B, Ponnampalavanar SSLS. Factors influencing inappropriate use of antibiotics: Findings from a nationwide survey of the general public in Malaysia. PLoS One 2021; 16:e0258698. [PMID: 34669733 PMCID: PMC8528291 DOI: 10.1371/journal.pone.0258698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/02/2021] [Indexed: 01/21/2023] Open
Abstract
Antibiotic resistance is one of the biggest threats to global public health. Misuse of antibiotics has never been investigated on a nationwide scale among the general public in Malaysia. This study aimed to identify sociodemographic and knowledge factors associated with inappropriate use of antibiotics in the Malaysian context to inform the development of interventions to mitigate inappropriate antibiotic use. We conducted computer-assisted telephone interviews (CATI) between June 2019 and December 2019. The telephone numbers were randomly generated from the electronic residential telephone directory of all 13 states and 3 Federal Territories in Malaysia. The survey consisted of questions on demographics, knowledge about antibiotics and antibiotic resistance (53 items), and practices of antibiotic use (16 questions). A total of 864 complete responses were received. Pronounced erroneous beliefs that antibiotics are effective against infections caused by viruses and that antibiotics can speed up recovery from coughs and colds were evident. The proportions that were aware of the terms ‘drug resistance’, ‘antimicrobial resistance’, and ‘superbugs’ were low. The mean and standard deviation (SD) for the antibiotic knowledge score was 23.7 (SD ±9.25; range 0 to 50) out of a possible score of 52. Regarding antibiotic practices, a considerable proportion reported non-adherence to recommended doses. The mean and SD for the antibiotic practices score was 37.9 (SD ± 6.5; range 17 to 47) out of a possible score of 48. Participants who earned an average monthly household income of MYR1001-3000 (OR 1.61, 95% CI 1.04–2.50) were more likely to report higher antibiotic practice scores than those with <MYR1000. Participants with tertiary education attainment reported higher antibiotic practice scores (OR 1.99; 95%CI 1.02–3.91) than those with primary school and below. High antibiotic knowledge scores (OR 3.94; 95% CI 2.71–5.73) were associated with higher antibiotic practice scores. Inappropriate antibiotic use is influenced by demographics and antibiotic knowledge. This study calls for education interventions focused on the lower socio-economic status population to increase awareness and to promote appropriate antibiotic use.
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Affiliation(s)
- Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail: (LPW); (SSLSP)
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Suraya Amir Husin
- Infection Control Unit at Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Zawaniah Brukan Ali
- Infection Control Unit at Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Benedict Sim
- Infectious Diseases Unit, Department of Medicine, Sg. Buloh Hospital, Sungai Buloh, Malaysia
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Aizman L, Barbieri JS, Feit EM, Lukowiak TM, Perz AM, Shin TM, Miller CJ, Golda N, Leitenberger JJ, Carr DR, Nijhawan RI, Hasan A, Eisen DB, Etzkorn JR. Preferences for Prophylactic Oral Antibiotic Use in Dermatologic Surgery: A Multicenter Discrete Choice Experiment. Dermatol Surg 2021; 47:1214-1219. [PMID: 34081047 DOI: 10.1097/dss.0000000000003113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antibiotics are often prescribed after dermatologic surgery for infection prophylaxis, but patient preferences about prophylactic antibiotics are not well understood. OBJECTIVE To understand patient preferences about taking antibiotics to prevent surgical site infection (SSI) relative to antibiotic efficacy and antibiotic-associated adverse drug reactions. MATERIALS AND METHODS Multi-center, prospective discrete choice experiment (DCE). RESULTS Three hundred thirty-eight respondents completed the survey and DCE. 54.8% of respondents preferred to take an antibiotic if it reduced the SSI rate from 5% to 2.5% and if the risk of adverse drug reactions was low (1% risk gastrointestinal upset, 0.5% risk itchy skin rash, 0.01% risk emergency department visit). Even if an antibiotic could eliminate SSI risk (0% risk SSI) and had a low adverse drug reaction profile, 26.7% of respondents prefer not to take prophylactic oral antibiotics. CONCLUSION Risk-benefit thresholds for taking antibiotics to prevent SSI vary widely. Clinical trials are needed to better characterize the effectiveness and risks of oral antibiotic SSI prophylaxis to guide decision-making. Future studies should also evaluate whether shared decision-making can improve the patient experience.
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Affiliation(s)
- Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - John S Barbieri
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elea M Feit
- LeBow College of Business, Drexel University, Philadelphia, Pennsylvania
| | - Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri
| | - Justin J Leitenberger
- Department of Dermatology, Oregon Health and Science University School of Medicine, Portland, Oregon
| | - David R Carr
- Division of Dermatology, the Ohio State University Medical Center, Columbus, Ohio
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aliza Hasan
- Department of Dermatology, University of California-Davis, Sacramento, California
| | - Daniel B Eisen
- Department of Dermatology, University of California-Davis, Sacramento, California
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Perioperative antimicrobial decision making: Focused ethnography study in orthopedic and cardiothoracic surgeries in an Australian hospital. Infect Control Hosp Epidemiol 2021; 41:645-652. [PMID: 32183916 DOI: 10.1017/ice.2020.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Antimicrobial use in the surgical setting is common and frequently inappropriate. Understanding the behavioral context of antimicrobial use is a critical step to developing stewardship programs. DESIGN In this study, we employed qualitative methodologies to describe the phenomenon of antimicrobial use in 2 surgical units: orthopedic surgery and cardiothoracic surgery. SETTING This study was conducted at a public, quaternary, university-affiliated hospital. PARTICIPANTS Healthcare professionals from the 2 surgical unit teams participated in the study. METHODS We used focused ethnographic and face-to-face semi-structured interviews to observe antimicrobial decision-making behaviors across the patient's journey from the preadmission clinic to the operating room to the postoperative ward. RESULTS We identified 4 key themes influencing decision making in the surgical setting. Compartmentalized communication (theme 1) was observed with demarcated roles and defined pathways for communication (theme 2). Antimicrobial decisions in the operating room were driven by the most senior members of the team. These decisions, however, were delegated to more junior members of staff in the ward and clinic environment (theme 3). Throughout the patient's journey, communication with the patient about antimicrobial use was limited (theme 4). CONCLUSIONS Approaches to decision making in surgery are highly structured. Although this structure appears to facilitate smooth flow of responsibility, more junior members of the staff may be disempowered. In addition, opportunities for shared decision making with patients were limited. Antimicrobial stewardship programs need to recognize the hierarchal structure as well as opportunities to engage the patient in shared decision making.
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Influence of Alternative Lifestyles on Antibiotic Use during Pregnancy, Lactation and in Children. Antibiotics (Basel) 2021; 10:antibiotics10070837. [PMID: 34356758 PMCID: PMC8300802 DOI: 10.3390/antibiotics10070837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
Alternative lifestyles are likely to be associated with distinct usage of specific medicinal products. Our goal was to find out whether the intake of antibiotics during pregnancy and by children differs according to whether the mothers have alternative or conventional lifestyles. Therefore, we investigated the use of antibiotics by pregnant women and by children up to 11 years of age participating in the KOALA Birth Cohort Study. This cohort comprises two recruitment groups of mother–infant pairs, one with alternative lifestyles (selected via organic food shops, anthroposophic clinicians and midwives, anthroposophic under-five clinics, Rudolf Steiner schools and relevant magazines, n = 491) the other with conventional lifestyles (no selection based on lifestyle, n = 2343). Mothers in the alternative lifestyle group more frequently adhered to specific living rules and identified themselves with anthroposophy more than mothers in the conventional lifestyle group. The results revealed significant differences in antibiotic use during pregnancy and in children from 3 months to 10 years of age between the two groups. The rate of antibiotic use in children was consistently lower in the alternative lifestyle group than in the conventional lifestyle group. Antibiotic use in pregnancy was higher in low educated women, and maternal antibiotic use during lactation was higher after an instrumented delivery in hospital. Antibiotic use in the infant was higher when they had older sibs or were born in hospital, and lower in those who had been longer breastfed. After adjustment for these factors, the differences in antibiotic use between the alternative and conventional groups remained. The results suggest that an alternative lifestyle is associated with cautious antibiotic use during pregnancy, lactation and in children.
