Self-medication with antimicrobial drugs in Europe

Prevalence of self-medication with antibiotics and its related factors among the general public and health professionals during the COVID-19 pandemic: A cross-sectional study in China

BACKGROUND

Self-medication with antibiotics (SMA) is a common public health concern. This study aimed to assess the prevalence of SMA in the general public and health professionals during the COVID-19 pandemic and identify the associated factors.

METHODS

A cross-sectional study was conducted from October 28, 2022, to November 6, 2022. Logistics regression analysis was used to examine the associated factors.

RESULTS

The rate of SMA was 10.25% in the general public and 12.69% in health professionals. For the public, those who perceived themselves as average or good health, had moderate antibiotic knowledge, and had easy access to nearby health facilities were less likely to SMA; while those who live in rural areas, found it easy to purchase antibiotics without prescriptions, and those who frequently encountered antibiotics recommended by pharmacy staff were more likely to SMA. For health professionals, those who were female, perceived themselves as good health, had moderate or high antibiotic knowledge, and had easy access to health facilities were less likely to SMA; while those who found it easy to purchase antibiotics without prescriptions were more likely to SMA.

CONCLUSIONS

SMA is prevalent in both the general public and health professionals. Promoting the rational use of antibiotics requires joint participation and effort.

Prevalence and predictors of self-medication with antibiotics in Ethiopia: a systematic review and meta-analysis

INTRODUCTION

Antibiotic self-medication is a global public health concern contributing to antibiotic resistance. This systematic review and meta-analysis aim to assess the prevalence of antibiotic self-medication and its associated factors in Ethiopia.

METHODS

A comprehensive search of electronic databases was conducted from MEDLINE (PubMed), Scopus, Google Scholar and Web of Science to identify relevant studies published between 2000 and 2024. Adult households, undergraduate university students and health care professionals who had taken antibiotics without a prescription in the household setting were included in this review. The primary outcome of this review is antibiotic self- medication. The random-effects model was used to estimate pooled prevalence rates. The outcome measure was analyzed with STATA version 17 software.

RESULTS

A total of nine studies were included in the Meta-analysis, comprising a sample size of 5908 participants. The pooled prevalence of antibiotic self-medication among Ethiopians was found to be 46.14 with 95% Confidence Interval [35.71, 56.57]. The most frequently used classes of self-medicated antibiotics were penicillins, followed by tetracyclines. Community pharmacies were the source of information that individuals utilized. The most common reported reasons for antibiotic self-medication include previous experience of treating a similar illness, to save cost, lack of time and avoiding waiting time for medical services. Participants having less than high school educational level was the most commonly reported factor associated with self-medication antibiotics.

CONCLUSION

Antibiotic self-medication is a prevalent practice in Ethiopia. This underscores the need for targeted interventions such as educating people about the risks associated with using antibiotics without medical guidance, which results in a reduction in antibiotic resistance.

Patients' Opinions on Antibiotics in the Treatment of Dental Infections: A Cross-Sectional Survey

Background: The aim of this study was to evaluate patients' knowledge and perceptions of the use of systemic antibiotics in the treatment of endodontic infections and to determine the possible contribution of patients to the development of bacterial resistance. Methods: A total of 550 patients were asked to respond to a survey on the perception of systemic antibiotic use in the treatment of endodontic infections and antibiotic resistance during January 2022 and March 2023. A bivariate and multivariate analysis was performed to determine possible correlates in the population regarding antibiotic use in the endodontic world. Results: A total of 514 patients were included in the study, 65.9% of whom were women. While 34.6% of the population studied thought that it was always necessary to take antibiotics prior to endodontics, 49.4% considered that they were necessary after endodontics, regardless of the clinical symptoms. The prevalence of self-medication was 17.3%, and women self-medicate more than men, with significant differences (p < 0.05), although they have a greater knowledge of antibiotic resistance than men (p < 0.05). Forty-four percent of the population expected to take antibiotics when faced with dental pain, mainly women (p < 0.05). Conclusions: The general population is contributing to the serious problem of bacterial resistance. It is necessary to promote educational strategies focused on the correct use of antibiotics in the community. The worst results were found mainly in the population with a low level of education. The level of education was the variable that most influenced the knowledge and attitudes of the population, followed by the sex of the participants.

Self-Medication Practices among Adult Population in Bangladesh: A Cross-Sectional Study

BACKGROUND

The practice of self-medication (SM) is common worldwide and is an important component of medical self-care. However, improper practice can be dangerous. This study aimed to estimate the prevalence of SM and the factors associated with it among Bangladeshi adults.

METHODS

A cross-sectional survey was conducted between April and June 2021 among Bangladeshi adults (aged > 19 years) using convenient sampling. A total of 1320 subjects were collected through face-to-face interviews using a standardized questionnaire. Multivariable logistic regression analysis was used to identify factors associated with the practice of SM.

RESULTS

Overall, 41% of adults in our survey reported SMP. The most common illnesses that prompted SM were common cold/flu (66.4%), gastric problems (65%), and headache (64.4%). The most frequent reasons for SM were to get better-perceived quality of care (30.6%), perceiving SM without side effects (23.3%), and saving time with effectiveness (14.56%). Potential risk factors included 10 years (AOR = 1.91; 95% CI: 1.04-3.50) and >12 years of schooling (AOR = 5.03; 95% CI: 2.27-11.15), being a businessman (AOR = 4.64; 95% CI: 1.74-12.37), having ≤6 family members (AOR = 2.13; 95% CI: 1.40-3.24), being a member of a social group (AOR = 1.53; 95% CI: 1.10-2.12), a health status check after every six months (AOR = 1.52; 95% CI: 1.08-2.13), and current ill-health (AOR = 1.41; 95% CI: 1.06-1.87). Protective factors identified included ≤30 years of age (AOR = 0.40; 95% CI: 0.17-0.93), and practice of modern (AOR = 0.39; 95% CI: 0.22-0.69) and herbal (AOR = 0.45; 95% CI: 0.21-0.97) treatment modality.

CONCLUSION

More than one-third of the study participants reported practicing SM. Increasing the community's awareness of the adverse outcomes of SM and not just the average experience might sway individuals away from SM, and implementing strict jurisdiction could be a way to minimize inappropriate SM.

Conserved molecular chaperone PrsA stimulates protective immunity against group A Streptococcus

Group A Streptococcus (GAS) is a significant human pathogen that poses a global health concern. However, the development of a GAS vaccine has been challenging due to the multitude of diverse M-types and the risk of triggering cross-reactive immune responses. Our previous research has identified a critical role of PrsA1 and PrsA2, surface post-translational molecular chaperone proteins, in maintaining GAS proteome homeostasis and virulence traits. In this study, we aimed to further explore the potential of PrsA1 and PrsA2 as vaccine candidates for preventing GAS infection. We found that PrsA1 and PrsA2 are highly conserved among GAS isolates, demonstrating minimal amino acid variation. Antibodies specifically targeting PrsA1/A2 showed no cross-reactivity with human heart proteins and effectively enhanced neutrophil opsonophagocytic killing of various GAS serotypes. Additionally, passive transfer of PrsA1/A2-specific antibodies conferred protective immunity in infected mice. Compared to alum, immunization with CFA-adjuvanted PrsA1/A2 induced higher levels of Th1-associated IgG isotypes and complement activation and provided approximately 70% protection against invasive GAS challenge. These findings highlight the potential of PrsA1 and PrsA2 as universal vaccine candidates for the development of an effective GAS vaccine.

Self-medication with antibiotics in Georgian population

Background: Self-medication with antibiotics is a global phenomenon and a potential contributor to human pathogen resistance to antibiotics. It involves obtaining medication without a prescription, taking medicines based on the advice of friends and relatives, or previous treatment experience. Self-medication is common in both developed and developing countries; however, the prevalence of self-medication is higher in developing countries. The aim of this study was to determine the characteristics of antimicrobial self-medication in Georgia and its potential to influence the overall situation regarding antimicrobial consumption in the country. Methods: We conducted a cross-sectional study using a random sampling method and developed a self-administered questionnaire to collect the data. The survey was conducted via the Internet using the Google Forms platform. Results: The overall number of respondents was 742 adults living in Georgia. The results showed that 23.8% (n = 177) of adults had consumed antibiotics without a doctor's prescription, and 12.7% (n = 94) confirmed the use of antibiotics by their own decision to treat minor family members. The total prevalence of self-medication was 32.6%. The data analysis revealed a correlation between factor F1 ("personal experience") and gender (p = 0.042, F = 2.6), and between age and factor F2 ("lack of trust in medical practitioners") (p = 0.047, F = 2.691). The correlation was stronger among young adults (aged 18-24) and senior adults (aged 60+). The correlation between the level of education and factor F2 was stronger (p = 0.00; F1 = 7.9) than with factor F1 (p = 0.04; F = 2.2). Conclusion: Self-medication is prevalent in Georgia; pharmacies are the main sources of antimicrobials. No correlation was found between factor F2, pertaining to "lack of trust in medical practitioners" and gender, between age and factor F1, linked to "personal experience." The study uncovered a lack of knowledge about self-medication with antibiotics and emphasized the importance of public awareness campaigns and implementing effective interventions to regulate the sales of antibiotics without a doctor's prescription.

