Keeping Antibiotics at Home Promotes Self-Medication with Antibiotics among Chinese University Students

Unused, expired pharmaceuticals and their disposal practices among the general public in Burdur-Türkiye: a cross-sectional study

BACKGROUND

Unused pharmaceuticals are currently a public health problem. This study aimed to identify unused pharmaceuticals, research practices about the disposal methods, classify the medicines according to Anatomical Therapeutic Chemical codes (ATC) and, to determine the number of unused medicines.

METHODS

The study was designed as a cross-sectional study. Data were collected between April and August 2023 in Burdur-Türkiye by non-probability sampling technique (convenience method). Pharmaceuticals were classified according to ATC. Statistical Package for Social Science SPSS (V.24) package program was used for data analysis.

RESULTS

A total of 1120 people, 1005 in the first sample group and 115 in the second sample group, participated in the study. Findings of first sample group: A total of 4097 boxes of unused pharmaceuticals (4.7 ± 4.3 boxes/per capita) were detected. It was found that pharmaceuticals were stored in areas such as kitchens (59.1%) and refrigerators (38.6%), the reason for keeping them was reuse (41%), and the disposal practice was household garbage (81%). Paracetamol (648 boxes), Other cold preparation (303 boxes), Dexketoprofen (239 boxes), Diclofenac (218 boxes), Amoxicillin and beta-lactamase inhibitor (190 boxes) were found to be the most frequently unused pharmaceuticals. Using the unused medicines at home without consulting a physician was 94.1% (self-medication). Findings of second sample group: Of the 6189 dosage forms in 265 boxes pharmaceutical, 3132(50.6%) dosage forms were used and 3057(49.4%) were found to be unused.

CONCLUSION

There is a significant amount and number of unused medicines in households, and self-medication is common. Medicines are not properly disposed of and some of them expire. Public information is needed. A "drug take-back system" for unused medicines can be useful in solving this problem.

Health literacy, knowledge, household disposal, and misuse practices of antibiotics among UAE residents: a nationwide cross-sectional study

BACKGROUND

The study aimed to evaluate health literacy, knowledge, household disposal, and misuse practices of antibiotics among the United Arab Emirates (UAE) residents.

RESEARCH DESIGN AND METHODS

An observational cross-sectional study was conducted between May 1st and August 31st, 2022. The study encompassed a sample of 1074 participants.

RESULTS

Participants involved in a medical field (OR: 1.98, 95% CI: 1.45-2.69, p < 0.001) were more likely to have adequate health literacy. Most participants rarely (n = 315; 29.33%) or sometimes (n = 292; 27.19%) sought help from a doctor or pharmacist with reading the instructions and leaflets of antibiotics. A bachelor`s degree was associated with a reduced odds ratio of self-medication with antibiotics (OR: 0.46, 95% CI: 0.29-0.75, p = 0.002). Only 10.61% of unneeded antibiotics were returned to the pharmacy, 79.42% were disposed of at home and 10% were disposed of using other disposal practices.

CONCLUSIONS

Higher levels of adequate health literacy were observed in those involved in the medical field and those with higher educational levels. The prevalence of self-medication with antibiotics among the UAE population was low. These findings highlight the importance of improving health literacy, promoting responsible antibiotic use, and encouraging proper disposal practices among the population.

Occurrence, removal, emission and environment risk of 32 antibiotics and metabolites in wastewater treatment plants in Wuhu, China

Wastewater treatment plants (WWTPs) are considered important sources of antibiotics and metabolites in aquatic environments and pose a serious threat to the safety of aquatic organisms. In this study, we investigated the seasonal occurrence, removal, emission, and environmental risk assessment (ERA) of 32 antibiotics and metabolites at four WWTPs located in Wuhu, China. The main findings of this study are as follows: Ofloxacin concentrations dominated all WWTPs, and large quantities of sulfachinoxalin were only detected in WWTP 2 treating mixed sewage. The average apparent removal of individual parent antibiotics or metabolites ranged from -94.7 to 100 %. There was a noticeable seasonal emission pattern (independent t-test, t = 9.89, p < 0.001), with lower emissions observed during summer. WWTPs discharged 85.2 ± 43.8 g of antibiotics and metabolites each day. Approximately 87 % of emissions were discharged into the mainstream of the Yangtze River, while the remainder were discharged into its tributary, the Zhanghe River. The total emissions of 21 parent antibiotics were approximately 18 % of the prescription data, indicating that a considerable and alarming amount of prototype drugs entered the receiving water body. Based on the risk quotient (RQ) of the ERA, the Zhanghe River has a moderate risk of ofloxacin (RQ = 0.111-0.583), a low or insignificant risk of sulfamethoxazole (RQ = 0.003-0.048), and an insignificant risk of other antibiotics or metabolites. However, the risk of antibiotics or metabolites in the mainstream of Yangtze River is insignificant. This study could help understand the seasonal emission patterns of antibiotics and metabolites, as well as more antibiotics sensitive of environmental risks in tributary than that in mainstream.