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Wilding S, Kettu V, Thompson W, Howard P, Jeuken LJC, Pownall M, Conner M, Sandoe JAT. Development and randomized controlled trial of an animated film aimed at reducing behaviours for acquiring antibiotics. JAC Antimicrob Resist 2021; 3:dlab083. [PMID: 34223142 PMCID: PMC8251327 DOI: 10.1093/jacamr/dlab083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/17/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global health crisis but reducing antibiotic use can help. Some antibiotic use is driven by patient demand. OBJECTIVES To develop an intervention to discourage antibiotic-seeking behaviour in adults. METHODS Literature reviewed to identify behaviours for acquiring antibiotics among adults in the community. Behaviour change wheel approach was used to select the target behaviour and behaviour change techniques. An intervention in the form of a short animated film was developed and its potential impact evaluated in a randomized, controlled, online questionnaire study. RESULTS Asking a general medical/dental practitioner for antibiotics was identified as the target behaviour. A short stop-motion animated film was chosen to deliver several behaviour-change techniques. Education and persuasion were delivered around information about the normal microbial flora, its importance for health, the negative effect of antibiotics, and about AMR. 417 UK-based individuals completed the questionnaire; median age 34.5 years, 71% female, 91% white ethnicity. 3.8% of participants viewing the test film intended to ask for antibiotics compared with 7.9% viewing the control film. Test film viewers had significantly higher knowledge scores. At 6 week follow up, knowledge scores remained significantly different, while most attitude and intention scores were not different. CONCLUSIONS Some patients continue to ask for antibiotics. The film increased knowledge and reduced intentions to ask for antibiotics. At 6 weeks, knowledge gains remained but intentions not to ask for antibiotics had waned. Evaluation in the clinical environment, probably at the point of care, is needed to see if antibiotic prescribing can be impacted.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of
Leeds, Leeds, UK
| | | | - Wendy Thompson
- Division of Dentistry, University of
Manchester, Manchester, UK
| | - Philip Howard
- School of Healthcare, University of
Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust,
Leeds, UK
| | - Lars J C Jeuken
- School of Biomedical Sciences, University of
Leeds, Leeds, UK
| | | | - Mark Conner
- School of Psychology, University of
Leeds, Leeds, UK
| | - Jonathan A T Sandoe
- Leeds Teaching Hospitals NHS Trust,
Leeds, UK
- Leeds Institute of Medical Research, School of
Medicine, University of Leeds, Leeds, UK
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Rodrigues AT, Nunes JCF, Estrela M, Figueiras A, Roque F, Herdeiro MT. Comparing Hospital and Primary Care Physicians' Attitudes and Knowledge Regarding Antibiotic Prescribing: A Survey within the Centre Region of Portugal. Antibiotics (Basel) 2021; 10:antibiotics10060629. [PMID: 34070337 PMCID: PMC8229910 DOI: 10.3390/antibiotics10060629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/14/2021] [Accepted: 05/23/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Antibiotic resistance is a worldwide public health problem, leading to longer hospital stays, raising medical costs and mortality levels. As physicians' attitudes are key factors to antibiotic prescribing, this study sought to explore their differences between primary care and hospital settings. METHODS A survey was conducted between September 2011 and February 2012 in the center region of Portugal in the form of a questionnaire to compare hospital (n = 154) and primary care (n = 421) physicians' attitudes and knowledge regarding antibiotic prescribing. RESULTS More than 70% of the attitudes were statistically different (p < 0.05) between hospital physicians (HPs) and primary care physicians (PCPs). When compared to PCPs, HPs showed higher agreement with antibiotic resistances being a public health problem and ascribed more importance to microbiological tests and to the influence of prescription on the development of resistances. On the other hand, PCPs tended to agree more regarding the negative impact of self-medication with antibiotics dispensed without medical prescription and the need for rapid diagnostic tests. Seven out of nine sources of knowledge's usefulness were statistically different between both settings, with HPs considering most of the knowledge sources to be more useful than PCPs. CONCLUSIONS Besides the efforts made to improve both antibiotic prescribing and use, there are differences in the opinions between physicians working in different settings that might impact the quality of antibiotic prescribing. In the future, these differences must be considered to develop more appropriate interventions.
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Affiliation(s)
- António Teixeira Rodrigues
- Department of Medical Sciences, iBiMED—Institute of Biomedicine, University of Aveiro, 3800 Aveiro, Portugal; (A.T.R.); (M.E.); (M.T.H.)
- Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies, 1249 Lisbon, Portugal
| | - João C. F. Nunes
- Department of Chemistry, CICECO—Aveiro Institute of Materials, University of Aveiro, 3800 Aveiro, Portugal;
| | - Marta Estrela
- Department of Medical Sciences, iBiMED—Institute of Biomedicine, University of Aveiro, 3800 Aveiro, Portugal; (A.T.R.); (M.E.); (M.T.H.)
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain;
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health—CIBERESP), 28001 Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic of Guarda (IPG-UDI), 6300 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200 Covilhã, Portugal
- Correspondence:
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, iBiMED—Institute of Biomedicine, University of Aveiro, 3800 Aveiro, Portugal; (A.T.R.); (M.E.); (M.T.H.)
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Abdelmalek S, AlEjielat R, Rayyan WA, Qinna N, Darwish D. Changes in public knowledge and perceptions about antibiotic use and resistance in Jordan: a cross-sectional eight-year comparative study. BMC Public Health 2021; 21:750. [PMID: 33874935 PMCID: PMC8054398 DOI: 10.1186/s12889-021-10723-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 03/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Resistance to antibiotics is a growing problem, worldwide and particularly in developing countries like Jordan. Raising public awareness on appropriate antibiotic use is crucial to combat this problem. The current study describes the change in public Knowledge and attitudes towards the use of antibiotics over a period of 8 years. Methods Two cross-sectional studies were performed 8 years apart on Jordanians of different age groups, and social settings, residing in Amman, Jordan. Convenience non-probability sampling techniques were used. In 2010, a questionnaire was distributed in paper form, whereas in 2018 snowball sampling was used to disseminate an identical electronic questionnaire. Chi-square test and post hoc analysis were done using the z-test to compare column proportions, adjustment for multiple testing using the Bonferroni method. Multiple logistic regression was used to adjust for case mix for each survey. Comparisons were made across the two studies and within each study. Results A total of 711 participants in 2010 and 436 participants in 2018 were surveyed. Over the 8-year period, there was a significant improvement in the beliefs regarding the use of antibiotics such as disagreeing to keeping left over antibiotics for later use from 57 to 70% (p < 0.05) and disagreeing to buying antibiotics without physicians’ consent increased from 80 to 89% (P value < 0.001). There was no significant change in the beliefs that support self-medication such as: using antibiotics from a friend (72 to 77%) buying antibiotics without a prescription (42 to 45%), and getting information about medication use from leaflet without referring to a health care professional (60 to 63%). There were some areas of confusion regarding antibiotic range of effectiveness, and origin of resistance. Agreement about antibiotic resistance being a problem in Jordan increased significantly from 44 to 60% (p < 0.001). In addition, there was a significant increase in the percentage of participants who said that they don’t request antibiotics from physicians (56 to 75% (P ≤ 0.001) and who said they would trust physicians’ decisions about the necessity of antibiotics (70 to 83% P < 0.05). Conclusion Findings indicate the need for better suited, and more inclusive, public educational campaigns. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10723-x.
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Affiliation(s)
- Suzanne Abdelmalek
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan.
| | - Rowan AlEjielat
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Walid Abu Rayyan
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Nidal Qinna
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Dana Darwish
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
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Chan AHY, Horne R, Lycett H, Raebel E, Guitart J, Wildman E, Ang K. Changing Patient and Public Beliefs About Antimicrobials and Antimicrobial Resistance (AMR) Using a Brief Digital Intervention. Front Pharmacol 2021; 12:608971. [PMID: 33867978 PMCID: PMC8045782 DOI: 10.3389/fphar.2021.608971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/03/2021] [Indexed: 11/15/2022] Open
Abstract
Background: A key driver of antimicrobial resistance (AMR) is patient demand for unnecessary antibiotics, which is driven by patients’ beliefs about antibiotics and AMR. Few interventions have targeted beliefs to reduce inappropriate demand. Objective: To examine whether a brief, online algorithm-based intervention can change beliefs that may lead to inappropriate antibiotic demand (i.e. perceptions of antibiotic necessity and lack of concern about antibiotic harm). Design: Pre- and post-intervention study. Participants: Participants were 18 years or older, and residing in the United Kingdom, who self-selected to participate via Amazon mTurk, an online survey plaform, and via research networks. Intervention: Participants were presented with a hypothetical situation of cold and flu symptoms, then exposed to the intervention. The online intervention comprised: 1) a profiling tool identifying individual beliefs (antibiotic necessity, concerns, and knowledge) driving inappropriate antibiotic demand; 2) messages designed to change beliefs and knowledge (i.e. reduce antibiotic necessity, and increase antibiotic concerns and knowledge), and 3) an algorithm linking specific messages to specific beliefs and knowledge. Main measures: The profiling tool was repeated immediately after the intervention and compared with baseline scores to assess change in beliefs. A paired samples t-test was used to determine intervention effect. Key Results: A total of 100 respondents completed the study. A significant change in beliefs relating to inappropriate demand was observed after the intervention, with a reduction in beliefs about antibiotic necessity (t = 7.254; p < 0.0001), an increase in antibiotic concerns (t = −7.214; p < 0.0001), and increases in antibiotic and AMR knowledge (t = −4.651; p < 0.0001). Conclusion: This study is the first to demonstrate that patient beliefs about antibiotics and AMR associated with inappropriate demand can be changed by a brief, tailored online intervention. This has implications for the design of future interventions to reduce unnecessary antimicrobial use.
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Affiliation(s)
- Amy Hai Yan Chan
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, United Kingdom.,School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Rob Horne
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, United Kingdom
| | - Helen Lycett
- Spoonful of Sugar Ltd-a UCL-Business Company, London, United Kingdom
| | - Eva Raebel
- Spoonful of Sugar Ltd-a UCL-Business Company, London, United Kingdom
| | - Jordi Guitart
- Spoonful of Sugar Ltd-a UCL-Business Company, London, United Kingdom
| | - Emilie Wildman
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, United Kingdom.,Spoonful of Sugar Ltd-a UCL-Business Company, London, United Kingdom
| | - Karen Ang
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, United Kingdom.,School of Pharmacy, University of Auckland, Auckland, New Zealand.,Spoonful of Sugar Ltd-a UCL-Business Company, London, United Kingdom
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21
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Giacomini E, Perrone V, Alessandrini D, Paoli D, Nappi C, Degli Esposti L. Evidence of Antibiotic Resistance from Population-Based Studies: A Narrative Review. Infect Drug Resist 2021; 14:849-858. [PMID: 33688220 PMCID: PMC7937387 DOI: 10.2147/idr.s289741] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/11/2021] [Indexed: 12/23/2022] Open
Abstract
The 20th century witnessed the dawn of the antibiotic revolution and is now facing the rising phenomenon of antibiotic resistance. In this narrative review, we aim to describe antibiotic resistance in clinical practice settings through population-based studies from different countries reporting the role of misuse of antibiotics in the development of resistance and the clinical and economic burden associated. The misuse of antibiotics was documented in the wide population as well as in hospitals and care facilities. It was mainly reported as over-use and inappropriate prescribing. Improper dosage regimens and longer treatment duration were regarded as pivotal factors related to antibiotic resistance; the emerging strategy of "antibiotic-de-escalation" could be the key to overcome these issues. The investigation of the self-medication attitude revealed widespread antibiotic use without following medical instructions or medical consultation. Moreover, several studies established the association of antibiotic resistance with increased risk of longer hospitalizations and mortality, highlighting the heavy clinical and economic burden of this phenomenon. In this narrative review, the widespread inappropriate use of antibiotics emerged as one of the main causes of antibiotic resistance, which negative outcomes call for the development of antibiotic stewardship programs and global surveillance networks.
