Poor health knowledge and behaviour is a risk for the spread of antibiotic resistance: survey of higher secondary school students in Goa, India

Evaluation of pharmacist's practices regarding the antimicrobials dispensing: a simulated patient study

BACKGROUND

The indiscriminate use of antimicrobials is considered a major contributing factor to the increase in antimicrobial resistance. Community pharmacies are the main source of access to antimicrobials, and pharmacists are in a strategic position to promote rational use of these medicines. Therefore, it is important to know dispensing service quality.

OBJECTIVE

To evaluate the behavior of pharmacists in dispensing antimicrobials in community pharmacies in northeast Brazil.

METHODS

This cross-sectional pilot study was conducted from August to October 2021 in a private community pharmacy chain in Sergipe. Dispensing was evaluated using the simulated patient (SP) technique. Two SP asked the pharmacists for the antimicrobials (case clinic 1: upper respiratory infection; case clinic 2: urinary tract infection) and recorded the service through audio. Dispensing practices were independently analyzed by two researchers based on the tools available in the literature. Data were presented using descriptive statistics.

RESULTS

A total of 54 simulated patient visits were conducted. Based on the 12 steps recommended by the research team for good dispensing, pharmacists asked an average of 1 (±1.17) question for upper respiratory infections and 0.3 (±0.54) for urinary tract infections, as well as provided counseling (mean number of recommendations, 2.6 (±1.44) and 4.5 (±2.35), respectively). As for communication skills, pharmacists had a regular score (3.07 ± 0.34). Furthermore, there was no significant difference in the number of steps and counseling recommendations by pharmacists in dispensing clinical cases 1 and 2 (p = 0.0674).

CONCLUSION

The quality of antimicrobial dispensing was evaluated as suboptimal, requiring improvements in practice and multifaceted strategies to promote continuing education of these professionals. In addition, awareness actions for the population must be implemented to promote the rational use of antimicrobials and reduce microbial resistance.

Knowledge about infections is associated with antibiotic use: cross-sectional evidence from the health survey Northern Ireland

BACKGROUND

Antibiotic overuse is the main modifiable driver of antibiotic resistance. Factors associated with overuse have been inconsistently reported and vary across populations. Given the burgeoning occurrence of infectious diseases around the world, there remains a great need to identify barriers and solutions to the control of infections. We examined whether knowledge about infections and antibiotic resistance is associated with antibiotic use in a northern European population sample.

METHODS

The Health Survey Northern Ireland 2014/15 was completed by a cross-sectional sample of 4135 participants aged > 16 years. Participants were asked whether they had taken an antibiotic in the past 12 months; and six questions were asked concerning knowledge about infections and antibiotic resistance. Correct answers to the six knowledge questions defined a knowledge score (score range 0-6 correct answers). We used multivariable logistic regression to estimate odds of self-reported antibiotic use during the last 12 months in association with knowledge score (lowest score, 0/6, as referent), and response to each knowledge question. Covariates included sex, age group, smoking, alcohol drinking, deprivation index, self-rated health, and satisfaction with life. Results were outputted as Odds Ratios (OR) and 95% Confidence Intervals (CI).

RESULTS

Antibiotic use in the past 12 months was reported by 39.0% (1614/4135); and 84.2% (3482/4135) scored < 6/6 correct on knowledge statements. Compared to the lowest knowledge score (0/6 correct), the highest knowledge score (6/6 correct) was associated with higher odds of antibiotic use (adjusted OR 2.03, 95% CI [1.46, 2.81], p < 0.001), with a P-value < 0.001 for trend with increasing knowledge score. Female sex, age, high deprivation, and poor general health, were independently associated with higher odds of antibiotic use. Stratified analyses showed sex and age group differences.

CONCLUSION

Knowledge, and other modifiable and non-modifiable risk factors, were positively associated with antibiotic use in the past 12 months. While the causal direction of these associations could not be determined, given the high prevalence of lesser knowledge, as well as independent contributions of other factors including socioeconomic characteristics, health literacy campaigns to raise awareness of antibiotic resistance should take a multi-pronged approach.