Sociodemographic characterisation of antibiotic heavy users in the Danish elderly population

AIMS

The development of effective interventions to reduce inappropriate use of antibiotics in the elderly population requires knowledge on who can benefit from such interventions. Thus, we aimed to identify and characterise antibiotic heavy users among elderly patients in general practice with respect to sociodemographic variables.

METHODS

We conducted a retrospective nationwide register-based study on all Danish elderly citizens (⩾65 years) who redeemed an antibiotic prescription in 2017. Heavy users were defined as the 10% with the highest excess use, that is, their recorded use minus the average use for their sex, age group and comorbidity level as estimated from a linear regression model. Comparative analyses of sociodemographic characteristics (civil status, employment status, urbanity, educational level and country of origin) of heavy users and non-heavy users were performed using logistic regression models.

RESULTS

The study population consisted of 251,733 elderly individuals, who in total redeemed 573,265 prescriptions of antibiotics. Heavy users accounted for 68% of all excess use of antibiotics. In multivariable analyses, individuals with an educational level above basic schooling, non-retired, residing in an urban municipality and being born in a country outside Scandinavia all had lower odds of being a heavy user. Widowed, divorced or single individuals had higher odds of being a heavy user compared with married individuals. Relative importance analyses showed that civil status and educational level contributed considerably to the explained variance.

CONCLUSIONS

This study found an association between sociodemographic characteristics and risk of being a heavy user, indicating that sociodemographic variation exists with regard to antibiotic prescribing.

Self-medication practice among pregnant and postpartum women attending the regional hospital center of Souss Massa, Morocco: a cross-sectional study

Background: Self-medication among pregnant women represents a serious risk to the mother's and child's health. It is a global concern that requires careful attention from professionals in healthcare. In Morocco, there is a lack of available data on self-medication and predicting variables among pregnant and postpartum women. The purpose of this study was to determine the incidence of self-medication and the factors that contributed to it among pregnant and postpartum women in the Sous Massa Regional Hospital. Methods: A cross-sectional study was conducted using a pretested questionnaire among 420 pregnant and postpartum women who were attending the regional hospital center of the Sous Massa region from April to December 2022. Statistical analysis was performed using Jamovi Software. The logistic regression analysis was used to determine the significance of the association between the outcome and independent variables. Results: The research enrolled 420 pregnant and postpartum women. During the current pregnancy, 24.8% of the women used self-medication. The leading common causes/symptoms that necessitate self-medication among pregnant and postpartum women were Anemia (84.8%), epigastralgia (16.8%), vomiting, pyrosis (15.2%), and urinary and vaginal infections The therapeutic families concerned with self-medication practice were Analgesics (41.4%), Antacids (20.3%), antimicrobials (13.5%), and Vitamin supplements (9%). According to the findings, the most frequent sources of information were pharmacists (45.6%), followed by physicians (44.3%). The primary reasons given by respondents for self-medication were the need for rapid release (51.7%), previous treatments with the same drugs (31.7%), and 20% reported difficulty of access to healthcare professionals. Out of 95.9% of the participants reported that they knew the dangers of self-medication and 96% of them were informed and received information about the dangers and contraindications of self-medication during pregnancy. This was significantly statistically associated with self-medication respectively with p-value = 0.031 and p-value = 0.005. Conclusion: The findings of the present study provide an initial awareness of the state of self-medication among pregnant and postpartum women attending the regional hospital centers. It is recommended that healthcare professionals increase their interventions to improve the consciousness of pregnant women; this might require implementing suitable strategies to regulate the commercialization, delivery, and use of conventional medications.

Patterns and Prevalence of Self-Medication in Saudi Arabia: Insights From a Nationwide Survey

Self-medication, the unsupervised use of drugs, is a common global behavior with potential adverse health outcomes. This study explores the prevalence and patterns of self-medication in Saudi Arabia, focusing on factors such as drug availability, economic constraints, and public trust in healthcare systems. Particular emphasis is placed on self-medication with antibiotics and prescription drugs due to their significant public health risks. Our comprehensive, quantitative, cross-sectional study surveyed 1,671 individuals across Saudi Arabia's diverse regions. We found that 75.5% of respondents engaged in self-medication, primarily on an occasional basis. While 59.8% of participants perceived self-medication as safe, 17.5% reported experiencing adverse effects. Respondents strongly advocated for increased regulatory measures (87.7%) and a pressing need for enhanced public education (92.6%) to address the associated risks. The study highlights the widespread practice of self-medication in Saudi Arabia, influenced by various factors, and underscores the need for targeted health policies and educational campaigns to mitigate these risks.

Patterns of Drug Utilization and Self-Medication Practices: A Cross Sectional Study

BACKGROUND

Self-medication (SM) is a growing phenomenon worldwide that has recently been classified as one of the most serious public health problems. SM can result in an incorrect self-diagnosis, inappropriate treatment, potential adverse reactions, interactions, and the masking of more sinister disease.

OBJECTIVES

To assess the prevalence of SM practices amongst healthcare professionals and the general population in Saudi Arabia and to identify the sociodemographic contributing factors to this practice.

METHODS

A total of 540 participants were enrolled in this study. Participants were asked to complete the study questionnaire comprising two sections to gather demographic information and to collect data regarding SM practice.

RESULTS

The prevalence of SM practice among the study participants was 78.6%, and it was the highest among the middle age groups of (21-40 years) 82% compared to the younger and older age groups. The observed prevalence was higher in the female participants (53.7%) and those who live alone. Type of education did not affect the attitude of SM (p = 0.374); however, level of education strongly affected the prevalence of the SM, with higher incidence among university graduates (p < 0.001). Analgesics with antipyretics properties were the most self-medicated drugs. Patients considering their illnesses minor was the main reason behind the high prevalence of this practice. Among healthcare professions the highest prevalence of SM was found among pharmacists (95%), followed by physicians, nurses, and other medical practitioners.

CONCLUSION

The general population should be better educated and made conscious about the consequences, risks, and side effects of SM. Awareness campaigns may prove to be useful in this matter, allowing the patient to consider the appropriateness of this practice. Individuals in the age group of 21-40 years, females, and those who live alone should be considered priority target populations in the design and implementation of SM awareness projects.

Antibiotic-Dispensing Patterns and Awareness of Anti-microbial Resistance Among the Community Pharmacists in South-Central India

Background Anti-microbial resistance (AMR) is an ongoing epidemic contributing to extremely high healthcare costs and hospital admissions. Inappropriate dispensing of antibiotics is one of the root causes of AMR. Hence, our study aimed to assess antibiotic-dispensing patterns and AMR awareness among pharmacists from South-Central India. Methodology This cross-sectional observational study was conducted over a period of two months from June to July 2023. The pharmacies in urban and semi-urban areas of coastal and central districts of the Indian state of Andhra Pradesh were surveyed. Data were collected using a predesigned questionnaire for antibiotic-dispensing patterns and awareness of AMR, as approved by the Institutional Ethics Committee of Aster Ramesh Hospital, Vijayawada, India. The data were collected and analyzed descriptively by cross-tabulation. Results Among the 389 pharmacies that responded, 78% (n = 303) were dispensing antibiotics over the counter (OTC) and 22% (n = 86) were dispensing antibiotics only for valid prescriptions. It was found that antibiotics were dispensed OTC for common ailments such as the common cold, cough, sore throat, nasal congestion, fever, diarrhea, and urinary tract infections. As per the World Health Organization-recommended Access, Watch, and Reserve (AWaRe) criterion, antibiotics under the Watch group such as macrolides (azithromycin), fluoroquinolones (ciprofloxacin, norfloxacin, levofloxacin, and ofloxacin) and third-generation cephalosporins (cefixime and cefpodoxime) were found to be widely dispensed OTC. The most common antibiotics dispensed OTC were azithromycin (54.1%), amoxicillin (47.5%), cefixime (40%), amoxicillin + clavulanic acid (15.2%), ofloxacin (13.5%), ciprofloxacin (10%), and doxycycline (6.6%). Among the OTC dispensers, 82.5% (n = 250) were unaware of AMR and 17.5% were partially aware. However, 57% (n = 49) were unaware of AMR and its effects, in pharmacies dispensing antibiotics for valid prescriptions. Conclusion Our findings aggregate evidence on the alarming trend of inappropriate antibiotic-dispensing patterns that may further exacerbate AMR. Strict regulatory enforcement and periodical monitoring to regulate antibiotic dispensing to control unethical dispensing are inevitably necessary.