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Affiliation(s)
- Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | | | | | - Daniela Paoli
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - Carmela Nappi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
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22
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Diedrich S, Görig T, Dittmann K, Kramer A, Heidecke CD, Hübner NO. Active Integration of Patients into Infection Control, as perceived by Health Care Professionals: Results of the AHOI Pilot Study. Infect Drug Resist 2020; 13:4009-4019. [PMID: 33204118 PMCID: PMC7667167 DOI: 10.2147/idr.s261343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
Objective Medical professionals have a key role in active patient involvement in infection control and prevention (ICP). ICP of hospital-associated infections is critical for patient safety and requires targeted integration of patients and their relatives. The possibilities of proper involvement are identified, tested and realized in the innovative AHOI project. Its acronym stands for Activation, Help, Open communication and Infection prevention. The project is based on the three dimensions acceptance, empowerment and adherence. The results presented here are from a health-care professional (HCP) focused part of a pilot study to implement AHOI intervention. This section aimed at the HCPs’ evaluation of the intervention material, their perception and acceptance of the adherence and empowerment of patients, as well as the perception of their and colleagues’ own behavior. Methods The cross-sectional survey was conducted with a questionnaire at two surgical wards of a third-level hospital for 14 weeks. All HCPs with contact to patients were entitled to voluntarily participate in the study. AHOI instruments such as visual reminder, videos for patients and the AHOI-box were implemented on the wards. Additionally, the ward personnel received a psychological and practical train-the-trainer curriculum. Results Sixty-nine questionnaires were handed out and 29 returns were analyzed. The results show a strong identification and acceptance of HCPs with their role in the AHOI project. No additional workload was perceived by implementing AHOI. Teaching of medical professionals and information materials are seen as good supports. HCPs are empowering hygienic behavior in patients and colleagues. HCPs observed increasing adherence of patients. Conclusion HCPs positively perceived acceptance, support and identification with the ideas of the AHOI project. Therefore, since HCPs are key for patients and their relatives, AHOI intervention seems to be a feasible instrument and aid in implementing national and international recommendations for hygienic behavior.
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Affiliation(s)
- Stephan Diedrich
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Tillmann Görig
- Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Kathleen Dittmann
- Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Claus-Dieter Heidecke
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Nils-Olaf Hübner
- Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Greifswald, Germany
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23
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Fletcher-Miles H, Gammon J. A scoping review on the influential cognitive constructs informing public AMR behavior compliance and the attribution of personal responsibility. Am J Infect Control 2020; 48:1381-1386. [PMID: 32067811 DOI: 10.1016/j.ajic.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Antibiotic resistance is a growing threat to public health. Despite various attempts at educating the public on antimicrobial resistance (AMR) and judicial antibiotic use, fallacies and misconceptions remain. To successfully promote behavior change, various cognitive constructs pertaining to antibiotic behavior need to be identified and targeted. METHODS Using the Arksey and O'Malley (2005) methodological framework, a credible reflexive examination of literature was conducted, permitting identification of a breadth of literature that pertained to the influence of cognitive constructs on public antimicrobial behavior. RESULTS From 393 abstracts identified, 67 full articles were screened, and 43 papers were chosen for review. Three themes were identified (1) sociodemographic influences; (2) knowledge, misconceptions, and fallacies; and (3) public attitudes and the social influence of friends and family. Geographical location, education level, cognitive dissonance, and social norms were found to influence AMR cognition, resulting in disproportionate risk assessments that are facilitated by social information brokering. CONCLUSIONS Public AMR resilience, responsibility, and behavior compliance are influenced by cognitive constructs, which are liable to the appropriation of misconceptions, fallacies, and social behavior models obtained via information brokering. A cohesive multidisciplinary participatory approach to AMR management and interventional design that applies the influence of cognitive constructs to inform public AMR behavior compliance is recommended.
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Affiliation(s)
- Hayley Fletcher-Miles
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom.
| | - John Gammon
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
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24
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Pinho AC, Piedade AP. Polymeric Coatings with Antimicrobial Activity: A Short Review. Polymers (Basel) 2020; 12:polym12112469. [PMID: 33114426 PMCID: PMC7692441 DOI: 10.3390/polym12112469] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/21/2022] Open
Abstract
The actual situation of microorganisms resistant to antibiotics and pandemics caused by a virus makes research in the area of antimicrobial and antiviral materials and surfaces more urgent than ever. Several strategies can be pursued to attain such properties using different classes of materials. This review focuses on polymeric materials that are applied as coatings onto pre-existing components/parts mainly to inhibit microbial activity, but polymer surfaces with biocidal properties can be reported. Among the several approaches that can be done when addressing polymeric coatings, this review will be divided in two: antimicrobial activities due to the topographic cues, and one based on the chemistry of the surface. Some future perspectives on this topic will be given together with the conclusions of the literature survey.
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25
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A population-base survey on knowledge, attitude and awareness of the general public on antibiotic use and resistance. Antimicrob Resist Infect Control 2020; 9:105. [PMID: 32653034 PMCID: PMC7353772 DOI: 10.1186/s13756-020-00768-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/23/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives This study was designed to assess the awareness and knowledge of antibiotic usage and antibiotic resistance among the general public in the Cape Coast metropolis of Ghana. It also tries to decipher whether the level of education and the professional status of an individual has a positive association with the level of knowledge on antibiotic resistance. Methods A population-base survey involving members of the public was conducted from August to November 2019. A structured questionnaire was developed to collect data from 632 respondents. Data were analyzed through SPSS v.21 using Chi square statistics and multivariate regression. Differences in knowledge were evaluated using ANOVA and the assumption of equal variance was tested with Levene statistics. Results The response rate was 74.3%. Lower educational status group had a greater knowledge level (39.7%) on antibiotic resistance. Despite the high score, the lowest educational status group, (M = 1.82, SD = 0.769), middle educational status group (M = 1.98, SD = 0.748), and the high educational status group (M = 1.88, SD = 0.773) were not significantly different from each other with regard to their general knowledge level on antibiotic resistance (P < 0.05). The study revealed that, working in the healthcare sector is a major contributor to the level of knowledge on antibiotic resistance. Conclusion Given the scale of the issue on antibiotic resistance and the fact that attempts to resolve it will involve efforts on the part of all, it is important that the public is aware of the importance of the issue of antibiotic resistance, its implications and what they can do to address it. The level of knowledge among respondents with lower educational status should be enough evidence to introduce more educational campaigns on antibiotic resistance.
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26
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Mortazhejri S, Patey AM, Stacey D, Bhatia RS, Abdulla A, Grimshaw JM. Understanding determinants of patients' decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study. BMC FAMILY PRACTICE 2020; 21:119. [PMID: 32580696 PMCID: PMC7313109 DOI: 10.1186/s12875-020-01196-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 06/16/2020] [Indexed: 01/11/2023]
Abstract
Background Although antibiotics have little or no benefit for most upper respiratory tract infections (URTIs), they continue to be prescribed frequently in primary care. Physicians perceive that patients’ expectations influence their antibiotic prescribing practice; however, not all patients seek antibiotic treatment despite having similar symptoms. In this study, we explored patients’ views about URTIs, and the ways patients manage them (including attendance in primary care and taking antibiotics). Methods Using a qualitative descriptive design, adult English-speaking individuals at a Canadian health center were recruited through convenient sampling. The participants were interviewed using semi-structured interview guide based on the Common Sense-Self-Regulation Model (CS-SRM). The interviews were transcribed verbatim and coded according to CS-SRM dimensions (illness representations, coping strategies). Sampling continued until thematic saturation was achieved. Thematic analysis related to the dimensions of CS-SRM was applied. Results Generally, participants had accurate perception about the symptoms of URTIs, as well as how to prevent and manage them. However, some participants revealed misconceptions about the causes of URTIs. Almost all participants mentioned that they only visited their doctor if their symptoms got progressively worse and they could no longer self-manage the symptoms. When visiting a doctor, most participants reported that they did not seek antibiotics. They expected to receive an examination and an explanation for their symptoms. Conclusion Our participants reported good understanding regarding the likely lack of benefit from antibiotics for URTIs. Developing interventions that specifically help patients discuss their concerns with their physicians, instead of providing more education to public may help in reducing the use of unnecessary antibiotics.
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Affiliation(s)
- Sameh Mortazhejri
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Andrea M Patey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dawn Stacey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - R Sacha Bhatia
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
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27
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Khan FU, Khan FU, Hayat K, Chang J, Saeed A, Khan Z, Ashraf M, Rasheed UM, Atif N, Ji W, Aziz MM, Fang Y. Knowledge, attitude and practices among consumers toward antibiotics use and antibiotic resistance in Swat, Khyber-Pakhtunkhwa, Pakistan. Expert Rev Anti Infect Ther 2020; 18:937-946. [PMID: 32516001 DOI: 10.1080/14787210.2020.1769477] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Inappropriate use of antibiotics is one of the main causes of antibiotic resistance around the globe. The present study was aimed to assess the knowledge, attitude, and practices toward antibiotics and antibiotic resistance among consumers. Methods: A cross-sectional study was conducted from April 2019 to September 2019. The participants visiting community pharmacies to buy the antibiotics were approached by data collectors. The descriptive analysis, Kruskal Wallis, and Mann-Whitney statistical tests were used for data analysis through SPSS. Results: 399 participants at three pharmacies with male (n = 352, 88.2%), age (years) group between 34 to 41(n = 138, 34.6%), uneducated (n = 128, 32.1%), and higher education (n = 76, 19.0%) level of the participants were noted. Poor to moderate knowledge were observed; participants were unaware of the risk and misuse of antibiotics at all three pharmacies. By some means, a positive attitude noted, but the storage of antibiotics at home (Median = 2, IQR = 2) was preferred to use when needed. Most of the respondents didn't follow the actual dosage regimen as prescribed (n = 266, 66.7%, p < 0.05). Conclusion: A lack of knowledge and malpractices toward antibiotics use among consumers were observed. Education and awareness of the public about antibiotic resistance is the need of the hour.