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.

Public knowledge of antibiotics, self-medication, and household disposal practices in Jordan

BACKGROUND

This study aimed to assess public understanding of antibiotics, self-medication, and drug disposal practices.

METHODS

A cross-sectional self-administered online survey was undertaken in Jordan.

RESULTS

The study was completed by 1,105 participants. When asked about their knowledge of antibiotics, rational antibiotic use, and disposal practices, 16% percent believed they should discontinue antibiotics once they felt better, and 12% agreed to take the same antibiotics prescribed to others for the same illness. Self-medication with antibiotics was practiced by 44% of the participants. Prior experience, healthcare costs, and pharmacy location were all major determinants of self-medication. Only 6.4% of unneeded antibiotics were returned to the pharmacy, 60% were kept at home, and 26.6% were disposed of at home. Almost half of those who kept the antibiotics said they would use them again, and one-third said they would give them to friends and family. Respondents who had used antibiotics within the previous 6 months (p = 0.052) and relied on medication leaflets (p = 0.031) and physician recommendations (p = 0.001) were less likely to self-medicate with antibiotics.

CONCLUSIONS

The study highlighted areas of inappropriate use of antibiotics, self-medication and the improper antibiotic disposal that can inform antimicrobial stewardship.

Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries.

METHODS

A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage.

RESULTS

In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40-50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49-62%) than those studies with community surveys (40%; 95% CI: 34-46%) (P = 0.001). It was also varied by the recall period of antibiotics use-56% (95% CI: 50-62%) for instantly observed practice, 36% (95% CI: 22-50%) for within two week recall, 35% (95% CI: 26-45%) for 1-6 months recall, and 46% (95% CI: 37-54%) for more than six months recall (P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets.

CONCLUSIONS

We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries.

TRIAL REGISTRATION NUMBER

CRD42021288971 (PROSPERO).  https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971 .

Assessment of antibiotic storage practices, knowledge, and awareness related to antibiotic uses and antibiotic resistance among household members in post-conflict areas of Pakistan: Bi-central study

Background

The storage of antimicrobials at home is frequently in-practice in various developing countries, resulting an irrational use, antibiotic resistance, and toxicities. This condition may worsen more in conflict zones where health facilities are limited. This study aimed to determine the storage and use of leftover antibiotics among households (HHs) along with knowledge and awareness about antibiotics and antibiotic resistance (ABR).

Methods

A descriptive cross-sectional study design was employed. Members of HHs were invited to participate in the survey while using a convenient sampling technique. The data were obtained using a validated questionnaire and analyzed through SPSS.

Results

A total of 96 HHs were randomly selected from two districts (n = 50, n = 46), with most of the participants being men between the ages of 18 and 28 (n = 45, 46.9%) years. The majority of HHs (n = 32, 33.3%) had six to eight total family members, with one to two chronic diseases (n = 63, 65.6%), individual families (n = 60, 62.5%), and with (n = 35, 36.5%) LRTIs (lower respiratory tract infections). The HHs were aware of the word "antibiotic" (n = 59, 61.5%) and gave correct replies to amoxicillin as an antibiotic (n = 42, 43.8%); on the other hand, HHs also thought of paracetamol as an antibiotic (n = 45, 47.9%). They identified the most common brands of antibiotics easily, and a majority of them (n = 69, 71.9%) had never heard of ABR before and had lower levels of awareness. The most stored antibiotic at home (n=38, 39.6%) was azithromycin (J01FA10). In addition, they had multiple needless (1-2, n = 62, 64.6%; 3-4, n = 29, 30.2%) and antibiotics in their houses. Age had a strong association (p = 0.017, H = 12) affected the mean knowledge scores related to antibiotic use. Association of education levels (p = 0.001, H = 52.8) and occupation (p = 0.04, H = 10) with proper antibiotics use were found to be significant. However, family members with more than one chronic illness (p = 0.09, H = 0.8) showed a significant relationship with their awareness of antibiotics.