Knowledge, Attitude, and Practice of using Antibiotics among the Community in Eastern Province, Saudi Arabia

Objectives

The purpose of this study is to explore and evaluate the knowledge, attitude, and practice of using antibiotics among the community in the Eastern Province, of Saudi Arabia.

Methods

A cross-sectional study was conducted, from February 2022 through March 2022, among people in Eastern Province, Saudi Arabia.

Results

The study population was 753 of the Saudi community. The questionnaire used open-ended and multiple-choice questions. Out of 753 participants, only 254 (55.6%) think that antibiotics can treat a bacterial infection, whereas 163 (35.7%) and 82 (17.9%) think it treats viral and fungal infections respectively. 26 (5.7%) of the respondents think that they should be stopped when the antibiotics are finished, while 72 (15.8%) think that they should be stopped when the symptoms disappear. The most common side effect in the respondent's opinion was diarrhea 183 (40%), followed by 168 (36.76%) antibiotics resistance. The major reason for taking antibiotics without a prescription was found to be mild symptoms 28 (50.90%), adequate information 21 (38.18%), difficulty in taking appointments 17 (30.90%), long waiting hours during the hospital visits 15 (27.27%). 169 (36.9%) kept the leftover antibiotics for reuse. The most common antibiotics used for self-medication were found to be Amoxicillin and clavulanic acid 23 (41.8%), followed by Amoxicillin 9 (16.36%). Knowledge of antibiotic resistance was highest in the age group 20-30 (62.7%) (P < 0.05).

Conclusion

People in Saudi Arabia show a high awareness of antibiotics' proper usage, and this returns to the great awareness campaign held by The Ministry of Health (MoH).

Assessment of home storage of antimicrobials and its predictors in Mecha demographic surveillance and field research center: a cross-sectional study

BACKGROUND

Home storage of antimicrobials is a worldwide practice. Irrational storage and inappropriate use of antimicrobials should get special attention in low-income countries due to limited information, knowledge, and perceptions. This study was conducted to survey home storage of antimicrobials and assess its predictors in Mecha Demographic Surveillance and Field Research Center (MDSFRC), Amhara region, Ethiopia.

METHODS

A cross-sectional survey was conducted on 868 households. Predeveloped structured questionnaire was used to collect data on sociodemographics, knowledge on antimicrobials and perception about home stored antimicrobials. Data was analyzed using SPSS version 20.0 to execute descriptive statistics, and run binary and multivariable binary logistic regression. P-value < 0.05 was considered significant at 95% confidence level.

RESULTS

The total number of households included in this study were 865. Female respondents represent 62.6%. The mean age (±) of respondents was 36.2 (± 13.93) years. The mean family size (±) of the household was 5.1 (± 2.5). Nearly one-fifth (21.2%) of the households stored antimicrobials at home with a condition similar to any household material. Most commonly stored antimicrobials were: Amoxicillin (30.3%), Cotrimoxazole (13.5%), Metronidazole (12.0%), and Ampicillin (9.6%). The most common immediate source of home stored antimicrobials was discontinuation of therapy (70.7%) either from symptomatic improvement (48.1%) or missing doses (22.6%). Predictors of home storage of antimicrobials with corresponding p-value were: age (0.002), family size (0.001), education status (< 0.001), home distance from the nearby healthcare institution (0.004), counseling while obtaining antimicrobials (< 0.001), knowledge level on antimicrobials (< 0.001), and perception of home stored antimicrobials as a wisdom (0.001).

CONCLUSION

Substantial proportion of households stored antimicrobials in a condition that may exert selection pressure. To reduce home storage of antimicrobials and its consequences, stakeholders should give due attention to predictors variables related to sociodemographics, level of knowledge on antimicrobials, perception of home storage as a wisdom, and counseling service.

Modalities of group A streptococcal prevention and treatment and their economic justification

Infection by group A Streptococcus (Strep A) results in a diverse range of clinical conditions, including pharyngitis, impetigo, cellulitis, necrotising fasciitis, and rheumatic heart disease. In this article, we outline the recommended strategies for Strep A treatment and prevention and review the literature for economic evaluations of competing treatment and prevention strategies. We find that most economic evaluations focus on reducing the duration of illness or risk of rheumatic fever among people presenting with sore throat through diagnostic and/or treatment strategies. Few studies have evaluated strategies to reduce the burden of Strep A infection among the general population, nor have they considered the local capacity to finance and implement strategies. Evaluation of validated costs and consequences for a more diverse range of Strep A interventions are needed to ensure policies maximise patient outcomes under budget constraints. This should include attention to basic public health strategies and emerging strategies such as vaccination.

Determinants of antibiotic self-medication: A systematic review and meta-analysis

BACKGROUND

Decreasing the prevalence of antibiotic self-medication among the public requires proper understanding of the risk factors involved. However, the determinants of antibiotic self-medication are not well defined.

OBJECTIVES

To identify patient and health system-related determinants of antibiotic self-medication among the public.

METHODS

A systematic review of quantitative observational studies and qualitative studies was undertaken. PubMed, Embase, and Web of Science were searched to identify studies on determinants of antibiotic self-medication. The data were analyzed using meta-analysis, descriptive analysis, and thematic analysis.

RESULTS

Sixty-eight studies were included in the review. From meta-analyses, male sex (pooled odds ratio [POR]: 1.52, 95% confidence interval [CI]: 1.19-1.75), lack of satisfaction with healthcare services/physicians (POR: 3.53, 95% CI: 2.26-4.75) were associated with antibiotic self-medication. In subgroup analysis, lower age was directly associated with self-medication in high-income countries (POR: 1.61, 95% CI: 1.10-2.36). In low- and middle-income countries, people with greater knowledge of antibiotics were less likely to self-medicate (POR: 0.2, 95% CI: 0.08-0.47). Patient-related determinants identified from descriptive and qualitative studies included previous experience with antibiotics and similar symptoms, perceived low severity of disease, intention to save time and get better quickly, cultural beliefs about curative power of antibiotics, advice from family/friends, and having home stock of antibiotics. Health system-related determinants included high cost of consulting physicians and low cost of self-medication, lack of access to physician/medical care, lack of trust/confidence in physicians, greater trust in pharmacists, long distance of physicians/healthcare facilities, long waiting time at healthcare facilities, easy access to antibiotics from pharmacies, and convenience associated with self-medication.

CONCLUSIONS

Patient and health system-related determinants are associated with antibiotic self-medication. Interventions to decrease antibiotic self-medication should incorporate community programs along with appropriate policies and healthcare reforms targeting these determinants with specific attention to population at high risk of self-medication.

Prevalence and Predictors of Using Antibiotics without a Prescription in a Pediatric Population in the United States

Non-prescription antibiotic use (using antibiotics without clinical guidance) increases the risk of the development of antibiotic resistance, adverse drug reactions, and other potential patient harm. Few studies have explored non-prescription use in children in the U.S. From January 2021 to April 2022, a diverse sample of caregivers of children under 18 years were surveyed in English and Spanish at two safety net clinics in Texas. We assessed the prevalence of antibiotic use in children in the previous 12 months, storage of antimicrobials, and intended use of non-prescription antibiotics (professed intention for future non-prescription antibiotic use). We also measured sociodemographic factors, types of antibiotics used, and symptoms that trigger non-prescription use. The response rate was 82%, and 17% were surveyed in Spanish. Of 322 participants surveyed, three Spanish-speaking caregivers reported giving non-prescription antibiotics to their child in the previous 12 months. Approximately 21% (n = 69) reported storing antimicrobials at home, specifically amoxicillin (n = 52), clindamycin (n = 10), cephalexin (n = 5), penicillin (n = 3), and trimethoprim/sulfamethoxazole (n = 3). Nearly 15% (n = 46) reported intention to give non-prescription antibiotics to their children. Younger caregiver age was associated with storage and intended use of non-prescription antibiotics. Our findings will guide the development of an educational intervention to decrease non-prescription antibiotic use.

Behavioral and Knowledge Patterns Regarding the Use of Antibiotics Among Urban and Rural Population in Bosnia and Herzegovina-a Cross-sectional Study

Background

Antimicrobial resistance imposes one of the leading global health issues and is strongly associated with the overuse and misuse of antimicrobials.

Objective

The present study aimed to determine the level of knowledge, attitudes, and behavior regarding the use of antibiotics among urban and rural population in the southeastern European country of Bosnia and Herzegovina.