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Affiliation(s)
- Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an, China.,Shaanxi Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Farman Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an, China.,Shaanxi Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an, China.,Shaanxi Centre for Health Reform and Development Research , Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences , Lahore, Pakistan
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an, China.,Shaanxi Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Amna Saeed
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an, China.,Shaanxi Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Zakir Khan
- Departmentof Pharmacy, Quaid-i-Azam University Islamabad , Pakistan.,Institute of Health Sciences, Department of Pharmacology, Cukurova University , Adana, Turkey
| | - Muhammad Ashraf
- Department of Pharmacy, University of Malakand , Khyber Pakhtunkhwa, Pakistan
| | - Usman Malik Rasheed
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an, China.,Shaanxi Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Naveel Atif
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an, China.,Shaanxi Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an, China.,Shaanxi Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Muhammad Majid Aziz
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an, China.,Shaanxi Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an, China.,Shaanxi Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
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28
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van Esch TEM, Brabers AEM, Hek K, van Dijk L, Verheij RA, de Jong JD. Does shared decision-making reduce antibiotic prescribing in primary care? J Antimicrob Chemother 2019; 73:3199-3205. [PMID: 30165644 DOI: 10.1093/jac/dky321] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/12/2018] [Indexed: 01/19/2023] Open
Abstract
Background Increasing antibiotic resistance is recognized as a major threat to global health and is related to antibiotic prescription rates in primary care. Shared decision-making (SDM), the process in which patients and doctors participate together in making decisions, is argued to possibly promote more appropriate use of antibiotics and reduce prescribing. However, it is unknown whether in practice fewer antibiotics are prescribed where more SDM takes place. Objectives To investigate whether more SDM is related to less antibiotic prescribing and whether this relationship differs between subgroups of patients (male/female and age groups). Patients and methods A questionnaire survey was conducted among 2670 members of the Dutch Health Care Consumer Panel to measure SDM (response rate 45%). Average practice-level SDM scores were calculated for 15 general practices. Data from routine electronic health records of 8192 adult patients of these general practices participating in the Nivel Primary Care Database were used to assess relevant illness episodes (acute cough, acute rhinosinusitis and urinary tract infection), the indication for antibiotics and antibiotic prescriptions. Logistic multilevel regression analyses were performed to investigate the relationship between practice-level SDM and patient-level antibiotic prescriptions. Results In practices where more SDM takes place, general practitioners prescribed fewer antibiotics for adult patients under the age of 40 years in preference-sensitive situations (i.e. situations in which antibiotics could be considered according to clinical guidelines). Conclusions SDM can be a framework to reduce the prescribing of antibiotics and thus to control antibiotic resistance.
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Affiliation(s)
- Thamar E M van Esch
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands
| | - Anne E M Brabers
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands
| | - Karin Hek
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands
| | - Liset van Dijk
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands
| | - Robert A Verheij
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands.,Health Services Research Maastricht University, MD Maastricht, The Netherlands
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29
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Ozturk Y, Celik S, Sahin E, Acik MN, Cetinkaya B. Assessment of Farmers' Knowledge, Attitudes and Practices on Antibiotics and Antimicrobial Resistance. Animals (Basel) 2019; 9:ani9090653. [PMID: 31487911 PMCID: PMC6770244 DOI: 10.3390/ani9090653] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/31/2019] [Accepted: 09/02/2019] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Antibiotic resistance is a global problem that threatens human and animal health and has increased in recent years. Although many factors are responsible for the development of resistance, antibiotics used in animals for preventive, therapeutic, and other purposes play a major role. Conscious and rational antibiotic use in animals will contribute to decreases in resistance. It is therefore important to determine knowledge, attitudes, and behaviors of farmers working in the livestock sector with regard to antibiotic knowledge, use, and resistance in order to develop communication strategies accordingly. The aim of this study was to measure the knowledge of livestock farmers about antibiotics by conducting a questionnaire survey. As a result of the survey, it was found that knowledge of the participants on antibiotics and resistance was very low. It was concluded that periodic training programs can be employed to overcome this problem and raise awareness among farmers. Abstract The aim of this study was to determine knowledge, attitudes, and behaviors of farmers dealing with animal husbandry in eastern Turkey with regard to antibiotic knowledge, use, and resistance. A face to face questionnaire survey, consisting of five sections with 42 questions in total, was applied to 360 farmers located in the region. The questions in the first and fifth sections were closed-ended while those in other sections were prepared using the Likert scale. It was determined that knowledge of the farmers about antibiotic use, duration, storage, and resistance was well below desired levels. This was particularly remarkable in the participants with a low level of education, living in rural areas, and those at 48 years of age or over. In contrast, younger and highly educated participants living in urban areas were more knowledgeable about antibiotic use and they were well aware of the fact that resistance might pose a great risk for public health. Providing appropriate antibiotic use in animals through systematic training of livestock farmers is crucial in tackling the resistance problem.
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Affiliation(s)
- Yasin Ozturk
- Department of Pharmacology, Faculty of Veterinary Medicine, University of Bingol, 12000 Bingol, Turkey.
| | - Senol Celik
- Department of Biostatistics, Faculty of Agriculture, University of Bingol, 12000 Bingol, Turkey.
| | - Emre Sahin
- Department of Animal Nutrition, Faculty of Veterinary Medicine, University of Bingol, 12000 Bingol, Turkey.
| | - Mehmet Nuri Acik
- Department of Microbiology, Faculty of Veterinary Medicine, University of Bingol, 12000 Bingol, Turkey.
| | - Burhan Cetinkaya
- Department of Microbiology, Faculty of Veterinary Medicine, University of Firat, 23119 Elazig, Turkey.
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30
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Masci D, Hind C, Islam MK, Toscani A, Clifford M, Coluccia A, Conforti I, Touitou M, Memdouh S, Wei X, La Regina G, Silvestri R, Sutton JM, Castagnolo D. Switching on the activity of 1,5-diaryl-pyrrole derivatives against drug-resistant ESKAPE bacteria: Structure-activity relationships and mode of action studies. Eur J Med Chem 2019; 178:500-514. [DOI: 10.1016/j.ejmech.2019.05.087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 12/13/2022]
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31
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Mo Y, Seah I, Lye PSP, Kee XLJ, Wong KYM, Ko KKK, Ong RTH, Tambyah PA, Cook AR. Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey. BMJ Open 2019; 9:e023859. [PMID: 30842108 PMCID: PMC6429736 DOI: 10.1136/bmjopen-2018-023859] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To study the correlation between knowledge, attitude and practices (KAP) of antibiotic consumption with epidemiology and molecular characteristics of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) carriage, in order to identify modifiable factors and public health interventions to reduce prevalence of multidrug-resistant organism colonisation in the community. DESIGN Cross-sectional questionnaire of KAP towards antibiotic use and collection of stool samples or rectal swabs. ESBL-PE isolates obtained underwent whole genome sequencing to identify resistance genes. SETTING A densely populated community in Singapore. PARTICIPANTS There were 693 healthy community-dwelling questionnaire respondents. Out of which, 305 provided stool samples or rectal swabs. RESULTS The overall knowledge of antibiotic use was poor (mean score 4.6/10, IQR 3.0-6.0). 80 participants (80/305, 26.2%) carried at least one ESBL-PE isolate. The most common ESBL-PE was Escherichia coli sequence type 131 carrying CTX-M type beta-lactamases (11/71, 15.5%). Living overseas for >1 year (OR 3.3, 95% CI 1.6 to 6.9) but not short-term travel, recent hospitalisation or antibiotic intake was associated with ESBL-PE carriage. Interestingly, higher knowledge scores (OR 2.0, 95% CI 1.03 to 3.9) and having no leftover antibiotics (OR 2.4, 95% CI 1.2 to 4.9) were independent factors associated with ESBL-PE carriage in the multivariate logistic regression model. CONCLUSIONS While the role of trans-border transmission of antimicrobial resistance is well known, we may have to examine the current recommendation that all antibiotics courses have to be completed. Clinical trials to determine the optimum duration of treatment for common infections are critically important.