Conclusion

Participants generally stored various antibiotics of different classes in their homes. Lack of knowledge related to the appropriate usage of antibiotics, use of leftover antibiotics, and awareness related to ABR were unknown to the participants.

Income level and antibiotic misuse: a systematic review and dose-response meta-analysis

OBJECTIVES

To quantify the association between income and antibiotic misuse including unprescribed use, storage of antibiotics and non-adherence.

METHODS

We identified pertinent studies through database search, and manual examination of reference lists of selected articles and review reports. We performed a dose-response meta-analysis of income, both continuous and categorical, in relation to antibiotic misuse. Summary odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated under a random-effects random effects model.

RESULTS

Fifty-seven studies from 22 countries of different economic class were included. Overall, the data are in agreement with a flat linear association between income standardized to socio-economic indicators and antibiotic misuse (OR per 1 unit increment = 1.00, p-value = 0.954, p-value non-linearity = 0.429). Data were compatible with no association between medium and high income with general antibiotic misuse (OR 1.04; 95% CI 0.89, 1.20 and OR 1.03; 95% CI 0.82, 1.29). Medium income was associated with 19% higher odds of antibiotic storage (OR 1.19; 95% CI 1.07, 1.32) and 18% higher odds of any aspect of antibiotic misuse in African studies (OR 1.18; 95% CI 1.00, 1.39). High income was associated with 51% lower odds of non-adherence to antibiotic treatment (OR 0.49; 95% CI 0.34, 0.60). High income was also associated with 11% higher odds of any antibiotic misuse in upper-middle wealth countries (OR 1.11; 95% CI 1.00, 1.22).

CONCLUSIONS

The association between income and antibiotic misuse varies by type of misuse and country wellness. Understanding the socioeconomic properties of antibiotic misuse should prove useful in developing related intervention programs and health policies.

Reliability and validity evaluation of the appropriate antibiotic use self-efficacy scale for Chinese adults

BACKGROUND

Antibiotic resistance is one of the greatest threats to global public health. Inappropriate use of antibiotics can lead to an increase in antibiotic resistance. Individual self-efficacy in the appropriate use of antibiotics plays a key role, especially in China where the population has easy access to antibiotics. However, there are no tools available to assess the self-efficacy of appropriate antibiotic use for Chinese adults. We aimed to translate and develop a Chinese version of the Appropriate Antibiotic Use Self-Efficacy Scale (AAUSES), and validate its reliability and validity.

METHODS

A total of 659 adults were recruited to participate in the questionnaire. The original version scale was first translated into Chinese using the backward and forward translation procedures. The internal consistency reliability of the scale was measured by the Cronbach alpha coefficient, the test-retest reliability, and the corrected item-total correlation. The validity of the scale was assessed by the content validity index, exploratory factor analysis, and confirmatory factor analysis.

RESULTS

The content validity index of the scale was 0.96. Exploratory factor analysis (EFA) supported a 4-factor structure of the translated questionnaire, and the discriminant validity of the scale was good. Confirmatory factor analysis (CFA) showed in the model fitness index, the chi-square degree of freedom was 2.940, the goodness-of-fit index(GFI) was 0.929, the incremental fit index (IFI) was 0.908, the comparative fit index(CFI) was 0.906, root mean square error of approximation(RMSEA) was 0.077, and standardized root mean residual (SRMR) was 0.0689, and the model fitting indexes were all in the acceptable range. Cronbach alpha coefficient for the scale was 0.910. The test-retest reliability was 0.947, and the corrected item-total correlations for the items ranged from 0.488 to 0.736. Self-efficacy for appropriate antibiotic use in adults varied by education, occupation, income, place of residence, and whether or not they had heard of antibiotic resistance.

CONCLUSIONS

The results indicated that the Chinese version of the AAUSES had good reliability and validity. Therefore, it can be considered a tool to evaluate the appropriate antibiotic use self-efficacy of adults in China.

Knowledge, attitudes and influencers of cat owners in North America around antimicrobials and antimicrobial stewardship

Objectives

The primary aims of this study were to determine preferences of North American cat owners when they are prescribed an antimicrobial for their cat with regard to cost, method of administration and the importance of antibiotics for treating infections in people, and to establish baseline knowledge, attitudes and influencers of cat owners on antimicrobial resistance and stewardship.