Methods

A cross-sectional questionnaire-based study was conducted by convenience sampling technique among people who visited health centers, malls, and also online. In total, 1057 questionnaires were completed, of which 920 were completed in the city of Mostar (i.e. urban area), while 137 in the municipality of Grude (i.e., rural area). Descriptive statistical analysis was performed to process the results.

Results

Participants from Mostar had better knowledge about antibiotics (p = 0.031) and a higher level of education (p = 0.001). Women showed markedly better knowledge in the group of urban area responders (p = 0.004). Improper use of antibiotics was more common among respondents from Grude; they tend to use antibiotics more frequently and almost half of them are prone to self-medication (p = 0.017). Overall, those classified with adequate knowledge showed less tendency to irregular antibiotic intake. Having a medical worker in a family was significantly associated with better knowledge regarding antibiotics, while educational level was not.

Conclusion

Although a significant number of respondents showed adequate knowledge about the use of antibiotics, there were noticeable irregular behavioral patterns, while significant differences between urban and rural population were detected as well. Further analysis is required to access the whole specter of the issue and to initiate policies directed toward reducing inappropriate use of antibiotics and bacterial resistance to these medications.

Dispensing of antibiotics without prescription in the metropolitan area of Athens, Greece, in 2021-Can new legislation change old habits?

Objective

To assess the effect of new legislation on the dispensing of antimicrobials without prescription from pharmacies in Greece.

Design

In-person survey.

Setting

The study included 110 pharmacies in the greater Athens Metropolitan area.

Methods

Volunteer collaborators visited 110 pharmacies in the greater Athens Metropolitan area in December 2021 and January 2022. They asked for either ciprofloxacin or amoxicillin-clavulanate acid (6:5 ratio) without providing a prescription, without simulating symptoms, and without offering justification or insisting. Fluoroquinolones have additional dispensing restrictions in Greece. Results were compared to a 2008 study. In 2020, legislation allowed the dispensing of antibiotics from pharmacies only with an electronic prescription, overriding the 1973 forbidding the dispensing of all medications without prescriptions.

Results

All pharmacists refused to dispense ciprofloxacin without a prescription. Only 1 pharmacy dispensed amoxicillin-clavulanate without a prescription. Compared to the 2008 study, dispensing of amoxicillin-clavulanate without a prescription dropped from 100% in 2008 to 1% in 2021 and dispensing ciprofloxacin without a prescription dropped from 53% in 2008 to 0% in 2021.

Conclusions

A new and enforced law that requires electronic prescribing led to a dramatic reduction of antibiotic dispensing without prescription compared to 12 years ago. Similar initiatives could help solve the problem of antibiotic consumption and resistance in Greece and elsewhere.

Pre-Visit Use of Non-Prescribed Antibiotics among Child Patients in China: Prevalence, Predictors, and Association with Physicians’ Prescribing of Antibiotics at Medical Visits

Antibiotic resistance is one of the most serious global public health crises. Inappropriate use of antibiotics is an important contributor. Using a cross-sectional survey, we recruited 3056 caregivers from 21 provinces in China to complete a questionnaire pertaining to their most recent medical visits for children’s acute respiratory tract infection (ARTI) symptoms in October 2013. The findings show that the prevalence of caregivers giving children non-prescribed antibiotics before their medical visit was as high as 38%. Caring for an older child and having lower educational attainment increased the likelihood of self-medication with antibiotics; among Chinese residential areas, caregivers living in tier 2 urban districts were most likely to administer non-prescribed antibiotics before their visit. Physicians’ prescribing of antibiotics was significantly associated with caregivers’ self-reported pre-visit use of non-prescribed antibiotics. Misuse should be addressed by regulating the sale of antibiotics and improving communication at medical consultations.

A Cross-Sectional Study of the Knowledge, Attitude, and Practice of Self-Medication Among the General Population in the Western Region of Saudi Arabia

Introduction Self-medication (SM) is defined as consuming pharmaceutical drugs without the advice of a physician for either diagnosis or treatment. Reliance on self-medication has become a more common worldwide issue and now plays a major role in self-care. However, the practice is linked to many risks for patients and the whole community. This study assesses knowledge, attitudes, and practices associated with self-medication in the western region of Saudi Arabia. Methods This is an observational questionnaire-based cross-sectional study conducted over two months, between January and March 2022. The survey comprised 29 questions adapted from similar studies and was translated into Arabic to fit the study population. All residents of the three major cities, Makkah, Jeddah, and Taif, were included; the population under 18 years of age and health workers were excluded. We used OpenEpi version 3.0 (www.OpenEpi.com) for sample size calculation and Statistical Package for Social Sciences (IBM Corp, Armonk, USA) was used for data analysis. Results Most of the participants (67.7%) declared that they practiced self-medication: (28.6%) men and (39.1%) women. Self-medicating for different indications showed differences between men and women but without statistical significance. Major indications for self-medicating were headache (45.3%), cough, cold/flu (42.7%), and fever (34.0%). The primary reasons participants gave for choosing to self-medicate were easy availability of the medicines (41.4%) and that they were treating a minor illness (40.8%). Many types of medicines were used, most commonly analgesics (44.0%) and antipyretics (43.6%). Conclusion The practice of self-medication is high among the population in Makkah, Jeddah, and Taif. Educating the public on the consequences and adverse effects is necessary.

Knowledge, Attitudes and Practices of Parents and Pediatricians Regarding Antibiotic Use among Children: Differences in Relation to the Level of Education of the Parents in the Republic of Srpska Bosnia and Herzegovina

Antibiotics are often misused, especially for the treatment of upper respiratory tract infections (URTIs) in children, where their use is unnecessary and leads to antimicrobial resistance. This study sought to explore the knowledge, attitudes and practices (KAP) of parents and pediatricians on the use of antibiotics among children and whether the level of education of parents has an impact on their KAP. The research was carried out among 1459 parents of children under 6 years of age and among 18 pediatricians. Sixty percent of pediatricians (61.1%) were prescribed antibiotics daily in their practice. Most of the surveyed parents (98.4%) state that doctors are their main source of information when deciding on the use of antibiotics in the treatment of their children. Parents with a higher level of education use television less often as a source of information when making this decision compared to parents with a lower level of education (p = 0.039, i.e., p = 0.003). The majority of parents (80.7%) knew that Panklav (amoxicillin/clavulanic acid) is an antibiotic, while 52.5% identified Pancef (cefixime) as an antibiotic. Parents with a higher level of education correctly identified antibiotics significantly more often (p < 0.001). This study shows that in the Republic of Srpska, parents have adequate knowledge about antibiotics, especially those with a higher level of education, who show better KAP when it comes to antibiotic use.

Non-prescription acquisition of antibiotics: Prevalence, motives, pathways and explanatory factors in the Swedish population

Prior studies indicate prevalence of unregulated non-prescription use of antibiotics also in the northern European countries. The aim of this study is to investigate the extent to which antibiotics are acquired without prescription in Sweden, and people’s attitudes and motives linked to this practice. We use data from an online survey of a representative sample of the Swedish general population which included questions about respondents’ antibiotic use, attitudes towards antibiotics, health care contacts, self-rated health and trust in health care. We also asked about their reason for obtaining/not obtaining antibiotics without a prescription. The results show that, in the last five years, 2,3% of the respondents had acquired antibiotics in other ways than from a Swedish physician having issued a prescription, and 4,3% reported that they are likely to do so in the future. We also show that the two most important reasons for non-prescription acquisition were physicians’ refusal to prescribe antibiotics followed by travel abroad. The most important reason for not obtaining antibiotics without a prescription was to not contribute to antibiotic resistance. Using logistic regression, we show that non-prescription acquisition of antibiotics, and the intention to engage in this practice in the future, are strongly associated with low trust in health care.

Prevalence of inappropriate use behaviors of antibiotics and related factors among chinese antibiotic users: an online cross-sectional survey

Background

Inappropriate use of antibiotics could have a profound negative impact on individual and community. This study aimed to assess the prevalence of inappropriate use behaviors of antibiotics in Chinese antibiotic users and explored their related factors.

Methods

A cross-sectional survey was conducted from July 1, 2018 to September 30, 2018. A structured questionnaire was widely distributed on the online survey platform (Questionnaire Star, https://www.wjx.cn) and was used to collect data from respondents in China on demographic and sociological characteristics, antibiotic use and related knowledge. Main outcomes included self-medication with antibiotics (SMA), self-storage with antibiotics (SSA), and non-adherence to antibiotic treatment (NAAT). Logistic regression was used to identify the related factors of above inappropriate use behaviors of antibiotics.