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Affiliation(s)
- Yin Mo
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, Singapore
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Ivan Seah
- National University Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
| | | | - Xiang Lee Jamie Kee
- National University Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
| | | | - Kwan Ki Karrie Ko
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Rick Twee-Hee Ong
- National University Singapore Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Paul A Tambyah
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Alex R Cook
- National University Singapore Saw Swee Hock School of Public Health, Singapore, Singapore
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Elong Ekambi GA, Okalla Ebongue C, Penda IC, Nnanga Nga E, Mpondo Mpondo E, Eboumbou Moukoko CE. Knowledge, practices and attitudes on antibiotics use in Cameroon: Self-medication and prescription survey among children, adolescents and adults in private pharmacies. PLoS One 2019; 14:e0212875. [PMID: 30818373 PMCID: PMC6394986 DOI: 10.1371/journal.pone.0212875] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/11/2019] [Indexed: 12/04/2022] Open
Abstract
Benefits of antibiotics are threatened by the self-medication, people's lack of knowledge and inappropriate use of antibiotics, especially in developing countries. This study was designed to determine knowledge; attitudes and practices toward antibiotics use in an urban community, and evaluate the factors that are associated with antibiotic use. Between January and March 2015, a cross sectional and prospective study was conducted in all pharmacies within the Douala IV health district, Cameroon. Anonymous interviews including both open and closed ended questions were conducted in participants selected by convenience sampling Descriptive and logistic regression analysis were performed using StataSE11 software (version 11 SE) and R software (version 3.1.1) in data analysis. Overall 402 (33.7%) of 1,192 customers purchased antibiotics and of these, 47% bought antibiotics without a prescription. 60.7% of purchased antibiotics was for adult 'patients and around 60% of parents carried out self-medication on their children. The vast majority reported that all microbes can be treated with antibiotics (88.3%). The belief that antibiotics are appropriate for bacterial infections was more common among those with a higher level education (OR = 4.03, 95%CI:1.89-8.57, p<0.0001) and among public/private servants (OR = 2.47, 95%CI:1.21-5.08, p = 0.013). Physicians provide less explanations about antibiotics are and their potential side effects than the pharmacy auxiliaries (OR = 0.205, 95%CI = 0.09-0.46, p<0.0001), but more than pharmacists (OR = 3.692, 95%CI:1.44-9.25, p = 0.005). Indications on antibiotics use were 7 times more given to customers with a prescription compared to those without a prescription (OR = 7.37, 95% CI = 2.13-25.43, p = 0.002). Adult male (OR = 2.32, 95%CI:1.24-4.34, p = 0.009) and higher education (OR = 2.05, 95%CI:1.08-3.89, p = 0.027) were significantly associated with self-medication. Misuse, little "practical knowledge" and high self-medication confirm the unsatisfactory prescription and dispensing practices of the antibiotics in our country. These results highlight the important of the development and implementation appropriate guidelines for the responsible use of antibiotics for health care providers and health education targeting community members themselves.
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Affiliation(s)
- Grace-Ange Elong Ekambi
- Pharmaceutical Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Cécile Okalla Ebongue
- Biological Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Ida Calixte Penda
- Clinical Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Emmanuel Nnanga Nga
- Pharmaceutical Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Emmanuel Mpondo Mpondo
- Pharmaceutical Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Carole Else Eboumbou Moukoko
- Biological Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Centre Pasteur Cameroon, Yaoundé, Cameroon
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Jones LF, Owens R, Sallis A, Ashiru-Oredope D, Thornley T, Francis NA, Butler C, McNulty CAM. Qualitative study using interviews and focus groups to explore the current and potential for antimicrobial stewardship in community pharmacy informed by the Theoretical Domains Framework. BMJ Open 2018; 8:e025101. [PMID: 30593557 PMCID: PMC6318531 DOI: 10.1136/bmjopen-2018-025101] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Community pharmacists and their staff have the potential to contribute to antimicrobial stewardship (AMS). However, their barriers and opportunities are not well understood. The aim was to investigate the experiences and perceptions of community pharmacists and their teams around AMS to inform intervention development. DESIGN Interviews and focus groups were used to explore the views of pharmacists, pharmacy staff, general practitioners (GPs), members of pharmacy organisations and commissioners. The questioning schedule was developed using the Theoretical Domains Framework which helped inform recommendations to facilitate AMS in community pharmacy. RESULTS 8 GPs, 28 pharmacists, 13 pharmacy staff, 6 representatives from pharmacy organisations in England and Wales, and 2 local stakeholders participated.Knowledge and skills both facilitated or hindered provision of self-care and compliance advice by different grades of pharmacy staff. Some staff were not aware of the impact of giving self-care and compliance advice to help control antimicrobial resistance (AMR). The pharmacy environment created barriers to AMS; this included lack of time of well-qualified staff leading to misinformation from underskilled staff to patients about the need for antibiotics or the need to visit the GP, this was exacerbated by lack of space. AMS activities were limited by absent diagnoses on antibiotic prescriptions.Several pharmacy staff felt that undertaking patient examinations, questioning the rationale for antibiotic prescriptions and performing audits would allow them to provide more tailored AMS advice. CONCLUSIONS Interventions are required to overcome a lack of qualified staff, time and space to give patients AMS advice. Staff need to understand how self-care and antibiotic compliance advice can help control AMR. A multifaceted educational intervention including information for staff with feedback about the advice given may help. Indication for a prescription would enable pharmacists to provide more targeted antibiotic advice. Commissioners should consider the pharmacists' role in examining patients, and giving advice about antibiotic prescriptions.
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Affiliation(s)
| | - Rebecca Owens
- Primary Care Unit, Public Health England, Gloucester, UK
| | - Anna Sallis
- Behavioural Insights Team, Public Health England, London, UK
| | | | | | - Nick A Francis
- School of Medicine, University Hospital of Wales, Cardiff, UK
| | - Chris Butler
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
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Aziz SA, Kamel FO. Knowledge, Attitude and Practice toward the Use of Antibiotics without Prescription in Jeddah, Saudi Arabia: A Cross-sectional Study. JOURNAL OF MEDICAL SCIENCES 2018. [DOI: 10.3923/jms.2019.45.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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A survey of reported behaviours, attitudes and knowledge related to antibiotic use of hospitalised patients in Thailand. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Yezli S, Yassin Y, Mushi A, Maashi F, Aljabri N, Mohamed G, Bieh K, Awam A, Alotaibi B. Knowledge, attitude and practice (KAP) survey regarding antibiotic use among pilgrims attending the 2015 Hajj mass gathering. Travel Med Infect Dis 2018; 28:52-58. [PMID: 30118860 DOI: 10.1016/j.tmaid.2018.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/30/2018] [Accepted: 08/14/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Overuse and misuse of antibiotics have been reported in Hajj. However, little is known about Knowledge, Attitude and Practice (KAP) of pilgrims themselves in relation to these agents. METHODS Adult pilgrims from seven countries attending the 2015 Hajj were interviewed using a structured KAP questionnaire. RESULTS KAP information was collected from 1476 pilgrims. Misconceptions regarding antibiotics included that they: cure all diseases (24.6%); cure common cold and flu (63.0%); are used to stop fever (47.3%); have no side effects (43.2%). Negative attitudes included prophylactic use (50%), self-medication (43.2%), non-compliance with therapy (63.5%) and storage of left-overs for future use (54.1%). In practice, 87.3% of pilgrims admitted to using non-prescribed antibiotics, only 19.3% use antibiotic as directed by their doctor and 54% do not usually check the expiry date of antibiotics before use. Over 60% brought antibiotics from their home country to KSA and 39.2% acquired non-prescribed antibiotics in Saudi Arabia. KAP scores were higher among the younger age group (≤43 years old) and among those with healthcare-related work or education and increased with increasing levels of education. CONCLUSIONS Multifaceted and multidisciplinary approaches, both in KSA and in pilgrims' countries of origin, are needed to address antibiotic misuse during Hajj.
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Affiliation(s)
- Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.
| | - Yara Yassin
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulaziz Mushi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Fuad Maashi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Gamal Mohamed
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kingsley Bieh
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Awam Awam
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Badriah Alotaibi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
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Assessment of Knowledge, Attitude, and Practice toward Antibiotic Use among Harar City and Its Surrounding Community, Eastern Ethiopia. Interdiscip Perspect Infect Dis 2018; 2018:8492740. [PMID: 30174690 PMCID: PMC6106796 DOI: 10.1155/2018/8492740] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 12/21/2022] Open
Abstract
Purpose Community plays significant role in the process of emergence and spread of antibiotic resistance. The aim of this study is to assess knowledge, attitude, and practice toward antibiotic use among Harar city and its surrounding community, Eastern Ethiopia. Patient and Methods A cross-sectional study was conducted among 384 subjects from February 1 to May 1, 2017, through interview using pretested structured questionnaires. The data was entered into EpiData 3.1 and analyzed using Statistical Package for Social Science for windows version 20. Results A large number of the respondents (83%) replied that antibiotics speed up the recovery from coughs and colds. The majority of participants (78.4%) agreed that the unnecessarily use of antibiotics can increase the resistance of bacteria. Many respondents agreed on the importance of taking full dose (92.1%) and not to keep antibiotics for future use in their home (87.2%). They (90%) also had belief that antibiotics should not be shared from family or friends without a physician consultation and significant participants (73.1%) emphasized on the need for prescription to collect antibiotics from pharmacy. Around 79% of the subjects reported the use of antibiotic 1 year prior to study period at least once. During this period many subjects (65.3%) self-prescribed antibiotics without consulting physicians. Conclusion In the present study, widespread use of antibiotics was reported, most of this antibiotics being accessed without prescription. Respondent exhibited poor knowledge and attitude toward antibiotics use. There were also malpractices such as failing to take full dose. Therefore, educational interventions on antibiotics use and its association with drug resistance are needed to promote judicious use of antibiotic. Introducing and enforcing antibiotics regulations should be also considered to reduce antibiotics self-prescription.