Prevention of antibiotic resistance - an epidemiological scoping review to identify research categories and knowledge gaps

BACKGROUND

Antibiotics have become the cornerstone for the treatment of infectious diseases and contributed significantly to the dramatic global health development during the last 70 years. Millions of people now survive what were previously life-threatening infections. But antibiotics are finite resources and misuse has led to antibiotic resistance and reduced efficacy within just a few years of introduction of each new antibiotic. The World Health Organization rates antibiotic resistance as a 'global security threat' impacting on global health, food security and development and as important as terrorism and climate change.

OBJECTIVES

This paper explores, through a scoping review of the literature published during the past 20 years, the magnitude of peer-reviewed and grey literature that addresses antibiotic resistance and specifically the extent to which "prevention" has been at the core. The ultimate aim is to identify know-do gaps and strategies to prevent ABR.

METHODS

The review covers four main data bases, Web of Science, Medline, Scopus and Ebsco searched for 2000-17. The broader research field "antibiotic OR antimicrobial resistance" gave 431,335 hits. Narrowing the search criteria to "Prevention of antibiotic OR antimicrobial resistance" resulted in 1062 remaining titles. Of these, 622 were unique titles. After screening of the 622 titles for relevance, 420 abstracts were read, and of these 282 papers were read in full. An additional 53 references were identified from these papers, and 64 published during 2018 and 2019 were also included. The final scoping review database thus consisted of 399 papers.

RESULTS

A thematic structure emerged when categorizing articles in different subject areas, serving as a proxy for interest expressed from the research community. The research area has been an evolving one with about half of the 399 papers published during the past four years of the study period. Epidemiological modelling needs strengthening and there is a need for more and better surveillance systems, especially in lower- and middle-income countries. There is a wealth of information on the local and national uses and misuses of antibiotics. Educational and stewardship programmes basically lack evidence. Several studies address knowledge of the public and prescribers. The lessons for policy are conveyed in many alarming reports from national and international organizations.

CONCLUSIONS

Descriptive rather than theoretical ambitions have characterized the literature. If we want to better understand and explain the antibiotic situation from a behavioural perspective, the required approaches are lacking. A framework for an epidemiological causal web behind ABR is suggested and may serve to identify entry points for potential interventions.

What drives inappropriate use of antibiotics? A mixed methods study from Bahawalpur, Pakistan

Purpose

This study investigates the knowledge, attitudes and practices of the general public regarding the use of antibiotics in community pharmacy, in Pakistan.

Methods

This is a mixed method study where data were collected through a validated questionnaire and semi-structured interviews. Convenience sampling techniques were used to recruit participants from the general public of Bahawalpur, Pakistan who visited pharmacies to purchase antibiotics between 1 June 2018 and 31 July 2018. Descriptive statistics and regression analyses were used to tabulate the results of quantitative data while inductive thematic analysis was used to identify themes and draw conclusions from the qualitative data.

Results

Over 60% of the 400 survey participants (n=246; 61.5%) had a moderate level of antibiotic knowledge; however, attitudes regarding antibiotics use were poor in half the sample (n=201; 50.3%). More than half (n=226; 56.6%) of the respondents stated that antibiotics could cure all types of infections. Just under one third (n=129; 32.3%) of respondents obtained the appropriate dosage regimen while the majority did not complete the course (n=369; 92.3%); stopping when they felt better. Inductive thematic analysis yielded four themes, 10 subthemes and 27 categories. Two subthemes were related to knowledge, one to attitude, three to practices and four subthemes were related to suggestions to improve the healthcare system. Inappropriate antibiotic practices included: lack of consultation with healthcare professionals, purchase of antibiotics without prescription or refilling of previous prescription, use of home supply of antibiotics, sharing of antibiotics with others, improper dosage regimens and early cessation of antibiotic therapy.

Conclusion

Level of education, low health literacy, high consultation fees of private practitioners, inadequate health facilities in government hospitals and patient overload, busy schedules of people, poor healthcare infrastructure in rural areas and unrestricted supply of antibiotics were key factors associated with inappropriate use of antibiotics in Pakistan.