Results

Of the 15,526 participants, 37.1% reported SMA in the past 6 months, 67.9% reported SSA in the past 6 months, and 48.3%, 15.2%, 25.5% and 78.0% of respondents said that they had missed antibiotics, increased antibiotic dosage, decreased antibiotic dosage, and discontinued antibiotics once symptoms disappear, respectively. Overall, 53.3% reported NAAT during this period. After adjusting for other variables, multivariate logistic regression analyses showed that those aged 30–44 years old, with higher levels of education, poorer status of self-perceived health, or lower levels of antibiotic knowledge were more likely to have these inappropriate use behaviors of SMA, SSA, and NAAT (P < 0.05).

Conclusions

The prevalence of SMA, SSA, and NAAT is high in China. Developing a nationwide action plan for the rational use of antibiotics among publics, including national media publicity, online and offline health education, and medication guidance from general practitioners, is urgently needed.

Self-medication with antibiotics, self-storage with antibiotics, and non-adherence to antibiotic treatment are important performances of inappropriate use behaviors of antibiotics.

The results of this study showed that the prevalence of inappropriate use behaviors of antibiotics among Chinese antibiotic users were between 37.1% and 67.9%.

A nationwide action plan for rational use of antibiotics is urgently needed in China.

Risk factors associated with self-medication among the indigenous communities of Chittagong Hill Tracts, Bangladesh

Background

In developing countries like Bangladesh, self-medication has become a predicament associated with health risks and clinical complications. To date, no studies have been conducted on the practice of self-medication among the indigenous population living in Chittagong Hill Tract (CHT).

Objectives

This study was aimed to determine the prevalence of self-medication and analyzing the factors associated with it among the indigenous population in CHT.

Methods

This cross-sectional study was conducted from late October to early December 2020; among different indigenous group populations residing in the three districts of CHT aged 18 or more. A pre-tested and semi-structured questionnaire was developed to collect data on socio-demographic characteristics, health status, frequency of self-medication, reasons for self-medication in last one year, as well as other variables. Multivariate logistic regression was performed to assess associated factors with self-medication.

Results

A total of 1350 people from different indigenous populations were interviewed, among whom 49.9% practiced self-medication. The rate of self-prescribed antibiotics usage (80.9%) was significantly higher compared to other drugs. Self-prescribed medications were mostly used for diarrhea and food poisoning (60.6%), cough, cold and fever (51.4%), and headache (51.4%). A common source of self-prescribed medicines was community or retail pharmacy and the most reported reason for self-prescribed medication was the long-distance of healthcare facilities from home.

Conclusion

The prevalence of self-medication is substantially high among indigenous people and the effect is alarming. Particular concern is the misuse of antibiotics and analgesic drugs. Increasing awareness among the population of the negative effect of self-medication and implementation of proper policies and actions are urgently needed to prevent self-medication among indigenous population in Bangladesh.

Education level and misuse of antibiotics in the general population: a systematic review and dose-response meta-analysis

BACKGROUND

Numerous studies evaluated the association of education level with misuse of antibiotics by the general population, yet divergent findings were reported. Therefore, a meta-analysis was conducted to summarize this association.

METHODS

A categorical and continuous dose-response meta-analysis of the association of education level with antibiotic misuse was undertaken. Summary odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated using random-effect model.

RESULTS

The meta-analysis included 85 studies from 42 countries of different socioeconomic status. Compared to low education (≤ 9 years), medium education (> 9-12 years) is associated with 20% lower odds of antibiotic misuse in high-income countries (OR = 0.80; 95% CI 0.66, 0.97), while high education (> 12 years) is associated with 14% lower odds of any aspect of antibiotic misuse (OR = 0.86; 95% CI 0.72, 1.03). The association is more pronounced in Middle East (OR = 0.64; 95% CI 0.42, 1.00) and countries of lower-middle economies (OR = 0.67, 95% CI 0.41, 1.11). Inversely, in Europe, high education is associated with 25% higher odds of antibiotic misuse (OR = 1.25, 95% CI 1.00, 1.58). Each additional year of education was associated with 4% lower odds of any aspect of antibiotic misuse in lower-middle economies (OR = 0.96; 95% CI 0.92, 1.00) and in Middle East (OR = 0.96; 95% CI 0.93, 1.00). Conversely, it was associated with 3% higher odds of antibiotic storage, a specific type of misuse (OR = 1.03, 95% CI 1.01, 1.06).

CONCLUSION

Individuals misuse antibiotics irrespective of their education level. Intervention programs to enhance the proper use of antibiotics should target all communities independent of their education level.

Knowledge, attitudes and practices of parents regarding antibiotic use among children: Differences between urban and rural areas in the Republic of Srpska

Background/Aim: Antibiotic use and resistance represent a growing public health issue, with a specific risk of uncontrolled use of antibiotics in children. The aim of the study was to examine differences in parental knowledge, attitudes and practices about antibiotic use in children between urban and rural areas of the Republic of Srpska. Methods: A cross-sectional study was conducted among 1459 parents of children under 6 years of age, out of which 1201 (82.3 %) lived in urban areas while 258 (17.7 %) lived in rural areas. The research is conducted among parents who brought their children to the selected primary healthcare centres and among parents of children in preschool institutions. Results: The majority of respondents (98.4 %) state that doctors are their main source of information. Only 61.2 % of respondents precisely know which drug is an antibiotic when offered different drugs and respondents from rural areas (54.3 %) more often (p = 0.012) gave more accurate answers when compared to respondents from urban areas (37.3 %). Among parents, 86 % agree with the statement that improper use of antibiotics reduces their effectiveness and leads to bacterial resistance, regardless of groups. More than a half of respondents (52.4 %) do not think that children with flu or common cold symptoms recover faster when they receive antibiotics, significantly more respondents from urban areas (p = 0.001). Respondents from rural areas significantly more often believe that antibiotics can produce harmful effects compared to respondents from urban areas (p = 0.049). Respondents from rural areas significantly more often think that antibiotic use can prevent complications caused by inflammation of the upper respiratory tract (p = 0.006). Parents from rural areas give their children antibiotics without a paediatrician's recommendation significantly more often (4.3 %) compared to respondents from urban areas (0.6 %) (p < 0.001). Conclusion: There are differences in parental knowledge, attitudes and practices regarding antibiotic use and antimicrobial resistance among parents in rural and urban areas. There is need for additional education of parents and for greater engagement of paediatricians in providing guidance and explanations regarding the use of antibiotics.

SARS-CoV-2 and self-medication in Cameroon: a mathematical model

Self-medication is an important initial response to illness in Africa. This mode of medication is often done with the help of African traditional medicines. Because of the misconception that African traditional medicines can cure/prevent all diseases, some Africans may opt for COVID-19 prevention and management by self-medicating. Thus to efficiently predict the dynamics of COVID-19 in Africa, the role of the self-medicated population needs to be taken into account. In this paper, we formulate and analyse a mathematical model for the dynamics of COVID-19 in Cameroon. The model is represented by a system of compartmental age-structured ODEs that takes into account the self-medicated population and subdivides the human population into two age classes relative to their current immune system strength. We use our model to propose policy measures that could be implemented in the course of an epidemic in order to better handle cases of self-medication.

A scoping review of global aminoglycoside antibiotic overuse: A potential opportunity for primary ototoxicity prevention

BACKGROUND

Aminoglycosides are widely used, broad-spectrum antibiotics with significant potential for ototoxicity. Global efforts to prevent ototoxicity must account for aminoglycoside overuse and non-prescription use.

OBJECTIVES

The goals of this study were to a) estimate the prevalence of aminoglycoside overuse by synthesizing evidence on self-medication, over the counter (OTC) availability, and household antibiotic storage for later use, and to report the specific aminoglycosides used and the predictors of overuse, and b) leverage this information to comment on potential risk of ototoxicity.

METHODS

Two systematic search strings were conducted to extract peer-reviewed articles published from 2005 to 2020. The first focused on overuse of aminoglycoside antibiotics. The second focused on potentially ototoxic effects of aminoglycosides related to drug overuse.

RESULTS

A total of 26 articles were included (first search string: n = 21; second search string: n = 5). The prevalence of aminoglycoside self-medication was high and household storage and OTC availability of aminoglycosides was common. Gentamicin was the most commonly overused aminoglycoside. No studies provided information on antibiotic dosing or resultant toxicities, including ototoxicity.

CONCLUSIONS

The limited available evidence indicates that antibiotic overuse (self-medication, home storage, and non-prescription availability) is relatively common, especially in low resource settings, and that aminoglycoside antibiotics comprise a variable, but concerning, proportion of non-prescribed antibiotics. Additional evidence is needed to evaluate the relationship between these dispensing patterns and ototoxicity.