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Mason T, Trochez C, Thomas R, Babar M, Hesso I, Kayyali R. Knowledge and awareness of the general public and perception of pharmacists about antibiotic resistance. BMC Public Health 2018; 18:711. [PMID: 29884154 PMCID: PMC5994078 DOI: 10.1186/s12889-018-5614-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/25/2018] [Indexed: 01/21/2023] Open
Abstract
Background Antibiotic resistance (AR) continues to be a serious problem. Many factors contribute to AR, including inappropriate use of antibiotics, in which both healthcare professionals and patients play a contributing role. This study aimed to assess the awareness and knowledge of antibiotic usage and AR among the general public (in affluent and deprived areas) and community pharmacists’ (CPs’) in Greater London. Methods A cross-sectional survey involving members of the public was conducted between July 2014 and February 2015. Stage one involved members of the public (N = 384) residing in affluent areas of London. The second stage targeted public (N = 384) in deprived areas of London. In addition, CPs (N = 240) across the same areas were also surveyed. Data analysis was performed using Microsoft Excel and SPSS Software packages. Results Response rate: 36% (n = 139/384) and 57% (n = 220/384) and 25% (n = 60/240) of public residing in affluent areas, deprived areas and of CPs respectively was achieved. Definitive trends in knowledge of how antibiotics work could not be drawn to distinguish between affluent and deprived areas. However, public respondents residing in affluent areas possessed better understanding of AR and prudent use of antibiotics, and this was statistically significant in both cases (p < 0.05). Exposure to an antibiotic campaign (32% in affluent areas, 17% in deprived areas) did not raise public respondents’ knowledge on AR and only partially raised their general knowledge on antibiotics usage. Only 20% of public residing in deprived areas received counselling from a CP, among them 74% had an antibiotic prescribed on at least one previous occasion. Those who received counselling displayed better knowledge about concordance/adherence with respect to antibiotic usage (p < 0.05) whereas exposure to an antibiotic campaign made no significant impact on knowledge about concordance/adherence. Conclusion The study highlights that there has been no change in the status quo with respect to awareness of antibiotic usage and AR even after the implementation of several awareness campaigns in England. Those who benefited from CP counselling showed a significant better knowledge towards prudent antibiotic usage which stresses the importance of CPs’ counselling on antibiotic prescription.
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Affiliation(s)
- Thuy Mason
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston upon Thames, KT1 2EE, UK
| | - Claire Trochez
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston upon Thames, KT1 2EE, UK
| | - Remmya Thomas
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston upon Thames, KT1 2EE, UK
| | - Maria Babar
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston upon Thames, KT1 2EE, UK
| | - Iman Hesso
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston upon Thames, KT1 2EE, UK
| | - Reem Kayyali
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston upon Thames, KT1 2EE, UK.
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Demoré B, Tebano G, Gravoulet J, Wilcke C, Ruspini E, Birgé J, Boivin JM, Hénard S, Dieterling A, Munerol L, Husson J, Rabaud C, Pulcini C, Malblanc S. Rapid antigen test use for the management of group A streptococcal pharyngitis in community pharmacies. Eur J Clin Microbiol Infect Dis 2018; 37:1637-1645. [PMID: 29876774 DOI: 10.1007/s10096-018-3293-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
Despite group A streptococci being an infrequent cause of pharyngitis in adult outpatients, sore throat remains a common indication for antibiotic prescription. This prospective multicentre non-randomised study describes a community pharmacy-based antimicrobial stewardship intervention consisting in the implementation of rapid antigen testing (RAT) for the management of adults with sore throat. Trained pharmacists triaged patients presenting with symptoms of pharyngitis using the modified Centor score. Those at risk for streptococcal infection were tested with RAT. Patients with a positive RAT were invited to consult a physician, whereas others were offered a symptomatic treatment. All patients received educational leaflets and were asked to fill in a follow-up form 7 days later. Ninety-eight pharmacies in one French region participated, and 559 patients were included over 6 months. RAT was proposed in 367 (65.7%) cases, and it was positive in 28 (8.3%). The follow-up form was returned by 140 (38.5%) participants. Of these, 10/10 patients with positive RAT further consulted a physician and were prescribed an antibiotic treatment, whereas 96.5% (110/114) of patients with negative results and not having any other reason to seek for doctor's advice did not consult. All participants found the intervention useful. Pharmacists spent 6-15 min to perform the intervention, and 98.6% (73/74) of pharmacists giving a feedback declared to be ready to implement this intervention in daily practice, if endorsed and reimbursed. Our results suggest that a pharmacy-based programme for the management of sore throat is feasible and could increase adherence to guidelines.
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Affiliation(s)
- Béatrice Demoré
- Pharmacie Brabois Adultes, CHRU Nancy, Nancy, France.,Université de Lorraine, UMR 7565 (SRSMC) CNRS, Nancy, France.,ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France
| | - Gianpiero Tebano
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France. .,Université de Lorraine, APEMAC, F-54000, Nancy, France.
| | - Julien Gravoulet
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France.,Union Régionale des Professionnels de Santé Pharmaciens du Grand Est, 4 rue Piroux, Nancy, France
| | - Christophe Wilcke
- Union Régionale des Professionnels de Santé Pharmaciens du Grand Est, 4 rue Piroux, Nancy, France
| | - Eric Ruspini
- Union Régionale des Professionnels de Santé Pharmaciens du Grand Est, 4 rue Piroux, Nancy, France
| | - Jacques Birgé
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France
| | - Jean-Marc Boivin
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France
| | - Sandrine Hénard
- Infectious Diseases Department, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Annick Dieterling
- Agence Régionale de Santé du Grand Est. Direction de la Santé Publique, Nancy, France
| | - Lidiana Munerol
- Agence Régionale de Santé du Grand Est. Direction de la Santé Publique, Nancy, France
| | - Julie Husson
- Département Analyse des Données de Santé, Agence Régionale de Santé du Grand Est. Direction de la Qualité et de la Performance, Nancy, France
| | - Christian Rabaud
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France.,Infectious Diseases Department, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Céline Pulcini
- Université de Lorraine, APEMAC, F-54000, Nancy, France.,Infectious Diseases Department, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Sophie Malblanc
- Agence Régionale de Santé du Grand Est. Direction de la Santé Publique, Nancy, France
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Abstract
Cogent explanations are an indispensable means of providing new information and an essential component of effective education. Beyond this, we argue that there is tremendous untapped potential in using explanations to motivate behavior change. In this article we focus on health interventions. We review four case studies that used carefully tailored explanations to address gaps and misconceptions in people's intuitive theories, providing participants with a conceptual framework for understanding how and why some recommended behavior is an effective way of achieving a health goal. These case studies targeted a variety of health-promoting behaviors: (1) children washing their hands to prevent viral epidemics; (2) parents vaccinating their children to stem the resurgence of infectious diseases; (3) adults completing the full course of an antibiotic prescription to reduce antibiotic resistance; and (4) children eating a variety of healthy foods to improve unhealthy diets. Simply telling people to engage in these behaviors has been largely ineffective-if anything, concern about these issues is mounting. But in each case, teaching participants coherent explanatory frameworks for understanding health recommendations has shown great promise, with such theory-based explanations outperforming state-of-the-art interventions from national health authorities. We contrast theory-based explanations both with simply listing facts, information, and advice and with providing a full-blown educational curriculum, and argue for providing the minimum amount of information required to understand the causal link between a target behavior and a health outcome. We argue that such theory-based explanations lend people the motivation and confidence to act on their new understanding.
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Brabers AEM, Van Esch TEM, Groenewegen PP, Hek K, Mullenders P, Van Dijk L, De Jong JD. Is there a conflict between general practitioners applying guidelines for antibiotic prescribing and including their patients' preferences? Patient Prefer Adherence 2017; 12:9-19. [PMID: 29317801 PMCID: PMC5744739 DOI: 10.2147/ppa.s147616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES One perceived barrier to guideline adherence is the existence of conflicting patient preferences. We examined whether patient preferences influence the prescription of antibiotics in general practice, and how this affects guideline adherence. We hypothesized that preferences play a larger role in prescribing antibiotics if the guideline allows for preferences to be taken into account, ie, if prescribing antibiotics is an option which can be considered rather than a clear recommendation to prescribe or not. We included three guidelines: acute cough, acute rhinosinusitis, and urinary tract infections. METHODS Data from NIVEL (the Netherlands Institute for Health Services Research) Primary Care Database (NIVEL-PCD) were used to assess antibiotic indications and prescriptions. These data were combined with a questionnaire among members of NIVEL's Dutch Health Care Consumer Panel to examine patient preferences. According to NIVEL-PCD, 286 of these members contacted their general practitioner (GP) in 2015 for acute cough, acute rhinosinusitis or urinary tract infections. A logistic multilevel regression analysis was performed to test our hypothesis. RESULTS Patient preferences do play a role in GPs' prescribing of antibiotics only in situations where, in accordance with the guideline, their use is an option which could be considered (interaction between indication and preference: p=0.049). If patients ask for antibiotics themselves in such situations, then GPs prescribe antibiotics more often. CONCLUSION Patient preferences only play a role if the guideline provides room to take preferences into account. Therefore, our results do not suggest a conflict between applying guidelines and including patient preferences. Further research is recommended to examine this possible conflict in other situations.
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Affiliation(s)
- Anne EM Brabers
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht
| | | | - Peter P Groenewegen
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht
- Department of Sociology, Utrecht University, Utrecht
- Department of Human Geography, Utrecht University, Utrecht
| | - Karin Hek
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht
| | - Pé Mullenders
- The National Health Care Institute, Diemen, the Netherlands
| | - Liset Van Dijk
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht
| | - Judith D De Jong
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht
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Erku DA, Mekuria AB, Belachew SA. Inappropriate use of antibiotics among communities of Gondar town, Ethiopia: a threat to the development of antimicrobial resistance. Antimicrob Resist Infect Control 2017; 6:112. [PMID: 29152233 PMCID: PMC5678763 DOI: 10.1186/s13756-017-0272-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/01/2017] [Indexed: 12/05/2022] Open
Abstract
Background The emergence of antimicrobial resistance, the main cause of morbidity and mortality from otherwise treatable infections, is largely attributed to the inappropriate use of antimicrobials. However, data on the extent of inappropriate use of antibiotics in the community is scarce in Ethiopia. The aim of present study is to document the extent of inappropriate use of antibiotics and its associated factors among the communities of Gondar, Northwest Ethiopia. Methods A community based cross-sectional survey was conducted on a total of 650 participants in Gondar town, northwest Ethiopia from December 1, 2016 to January 30, 2017. Descriptive statistics, univariate and multivariate logistic regression analysis were also performed to express different variables and to examine factors associated with inappropriate use of antibiotics. Results According to the finding of our study, 315 (48.5%) of the participants took antibiotics in the past 1 year, of which 115 (35.9%) of them used inappropriately. Amoxicillin (72%) was the most commonly utilized antibiotics and respiratory tract infection (40.9%) was the most common disease condition to which antibiotics had been sought. About 36.8% of the respondents got antibiotics from community drug retail outlets without a prescription and 67.9% of respondents had discontinued the use of antibiotics once their symptoms subside. Low educational status (AOR = 5.01, 95% CI = 2.62–9.34), being employed (AOR = 2.12, 95% CI = 1.81–7.29) and unsatisfied with health care services provided (AOR = 5.41, 95% CI = 2.71-14.21) were found to be strong predictors of inappropriate use of antibiotics use among the community. Conclusion Inappropriate use of antibiotics was found to be considerably high in the communities of Gondar, northwest Ethiopia. Taking into consideration the heightened importance of comprehensive knowledge in the rational use of antibiotics, different stakeholders working in the public health sectors should provide a comprehensive and customized education to the public so as to improve their knowledge about antibiotics. It is also essential to adopt a strong and explicit line of actions towards the accessibility of antibiotics without a valid prescription in community medicine retail outlets.
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Affiliation(s)
- Daniel Asfaw Erku
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, 16 Gondar, Ethiopia.,Department of clinical pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Abebe Basazn Mekuria
- Department of Pharmacology, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, 16 Gondar, Ethiopia
| | - Sewunet Admasu Belachew
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, 16 Gondar, Ethiopia
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Is the level of knowledge a predictor of rational antibiotic use in Serbia? PLoS One 2017; 12:e0180799. [PMID: 28700631 PMCID: PMC5507268 DOI: 10.1371/journal.pone.0180799] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 06/21/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The objective of this study was to investigate the knowledge, attitudes and behavior regarding antibiotics of the general population. METHODS The study sample consisted of adult subjects who consulted general practitioners at health centers in Serbia and agreed to complete the questionnaire. A total of 668 questionnaires were distributed; 500 respondents completed the entire questionnaire (response rate 74.85%). RESULTS The average age was 51.65 ± 16.56 years, 60.80% of the respondents were women. The median antibiotic knowledge score was 9. Predictors of adequate antibiotic knowledge were higher education level and a family member whose ocuppation was related to health-care. Overall, 58.4% of respondents believed that antibiotics could be used to treat common cold. Around a half of the respondents (47.2%) self-medicated with antibiotics at least once during their life-time, and around a quarter (24.2%) during the last treatment of infection. Patients with inadequate knowledge had 3 times higher chances of self-medicating with antibiotics compared to those with adequate knowledge. Although 98.20% of respondents claimed that antibiotic treatment should be started after a visit to a doctor and receiving a prescription, only 65.8% obtained antibiotics with prescription from a doctor during the last infection. CONCLUSIONS Although these results demonstrate that respondents had a relatively adequate level of knowledge regarding antibiotics use, some areas of misconceptions and improper behavior were identified. Therefore, further rationalization should be focused on educational campaigns targeting the behavior of patients with regard to antibiotic use.
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Public knowledge and behaviours concerning antibiotic use and resistance in France: a cross-sectional survey. Infection 2017; 45:513-520. [PMID: 28405941 DOI: 10.1007/s15010-017-1015-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate knowledge and behaviours concerning antibiotics and bacterial resistance in the French population, and to identify the socio-demographic factors associated with a high level of such knowledge and appropriate behaviours. METHODS A survey of the general population was conducted in 2015 in northeast France. The 44-item standardized questionnaire used comprised three parts, focusing on the assessment of knowledge, behaviours, and the collection of main socio-demographic characteristics of respondents (gender, age, having children, education level, and profession). The association of these characteristics with the level of knowledge about antibiotics, and with related behaviours, as well as the association between knowledge and behaviours was identified in a bivariate analysis (Chi-2 tests) and a multivariate analysis when necessary (logistic regression). RESULTS The 200 respondents had quite a good level of knowledge about antibiotics for several points: the lack of effectiveness of antibiotics for colds (75.5%), the risk of inefficacy of antibiotics when misused (93%), and the effects of overconsumption on bacterial resistance (92%). Conversely, the effects of different doses and treatment durations on resistance were less well known. Inappropriate behaviours were frequent, especially non-adherence to dosing schedules and to treatment duration (35.5%), and self-medication practices (18%). Female gender, older age, and having children were independently associated with a good level of knowledge. A low level of education and older age were associated with appropriate behaviours. CONCLUSIONS No association was found between knowledge and behaviours, highlighting the relevance of national public information campaigns to limit the misuse of antibiotics.
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Alrafiaah AS, Alqarny MH, Alkubedan HY, AlQueflie S, Omair A. Are the Saudi parents aware of antibiotic role in upper respiratory tract infections in children? J Infect Public Health 2017; 10:579-585. [PMID: 28283368 DOI: 10.1016/j.jiph.2017.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/18/2016] [Accepted: 01/07/2017] [Indexed: 10/20/2022] Open
Abstract
Upper respiratory tract infection (URTI) is considered to be the most common reason for children's visits to emergency departments or outpatient clinics. The misuse and overuse of antibiotics are currently major public health problems worldwide. This study aimed to assess Saudi parents' knowledge, attitude, and practice (KAP) regarding the use of antibiotics in URTIs in children. This cross-sectional study was conducted in Saudi Arabia using a previously validated questionnaire, which was distributed using Twitter. A total of 385 individuals completed the questionnaire. For the majority of the participants (77%), physicians were the primary source of information regarding the use of antibiotics. Forty-four percent of parents agreed that most URTIs are caused by viruses, and 81% were aware that inappropriate use of antibiotics leads to the development of antibiotic resistance. Fever was the primary symptom (27%) that led parents to ask for prescriptions for antibiotics. Although women had a higher attitude score (p=0.01), there was no difference between genders regarding knowledge and practice. Older participants (41 years or more) had a lower attitude score (p=0.02). Furthermore, participants with five children or more had lower attitude and practice scores (p=0.006, 0.04, respectively). Participants who lived in large cities had greater knowledge compared to the inhabitants of small cities (p=0.01). In conclusion, the findings of this study demonstrated that most of the participants were educated but lacked knowledge regarding antibiotic use in URTIs in children. This lack of knowledge led to inappropriate attitude and practice. Thus, launching public educational campaigns and encouraging physicians to educate parents regarding the proper use of antibiotics are recommended.
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Affiliation(s)
- Abdulaziz S Alrafiaah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Meaad H Alqarny
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Haneen Y Alkubedan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sulaiman AlQueflie
- Department of Pediatric, King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia
| | - Aamir Omair
- Department of Medical Education, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Llor C, Vilaseca I, Lehrer-Coriat E, Boleda X, Cañada JL, Moragas A, Cots JM. Survey of Spanish general practitioners' attitudes toward management of sore throat: an internet-based questionnaire study. BMC FAMILY PRACTICE 2017; 18:21. [PMID: 28193184 PMCID: PMC5307696 DOI: 10.1186/s12875-017-0597-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 02/08/2017] [Indexed: 12/23/2022]
Abstract
Background The management of sore throat varies widely in Europe. The objective of this study was to gain insight into clinicians’ perceptions on the current management of sore throat in Spain. Methods Cross-sectional, internet-based questionnaire study answered from July to September 2013. General practitioners (GPs) affiliated with the two largest scientific societies of primary care were invited to participate in the study. Questions were asked about physician knowledge, the use of current national guidelines for sore throat management, and management in two clinical scenarios, depicting a young adult with sore throat and: 1. cough, coriza with or without fever, and 2. fever without cough and coriza. Results The questionnaire was completed by 1476 GPs (5%) and 12.7% declared using rapid antigen detection tests. Antibiotics were considered by 18.8% of the GPs in the first scenario and by 32% in the second scenario (p < 0.001). The antibiotics most commonly mentioned by GPs were amoxicillin and amoxicillin + clavulanate (52.7 and 31.2%, respectively) whereas penicillin V was only prescribed in 11.9% of the cases. The drugs most commonly considered in both scenarios were analgesics and anti-inflammatory drugs. Antitussives, decongestants and expectorants were more commonly prescribed in cases of suspected viral infection (p < 0.001). Conclusions GPs have misconceptions as to the indications for using rapid antigen detection tests and prescribing drugs in the management of sore throat. These results suggest that guidelines are seldom followed since one in five GPs declared giving antibiotics for patients with a suspected viral infection and the use of second-choice antibiotics seems considerable.