Assessing the Syrian Population's Knowledge, Attitudes, and Practices Regarding Antibiotic Usage

Background Antibiotic resistance is a serious public health threat that results mainly secondary to antibiotics misuse. The present study aimed to determine the knowledge, attitude, and practice toward antibiotic use among the Syrian population. Methods This cross-sectional study was conducted at the outpatient clinics of two major hospitals in Damascus, Syria. Applying a random convenience sampling, data were collected in a 1-week period by interviewing participants using a structured questionnaire, which targeted demographics, practice, knowledge, and attitude. Data were used to assess the relationship between the knowledge level and attitudes and demographics. Results Most respondents had a moderate level of knowledge (187, 74.8%) and a moderate attitude score (148, 59.2%). In addition, most respondents (149, 59.6%) stated that they take antibiotics based on pharmacist advice only and do not complete the full antibiotic course (200, 80%). A significant association was found between the knowledge level and financial status ( p -value = 0.003), education level ( p -value = 0.001), and having relatives working in the health care sector ( p -value = 0.021). In addition, a significant association was found between the attitude and having health insurance. Conclusion This study provides baseline evidence about the knowledge, attitudes, and practices regarding antibiotics among the Syrian population, that will help in designing targeted interventions to solve the inappropriate use of antibiotics.

Prevalence and Predictors of Self-Medication Practices in India: A Systematic Literature Review and Meta-Analysis

BACKGROUND

Self-Medication (SM) is a practice of using medications to treat selfdiagnosed symptoms without a legitimate prescription by a health care professional. Alongside posing a burden on a patient, SM practices are associated with certain unfavourable health conditions such as drug-resistance, adverse effects, drug-interactions, including death.

OBJECTIVE

To systematically review and quantify the prevalence of SM practices and its associated factors in India.

METHODS

A comprehensive systematic search was performed using scientific databases such as PubMed and Cochrane library for the peer-reviewed research articles that were conducted in India without any language and date restrictions. Studies which were cross-sectional by design and assessing the prevalence and predictors of SM practices in India were considered for the review, and all the relevant articles were screened for their eligibility.

RESULTS

Of 248 articles, a total of 17 articles comprising of 10,248 participants were included in the meta-analysis. Overall, the mean prevalence of SM practices in India was observed to be 53.57%. Familiarity with the medication appears to be a major reason to practice SM (PR: 30.45; 95% Confidence Interval [CI]: 17.08-43.82; 6 studies), and the practice was noticed more among individuals from a middle-lower class family with a prevalence rate of 26.31 (95%CI: 2.02-50.60; P<0.0001). Minor ailments were the primary reason for practicing SM (PR: 42.46; 95%CI: 21.87- 63.06), among which headache was the most commonly reported (PR: 41.53; 95%CI: 18.05-65.02).

CONCLUSION

Self-medication practices are quite frequent in India. While NSAIDs and anti-allergens are the most frequently utilized self-medicated drugs used for headache and cold and cough.

Prevalence of and Risk Factors for Nonprescription Antibiotic Use among Individuals Presenting to One Hospital in Saudi Arabia after the 2018 Executive Regulations of Health Practice Law: A Cross-Sectional Study

Antibiotic resistance is a worldwide public health emergency. Nonprescription antibiotic use is a chief cause of antibiotic resistance. The Saudi Government, as a consequence, imposed in 2018 executive regulations to prevent the distribution of antibiotics without a prescription. Herein, we aimed to investigate the prevalence of and risk factors for nonprescription antibiotic use among individuals presenting to one hospital in Saudi Arabia after enacting these regulations. This cross-sectional study was conducted on people, aged ≥18 years, who presented to the primary healthcare clinics of King Khalid University Hospital in Riyadh during the period between 1/1/2019 and 28/2/2019. Participants were asked to fill out a self-administrated questionnaire assessing their nonprescription antibiotic use during the past year in addition to sociodemographic information. Then, logistic regression analyses were performed to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for age, sex, education, and nationality of any nonprescription antibiotic use compared with no use within the past year. Out of 463 participants, 62.9% were females, 67.4% were <40 years, and 93.7% were Saudi citizens. Overall, 30.5% of participants reported nonprescription antibiotic use during the past year (19.7% one to two times and 10.8% more than two times). Male and non-Saudi participants were more likely to report any nonprescription antibiotic use, with HRs (95% CIs) of 1.99 (1.30, 3.04) and 3.81 (1.73, 8.35), respectively. The main reasons behind nonprescription antibiotic use were having previous experience with a health condition (69.2%), inaccessibility of healthcare (26.6%), and recommendation from a relative or a friend (16.1%). A major limitation of this study was that it included individuals attending one hospital. Individuals who seek medical consultation could be dissimilar to those who do not see doctors regarding nonprescription antibiotic use.

Trends in Antibiotic Self-Medication for Dental Pathologies among Patients in the Dominican Republic: A Cross-Sectional Study

The World Health Organisation has warned of the increase in antibiotic resistance, estimating that by 2050 it could become the leading cause of death worldwide. Several studies and literature reviews show a correlation between antibiotic use and bacterial resistance, with unnecessary broad-spectrum antibiotics, such as amoxicillin/clavulanic acid and azithromycin, being one of the main causative factors. An interview-based survey of 2160 participants was conducted to assess the prevalence in the practice of self-medication with antibiotics among dental patients in the Dominican Republic. A series of open-ended questions regarding self-medication and class of antibiotics were put to the patients. Over a third of the study population (39.7%) admitted to the practice of antibiotic self-medication. Most of the respondents (58.4%) who indulged in self-medication were females, and it was prevalent in the older adults between 32–42 years old (36%). There was a negative correlation between age and self-medication practice (p < 0.001) observed with point biserial correlation test. Binary logistic regression analysis found an odds ratio of 0.97 (p < 0.001). The most consumed antibiotics were amoxicillin/clavulanic acid (52%), amoxicillin (31.1%), and azithromycin (10.1%). It is imperative to educate patients about the harmful effects of self-medication and to stress the need for governments to implement stricter laws on non-prescription drug availability.

Parental Knowledge, Attitude, and Practices on Antibiotic Use for Childhood Upper Respiratory Tract Infections during COVID-19 Pandemic in Greece

This cross-sectional study aims to assess parents' knowledge, attitude, and practices on antibiotic use for children with URTIs symptoms in Greece in the era of the COVID-19 pandemic. We distributed a questionnaire to a random sample of parents who visited primary health care centers in Patras, Greece. Out of 412 participants, 86% believed that most infections with common cold or flu symptoms were caused by viruses, although 26.9% believed that antibiotics may prevent complications. Earache was the most common symptom for which antibiotics were needed. Most of them (69%) declare being considerably anxious about their children's health during the COVID-19 pandemic. The majority (85%) knew that COVID-19 was of viral origin, yet half of them declared uncertain whether antibiotics were needed. All demographic characteristics, except for gender, were found to have a significant effect on parents' knowledge, attitude, and practices on antibiotic use for URTIs and COVID-19. Factor analysis revealed six groups of parents with common characteristics associated with misuse of antibiotics. Our findings highlight the need to decrease misconceptions regarding antibiotic use by providing relevant education for parents targeting particular characteristics, especially during the COVID-19 pandemic. Continuous education of healthcare providers in the field is also of paramount importance.

Prevalence of self-medication with antibiotics and its related factors among Chinese residents: a cross-sectional study

Background

Self-medication is one of the most common forms of inappropriate use of antibiotics. This study aimed to assess the prevalence of self-medication with antibiotics (SMA) in China and evaluate the related factors.

Methods

A cross-sectional survey was conducted in Wuhan, Hubei, China from July 1, 2019 to July 31, 2019. Participants were recruited in public places to answer a structured questionnaire. The information of participants’ social demographic characteristics, antibiotic knowledge and health beliefs were collected. Binary Logistics regression analysis was used to examine the associated factors of SMA.

Results

Of the 3206 participants, 10.32% reported SMA in the past 6 months. Participants who with middle or high perceived barriers to seek health care services showed a higher likelihood of SMA (P < 0.05). Participants who with middle or high perceived threats of self-medication, and who with middle or high self-efficacy to overcome obstacles showed a lower likelihood of SMA (P < 0.05).

Conclusions

Compared with developed countries, the prevalence of SMA in China is still higher. Measures to conduct public health education and improve the accessibility of health services are crucial to decrease the overall self-medication rate in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13756-021-00954-3.