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Affiliation(s)
- Carl Llor
- Primary Healthcare Centre Via Roma, Barcelona, Spain.
| | - Isabel Vilaseca
- Department of Otorhinolaringology, Hospital Clínic of Barcelona, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Xavier Boleda
- Pharmacy Arizcun (Group on respiratory diseases, Sociedad Española de Farmacia Comunitaria), Sant Pere de Ribes, Spain
| | - José L Cañada
- Primary Healthcare Centre Algorta (Group on Infectious Diseases SEMERGEN), Getxo, Vizcaya, Spain
| | - Ana Moragas
- Primary Healthcare Centre Jaume I, University Rovira i Virgili, Tarragona, Spain
| | - Josep M Cots
- Primary Healthcare Centre La Marina (Group on Infectious Diseases, semFYC), University of Barcelona, Barcelona, Spain
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Topor G, Grosu IA, Ghiciuc CM, Strat AL, Lupuşoru CE. Awareness about antibiotic resistance in a self-medication user group from Eastern Romania: a pilot study. PeerJ 2017; 5:e3803. [PMID: 28924507 PMCID: PMC5600173 DOI: 10.7717/peerj.3803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/23/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Awareness about antibiotic resistance depends on the attitudes and information about antibiotic resistance of both patients and physicians. Persons who practice self-medication are at high risk of also self-medicating with antibiotics. The purpose of the present study was to evaluate the awareness about antibiotic resistance by investigating the practice in a group of self-medication users in a sample of adults in Romania and the variables associated with such practice. MATERIAL AND METHODS A cross-sectional self-filled questionnaire based study was conducted from December 2016 through January 2017 amongst 218 self-medication users (SMUG). The attitudes, the level of knowledge, the perceptions, about antibiotic use (ABU) and about antibiotic resistance (ABR) were compared to a reference group represented by medical residents group in their specialty training (MRG) considered to have a higher level of knowledge and awareness about ABU and ABR. RESULTS The response rate was 87.2% in the SMUG group and 100% in the MRG group. The SMUG group reported self-medication practices for antibiotics with a high frequency at any time in life (72%), but with a very low frequency from the month previous to the date of the study (12%), comparative with the MRG group (75% and 7%, respectively). The multivariate logistic regression analysis showed that self-medication with antibiotics at any time in life in the SMUG group could be predicted by the answers to two questions regarding the practices and knowledge about ABU (Q13 and Q20). On the other hand, in the MRG group, a question about ABR perception (Q23), could be predictor for self-medication with antibiotics. Self-medication with antibiotics in the month previous to the date of the study in the SMUG group could be predicted with three questions: one about ABU practice (Q14), one about ABR perception (Q26) and one referring to ABR knowledge (Q28). On the other hand, in the MRG group, a question about ABR knowledge (Q32) could be predictor for self-medication with antibiotics. The reduced awareness about ABR in the SMUG group, is revealed by the reduced number of subjects (38%), who did not know that missing an antibiotic dose during a medical treatment contributes to ABR, comparative with the MRG group (84%). Indirectly, low ABR awareness in the SMUG group is revealed by the confusion about the appropriate use of antibiotics in bacterial or viral infections (that antibiotics are not used against viruses). CONCLUSIONS The findings from our study on the awareness about antibiotic resistance in the SMUG group might help the policy makers and regulatory authorities to develop educational programs directed to change the perceptions and attitudes about the appropriate use of antibiotics in order to diminish self-medication practices with antibiotics.
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Affiliation(s)
- Gabi Topor
- Department of Pharmacology—Morphofunctional Sciences II, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
| | - Ionela-Alina Grosu
- Department of Pharmacology—Morphofunctional Sciences II, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
| | - Cristina Mihaela Ghiciuc
- Department of Pharmacology—Morphofunctional Sciences II, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
| | - Aurel Lulu Strat
- Department of Pharmacology—Morphofunctional Sciences II, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
- Laboratory of Microbiology, Hospital of Infectious Diseases Saint Parascheva, Iasi, Romania
| | - Cătălina Elena Lupuşoru
- Department of Pharmacology—Morphofunctional Sciences II, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
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Abu Taha A, Abu-Zaydeh AH, Ardah RA, Al-Jabi SW, Sweileh WM, Awang R, Zyoud SH. Public Knowledge and Attitudes Regarding the Use of Antibiotics and Resistance: Findings from a Cross-Sectional Study Among Palestinian Adults. Zoonoses Public Health 2016; 63:449-57. [PMID: 26752329 DOI: 10.1111/zph.12249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Indexed: 02/05/2023]
Abstract
Antibiotics are considered to be among the most commonly sold drug classes in Palestine. Resistance to antibiotics has increased for reasons relating to the use and misuse of antibiotics. The aim of this study was to evaluate the knowledge, and attitudes regarding antibiotic use and awareness about resistance among adults visiting the emergency departments at hospitals in North Palestine. A self-administered cross-sectional questionnaire survey involving participants aged 18 or over was conducted from June 2012 to February 2013. Adults who visited the emergency departments at hospitals in North Palestine were included. Demographic characteristics, knowledge and attitudes towards antibiotic use were included in the questionnaire. Poor and good knowledge were defined as a total knowledge score of 0-7 and 8-15 of 15 questions, respectively. Attitude scores of 0-3 and 4-7 of 7 questions were considered poor and good, respectively. A total of 375 questionnaires were included in the study. A response rate of 83.3% was attained. About 55.0% of the participants had a good knowledge and 56.5% had a good attitude towards rational antibiotic use. A significant positive correlation was shown between participants' knowledge scores and participants' attitude scores towards antibiotic use (R = 0.344, P = 0.001. Participants with a high family income were more likely to be aware of appropriate antibiotic use than participants with a low family income (P-value <0.001). Participants with a higher educational level (university) had a good attitude towards rational antibiotic use than those with a lower education level (P-value <0.001). This study has documented important knowledge and attitude gaps in antibiotic use. These findings will help health policymakers in Palestine to implement intervention programmes to rationalize antibiotic use. Continuing medical education, professional development and training workshops for healthcare professionals regarding rational use of antibiotics and health risks associated with the spread of antibiotic resistance are needed. In addition, minimizing non-prescription use of antibiotics and increasing the public awareness about the health and economic hazards of antibiotic resistance are also required.
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Affiliation(s)
- A Abu Taha
- Department of Physiology and Pharmacology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - A H Abu-Zaydeh
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - R A Ardah
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - S W Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - W M Sweileh
- Department of Physiology and Pharmacology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - R Awang
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
| | - S H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Heid C, Knobloch MJ, Schulz LT, Safdar N. Use of the Health Belief Model to Study Patient Perceptions of Antimicrobial Stewardship in the Acute Care Setting. Infect Control Hosp Epidemiol 2016; 37:576-82. [PMID: 26809477 PMCID: PMC5262496 DOI: 10.1017/ice.2015.342] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify themes associated with patient perceptions of antibiotic use and the role of patients in inpatient antimicrobial stewardship. DESIGN We conducted semi-structured interviews with 30 hospitalized patients using the Health Belief Model as the framework for questions and analysis. SETTING An academic tertiary care hospital in Madison, Wisconsin. PARTICIPANTS A total of 30 general medicine inpatients receiving at least 1 anti-infective medication were interviewed. RESULTS Participants recognized antibiotic resistance as a serious public health threat but expressed low perceived susceptibility to being personally affected by antibiotic resistance. Views of susceptibility were influenced by a high degree of trust in physicians and misperceptions regarding the mechanisms underlying resistance. Participants expressed high self-efficacy and a desire to be involved in their health care. Perceived roles for patients in preventing the inappropriate use of antibiotics ranged from asking questions and speaking up about concerns to active involvement in decision making regarding antibiotic treatments. Few participants reported being offered the opportunity to engage in such shared decision making while hospitalized. CONCLUSIONS Our findings suggest an important role for patients in improving antibiotic use in hospitals. However, patient engagement has not been recognized as a critical component of antimicrobial stewardship programs. Our study suggests that the likelihood of patient engagement in stewardship practices is currently limited by low perceived susceptibility and lack of cues to act. Further investigation into how patients may be engaged as good stewards of antibiotics may reveal new ways to improve antibiotic prescribing practices in the inpatient setting.
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Affiliation(s)
- Cydney Heid
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Mary Jo Knobloch
- William S. Middleton Memorial Veterans Hospital Madison, Wisconsin
| | - Lucas T. Schulz
- Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
- William S. Middleton Memorial Veterans Hospital Madison, Wisconsin
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Agarwal S, Yewale VN, Dharmapalan D. Antibiotics Use and Misuse in Children: A Knowledge, Attitude and Practice Survey of Parents in India. J Clin Diagn Res 2015; 9:SC21-4. [PMID: 26674397 DOI: 10.7860/jcdr/2015/14933.6819] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/18/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Antibiotic resistance is a topic of global concern these days. Irrational, excessive use of antibiotics by the general public is one of the key factors responsible for this. AIM Through this study, we aim to analyse the knowledge, attitude and practices of antibiotics use among parents of children presenting to a tertiary care hospital in India. Also, correlate it with the gender, education level and previous use of antibiotics by the parents. MATERIALS AND METHODS A cross sectional study was conducted at a tertiary care hospital in Navi Mumbai, India from September to November 2014 and a total of 1000 parents were interviewed using a questionnaire designed by the authors. Descriptive statistics were used for the analysis of data. RESULTS A total of 872 parents were included in the study. Around one in every four (28%) parents correctly identified that antibiotics are used against bacterial infections while only 15.5% parents knew the meaning of the term antibiotic resistance. Majority of the respondents appreciated that unnecessary use of antibiotics could harm the child (73.6%). It was noteworthy that 85.2% parents stated that they don't use leftover antibiotics from the previous prescription for the next time without doctor's consult. Males, parents with higher level of formal education and use of antibiotics previously were found to have more knowledge regarding antibiotics and lesser misconceptions (p<0.05). CONCLUSION Overall, in this study it was found that misconceptions exist about the use and indications of antibiotics. Lack of knowledge regarding antibiotic resistance was prevalent. But participants were aware of the risks associated with use of excessive antibiotics. More interaction with paediatricians and involvement of mass media may help to improve the antibiotics knowledge and practices among parents and consequently, control the problem of antibiotic resistance.
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Affiliation(s)
- Shreya Agarwal
- Medical Officer and Researcher, Department of Paediatrics, Dr. Yewale's Multispeciality Hospital for Children , Navi Mumbai, India
| | - Vijay N Yewale
- Professor and Head, Department of Paediatrics, Dr. Yewale's Multispeciality Hospital for Children , Navi Mumbai, India
| | - Dhanya Dharmapalan
- Associate Professor and Pediatrician, Department of Paediatrics, Dr. Yewale's Multispeciality Hospital for Children , Navi Mumbai, India
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