Factors Related to Antibiotic Supply without a Prescription for Common Infections: A Cross-Sectional National Survey in Sri Lanka

Inappropriate antibiotic use is a problem in Sri Lanka. We investigated pharmacy staff’s attitudes towards antibiotic supply for common infections in Sri Lanka. A self-reported cross-sectional survey was conducted among a random sample (n = 369) of pharmacies. We assessed staff’s beliefs and attitudes to antibiotic supplying for common infections (common cold and cough, sore throat, diarrhoea, wound and urinary tract infections (UTI)). Pharmacists (n = 210; 79%) and pharmacy assistants (n = 55: 21%) responded. About 30% (80/265) had supplied antibiotics without a prescription for common infections, including common cold (15.8%), sore throat (13.6%) and diarrhoea (10.2%). Overall, pharmacists were less likely to supply than non-pharmacists. Pharmacy staff with more positive beliefs about their professional competency to supply and monitor antibiotic use were more likely to supply antibiotics without a prescription for common cold (Adj.OR = 1.08; 95% CI: 1.01–1.15; p = 0.032), wound infections (Adj. OR = 1.06; 95% CI: 1.00–1.13; p = 0.059), and UTI (Adj.OR = 1.07; 95% CI: 0.99–1.15; p = 0.097). Pharmacy staff who believed in the effectiveness of antibiotics against common infections were more likely to supply antibiotics for common infections. Supply of antibiotics without a prescription was associated with staff’s beliefs about antibiotics’ effectiveness and their professional competency. Our findings could be used to strengthen regulatory strategies to improve practice.

Patient perception about the need for antibiotics after tooth extractions: A cross-sectional study

BACKGROUND

Although the current scientific literature does not support the routine use of antibiotics after dental extractions, patients believe that these drugs offer clear benefit during the postoperative period. The main objective of this study was to describe patient perception of the need for antibiotics after routine tooth extraction and to assess knowledge about the benefits and adverse effects of antibiotic therapy.

MATERIAL AND METHODS

A cross-sectional study was carried out. A total of 452 participants requiring tooth extraction and seen in the Dental Clinic of the University of Barcelona (Barcelona, Spain) were given a specific questionnaire on the need for antibiotics after dental treatments or diseases, and on their benefits and adverse effects. Descriptive bivariate and multivariate (logistic regression model) analyses were performed.

RESULTS

Of the 452 participants, 185 (40.9%) were men and 267 (59.1%) were women, with a mean age of 35.2 ± 15.9 years. Most of the patients (76.6%) expected to take antibiotics after tooth extraction. A higher level of education, older age and knowledge about bacterial resistances were inversely correlated to the perceived need for antibiotic treatment (p<0.05). According to the respondents, the main advantage of antibiotics was the reduction of infection rates, while the most frequently mentioned adverse events were allergic reactions, diarrhea and nausea or vomiting.

CONCLUSIONS

Most patients think that antibiotics are necessary after routine dental extraction to prevent postoperative infection. Younger patients with a low educational level and who are unaware of the problem posed by bacterial resistances seem to be more supportive of antibiotic prophylaxis. Most respondents are familiar with the main benefits and adverse effects of these drugs. Key words:Antibiotic, microbial drug resistance, tooth extraction, oral surgery, survey, postoperative wound infection.

Rapid antigen detection test (RADT) for pharyngitis diagnosis in children: Public and pharmacist perception

Background

Most common sought antibiotic-self treated infection globally is pharyngitis (sore throat). The aim of this study is to assess public's acceptance and potential use of Rapid Antigen Detection Test at community pharmacies in the diagnosis of bacterial pharyngitis in children prior to antibiotic dispensing in Saudi Arabia.

Method

A qualitative cross-sectional study was conducted on October 2017. Two self-conducted questionnaires were used. One targeted the public above 21 years old and was distributed via social media. The other randomly targeted community pharmacists in Jeddah.

Result

A total of 689 of the public and 40 community pharmacists completed the survey. Moreover, 571 (82.9%) of the public received antibiotics without a prescription; for symptoms related to sore throat (71%) followed by flu-like symptoms (24%). Only (3.77%) and (5%) of both public and community pharmacies have heard about RADT respectively, however the majority (93.03%) and (90%) of both respectively support its use in community pharmacies. Coded reasons for its use was mainly to decrease antibiotic misuse and/or abuse, increased specificity, decreased antibiotic side effects including bacterial resistance, and ease of use.

Conclusion

Both public and community pharmacists support the idea of using RADT. Future efforts should look into pharmacist's role in providing point of care tests that are cost-effective and convenient for the public.

Self-medication Behavior with antibiotics: a national cross-sectional survey in Sri Lanka

BACKGROUND

Antibiotic self-medication is common in low- and middle-income countries. This study aimed to evaluate the Sri Lankan public's knowledge about and attitudes toward antibiotic use and self-medication, and factors associated with self-medication.

METHODS

A national cross-sectional, interviewer-administered, survey of a random household sample (N = 1100) was conducted. Factor analysis of the attitudinal items was conducted to investigate the factors associated with antibiotic self-medication.

RESULTS

A response rate of ninety-one percent (n = 998) responded. Knowledge about antibiotics was poor (mean = 12.5; SD = 3.5; (scale 0-27)). Half had previously used an antibiotic once in the past three months. About 11% (108/998) had self-medicated the last time they took antibiotics; mostly obtained from a pharmacy (82%; 89/108). Three attitudinal factors were obtained, explaining 56.1% of the variance. Respondents were less likely to self-medicate if they did not support ease of access to antibiotics from pharmacies (p< 0.001) and situational use of antibiotics (p= 0.001); supported appropriate use of antibiotics (p= 0.003); and had greater knowledge about prescription requirements for antibiotics (p= 0.004).

CONCLUSION

There is limited knowledge about, and a high rate of self-medication with antibiotics.Factors contributing to self-medication could be addressed with appropriate public education campaigns, and policy changes.

Knowledge and behavior of consumers towards the non-prescription purchase of antibiotics: An insight from a qualitative study from New Delhi, India

Background:

In Low-and Middle-Income Countries, including India, consumers often purchase antibiotics over-the-counter (OTC) from retail pharmacies. This practice leads to the inappropriate use of antibiotics in the community which is an important driver for the development of antimicrobial resistance. A better understanding of consumers’ views towards this grave public health concern is critical to developing evidence-based intervention programs for awareness among the general population.

Objective:

To explore knowledge, practice and, behavior of consumers towards antibiotics, antibiotic use, antimicrobial resistance, purchasing behavior of consumers for antibiotics, and to gain insight which will help in developing evidence-based policy interventions.

Methods:

72 in-depth consumer interviews were conducted in all 11 districts of the National Capital Territory of Delhi. The qualitative data were analyzed using thematic analysis.

Results:

Our study found that retail pharmacies were the first point of consultation for common ailments for patients/consumers once home remedies failed; they were largely unaware of the threat of antimicrobial resistance. Consumers’ knowledge of antibiotic use and about antimicrobial resistance was low, they used old prescriptions, and bought antibiotics OTC to save time and money. Despite the presence of regulations constituted to regulate the sale of antibiotics by the Government and the implementation of national campaigns, the practice of self-medication and behaviors such as OTC purchase, non-adherence to prescribed antibiotics was prevalent. Consumers perceive that antibiotics provide quick relief and accelerate the curing process and retail pharmacy shops try to protect their retail business interests by honoring old prescriptions and self-medication for antibiotics.

Conclusions:

The lack of awareness and insufficient knowledge about what antibiotics are and issues such as antimicrobial resistance or antibiotic resistance resulted in misuse of antibiotics by consumers. Limited access to public healthcare and affordability of private healthcare are factors that contribute towards the self-medication/OTC purchase of antibiotics. The regular misuse of antibiotics through irrational use reinforces the need for strong enactment of strategies like continuous community awareness campaigns. Mitigation efforts should focus upon educating consumers continuously and sustainably for the understanding of antibiotic misuse, antimicrobial resistance, and promote better compliance with regulations.

Self-medication among people visiting outpatient clinics of a Tertiary care hospital, Karachi

Background and Aim:

“Self-medication” is the self-use of medicines for treatment of illnesses. Inappropriate use of medicines without prescription leads to unwanted adverse effects, harmful drug interactions, and antibiotic resistance which is an emerging concern in developing countries due to escalating burden of infectious diseases. This study aims at identifying the frequency and contributing factors of self-medication, nature of illness, and types of medicines used without doctor's prescription.

Material and Methods:

This cross sectional study was conducted at Indus Hospital Karachi between March 2017 and December 2018. Two hundred and forty people of any age visiting the outpatient clinics of the Indus hospital consenting to participate were included. Whereas all clinicians including medical officers, specialists and consultants were excluded from the study.

Results:

Three-fifth (n = 147; 61.3%) of the participants reported that they did self-medication either for themselves or for their children in the past one year. The most common symptoms for which self-medication was done were fever (n = 82, 55.8%), cough/cold (n = 38; 25.8%) or diarrhea (n = 22; 15.0%). Out of which, 122 (83%) did self-medication based on their previous experience, 18 (12.2%) used previous doctor's prescriptions, whereas 22 (15%) reported that other people advised them. Education, presence of unused medicines at home, and those who have heard of antibiotic were found to be the significant risk factors associated with self-medication.

Conclusion:

Among Pakistani population, the frequency of self-medication is very high, with most people practicing self-medication on the basis of their previous experiences. It puts them at risk of experiencing adverse reactions and most importantly antibiotic resistance.

Knowledge, attitudes, and practices regarding antibiotic use and resistance among community pharmacists: a cross sectional study in Jordan

Background Antibiotic resistance is a global threat and burden on healthcare systems. One major factor contributing to this problem is inappropriate use of antibiotics, which comprises suboptimal use, misuse, abuse, and dispensing errors. Another important factor is dispensing antibiotics without medical prescription. Many studies considered pharmacists as healthcare providers accountable for this malpractice. Objectives To investigate community pharmacists' knowledge, attitudes, and practices in relation to antibiotic dispensing, antibiotic resistance and antibiotic stewardship. Setting Community pharmacists selected from different areas in Amman/Jordan. Subjects were selected based on their availability and accessibility. Methods A descriptive cross-sectional survey of community pharmacists was conducted between May to October 2019, using a structured, validated, and pilot-tested questionnaire. A four-part systematic survey consisting of biography, knowledge, practice and attitude domains was used. Main outcome measure community pharmacist knowledge, practices and attitudes regarding antibiotic use and resistance. Results Of 150 community pharmacists approached, 114 completed and returned the questionnaire (response rate 76%). More than 83.3% perceived antimicrobial resistance as a global problem. A substantial percentage (59.7%) educate patients about issues of inappropriate antibiotics use. Almost half the participants (44.7%) agreed that implementing antimicrobial stewardship would result in better outcomes. Conclusion It is crucial to improve the curriculum in schools of pharmacy, emphasizing on interprofessional education and developing customized interventions. Regulations on dispensing antibiotics without prescription should be enforced. Policy makers need to implement antimicrobial stewardship and encourage the use of public educational interventions in community pharmacy.

Amoxicillin Utilization Pattern at Governmental Hospitals in Eastern Ethiopia

INTRODUCTION

Penicillin is among the highly used antibiotics in most parts of the world, with amoxicillin being the most frequently utilized drug in the category. However, amoxicillin use has been found to deviate from standard treatment guidelines (STGs).

OBJECTIVE

This study aimed to evaluate amoxicillin utilization patterns based on Ethiopian STGs criteria at four governmental hospitals in Harar town: Hiwot Fana Specialized University Hospital, Jugel Hospital, South East Command III Hospital, and Federal Harar Police Hospital in Eastern Ethiopia in 2016.

METHODS

A hospital-based retrospective cross-sectional study was employed using medication records of patients who received amoxicillin in 2016 at four governmental hospitals from May 15 to June 30, 2018. A total of 502 medication records were proportionally allocated based on the ratio of consumption data of each hospital. Simple random sampling was employed to collect the required sample from the sampling frame. The collected data were entered into SPSS version 21 and analyzed using descriptive analysis.

RESULTS

Amoxicillin was used in all age groups, including pregnant and lactating women. The majority (96.2%) of patients were from the outpatient departments. Complete blood count was the most laboratory investigation carried out in 24.9% whereas microbiological culture was not recorded at all. Top three indications include nonspecific upper respiratory tract infections (15.1%), pneumonia (13.5%) and dental problems (10.6%). Non-steroidal anti-inflammatory drugs (56.2%) were frequently co-administered agents. An appropriate utilization was made considering indication, dose, frequency and therapy duration in 23.9% as per the Ethiopian STG. The wrong indication (65.4%) was the prime reason for inappropriateness, followed by dose (14.6%) and duration of therapy (12.2%).

CONCLUSION

Amoxicillin utilization was appropriate in less than a quarter of patients. The wrong indication was the main reason for inappropriateness, predisposing to resistance development. Further studies identifying factors related to misuse and sensitivity tests should be the next steps.

Knowledge, attitude, and practice of pharmacy and medical students regarding self-medication, a study in Zabol University of Medical Sciences; Sistan and Baluchestan province in south-east of Iran

BACKGROUND

Self-medication is defined as using medicinal products to treat the disorders or symptoms diagnosed by oneself. Although informed self-medication is one of the ways to reduce health care costs, inappropriate self-treatment can pose various risks including drug side effects, recurrence of symptoms, drug resistance, etc. The purpose of this study was to investigate the knowledge, attitude, and practice of pharmacy and medical students toward self-medication.

METHODS

This study was conducted in Zabol University of Medical Sciences in 2018. Overall, 170 pharmacy and medical students were included. A three-part researcher-made questionnaire was designed to address the students' knowledge, attitude, and practice. Statistical analysis was performed in SPSS 25 software.

RESULTS

According to the results, 97 (57.1%) students had carried out self-medication within the past 6 months. Overall, the students self-medicated on average 4.2 ± 2.9 times per year. Self-medication was more common in male students (65.4%, P = 0.043). Cold was the most common ailment treated with self-medication (93.2%), and antibiotics (74.4%) were the most commonly used drugs. The primary information sources used by the students were their previous prescriptions (47.4%). Pharmacy students had a higher level of drug information (P < 0.001). There was a statistically significant association between the level of drug information and the tendency for self-medication (P = 0.005). Disease recurrence was the most common negative complication of self-medication.

CONCLUSION

There is a need to educate pharmacy and medical students regarding self-medication and its side effects. The high prevalence of self-medication and the overuse of antibiotics can pose a significant risk of drug resistance.

Knowledge, attitude, and practice regarding antibiotic use and resistance among medical students in Colombia: a cross-sectional descriptive study

BACKGROUND

This study was designed to describe the knowledge, attitude, and practice regarding antibiotic use and resistance among medical students in Medellín, Colombia.

METHODS

A cross-sectional study was conducted among medical students from three universities from September to December 2018. The sample size was calculated, the classrooms were visited, and those students who were willing to participate were invited to do so. The data collection instrument was constructed in three stages: i) the literature was systematically reviewed, ii) the items from the studies identified were extracted, and iii) item reduction was performed with exploratory factor analysis. Data were analyzed by calculating absolute and relative frequencies and means for quantitative variables. The indexes of knowledge, attitude, and practice were transformed to a scale from 0 (worst possible score) to 100. Comparisons were performed using the Mann-Whitney U test, Kruskall-Wallis H test, and linear regressions.

RESULTS

Five hundred and thirty-two medical students were included with a response rate of 96%. Of the total participants, 49.1% reported having used antibiotics within the past year. Regarding knowledge, only 18.2% had heard of the term "antimicrobial stewardship" and 69.3% were aware that empiric antibiotic therapy contributes to antibiotic resistance. Regarding attitude, 11.6% considered that antibiotics should be discontinued as soon as symptoms disappear and 24.6% stated that it is better to prescribe broad-spectrum antibiotics to ensure that the patient is cured. Regarding practice, 28.5% recognized that resistance is a multifactorial problem, but they do not act on it because they consider that individual actions would have little impact. The adjusted linear regression showed that the variables associated with knowledge, attitude, and practice were socioeconomic status, training cycle, university, previous experience of research or education, the general perception of the training received, and antibiotic consumption.

CONCLUSION

Knowledge, attitude, and practice differ widely depending on the university, training cycle, and socioeconomic status, and a significant proportion of students consider that the standard of training received at the university on antibiotics and bacterial resistance is poor or mediocre. These findings show that there is a need to strengthen the medical students' curriculum on antibiotics, mechanisms of antibiotic resistance, and the prudent use of antibiotics as an important strategy to combat problem-resistant public health, primarily in endemic countries.

Over-the-counter medicines, economic conditions, and citizens most in need in Greece: Is it a challenge for primary care research?

INTRODUCTION

Recent austerity experiences in Greece suggest a plausible link between extensive use of over-the-counter (OTC) medicines and socio-economic peculiarities of life.

COMMENTARY

During the economic crisis in Greece, accessibility to healthcare services has been impacted, particularly for people with low income. However, this fact has not been systematically analyzed in conjunction with an observed increase in use of OTC medicines. Gaining a better understanding of the reasons leading to self-care may help to answer additional questions. Further research is needed to assess the gap between self-care and medically assisted care/treatment by designing pilot monitoring actions and focusing on behaviours related to OTC medicine use. Primary care can offer more collaboration between primary care physicians, community pharmacists, patients, and their families.

IMPLICATIONS

It is crucial to create a multimodal research plan to gain a better understanding of motivational reasons that eventually lead to increasing use of OTC medicines. Efforts should be made to develop data collection techniques that will elicit information from various social groups that focus on changeable behaviours and perceived needs in relation to medicine consumption.