Methods

An online questionnaire was used for data collection from two cat-owner groups: US cat owners and Canadian cat owners. Participants were queried on antimicrobial resistance and stewardship, and their preferences for their own cat when prescribed an antimicrobial, with respect to cost, method of drug administration and the importance of a drug for treating infections in people. Responses were evaluated through conjoint analysis and Likert-type questions. Data were analyzed using descriptive and analytic statistics.

Results

A total of 630 complete responses were included in the final analysis. Cost (37%) and method of administration (38%) were of similar participant preference when assessed using conjoint analysis. The importance of a drug for treating infections in people was lower priority (21%). The majority of cat owners preferred an antimicrobial that was ‘very important’ in treating human infections. A low proportion (21%) of participants responded that antimicrobial use in pets posed a risk to humans. Participants with a university education were more likely to respond that antimicrobial use in pets was a concern for people (31%; P <0.001).

Conclusions and relevance

Cat owners prioritize antimicrobial cost and method of administration equally. Few cat owners recognized the human antimicrobial resistance risks associated with antimicrobial use in pets.

The effects of preoperative intestinal dysbacteriosis on postoperative recovery in colorectal cancer surgery: a prospective cohort study

Background

Accumulating evidence suggests a critical role of intestinal dysbacteriosis in surgical site infections and anastomotic leakage after abdominal surgery. However, a direct correlation between pre-existing dysbacteriosis and postoperative infectious complications has not yet been established clinically.

Methods

A total of 353 consecutive patients who underwent colorectal cancer (CRC) surgery were enrolled. Gram-stained faecal smears were tested at admission and the first defecation after surgery. Intestinal dysbacteriosis was graded into three groups: normal or slightly decreased intestinal microflora (grade 1), moderate dysbacteriosis (grade 2), and severe dysbacteriosis (grade 3). Clinical outcomes were postoperative infections and anastomotic leakage within 30 days after surgery.

Results

At the preoperative assessment, 268 (75.9%) patients had normal or slightly decreased intestinal microflora, 58 (16.4%) patients had moderate dysbacteriosis, and 27 (7.6%) patients had severe dysbacteriosis. The patients with preoperative dysbacteriosis had a higher rate of early postoperative diarrhoea (grade 2: OR = 4.53, 95% CI 2.28–9.00, grade 3: OR = 4.52, 95% CI 1.81–11.31), total complications (grade 3 40.7% vs. grade 2 25.9% vs. grade 1 12.7%, P < 0.001), and anastomotic leakage (grade 3 11.1% vs. grade 2 5.2% vs. grade 1 1.5%, P = 0.002). An interaction effect among preoperative dysbacteriosis and early postoperative diarrhoea on total complications was observed in rectal cancer patients (P for interaction = 0.007).

Conclusions

An imbalance of the intestinal microbiome exists in a considerable proportion of CRC patients before surgery. Preoperative dysbacteriosis is associated with higher rates of early postoperative diarrhoea, which further correlates with infectious complications and anastomotic leakage. However, the contribution of preoperative dysbacteriosis to the occurrence of anastomotic leakage needs to be clarified in further studies.

Trial registration ChiCTR, ChiCTR1800018755. Registered 8 October 2018—Retrospectively registered, http://www.chictr.org.cn/ChiCTR1800018755.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-021-02035-6.

Factors influencing inappropriate use of antibiotics in outpatient and community settings in China: a mixed-methods systematic review

BACKGROUND

For decades, antibiotics have been excessively consumed around the world, contributing to increased antimicrobial resistance (AMR) and negatively impacting health outcomes and expenditures. Antibiotic use in China accounts for half of worldwide antibiotic consumption, which mainly takes place in outpatient and community settings, and often unnecessarily for self-limiting community-acquired infections. This study aimed to identify and assess factors of inappropriate use of antibiotics in the Chinese context to inform the development of interventions to mitigate inappropriate consumption in the absence of clinical indications.

METHODS

We conducted a mixed-methods systematic review and included empirical studies with original data conducted in mainland China, Hong Kong and Taiwan that investigated factors of antibiotic use in the community including outpatient care among patients, caregivers and prescribers. We searched MEDLINE, EMBASE, the Cochrane Library, PsycINFO, Google Scholar and one Chinese database CNKI (China Knowledge Resource Integrated Database), using a combination of the key terms 'antibiotic', 'antimicrobial', 'use', 'consumption', 'behaviour', 'prescribe' and related syntax for all peer-reviewed publications published before June 2020. Health Belief Model was employed for data synthesis.

FINDINGS

Fifty-four studies were included in the full-text review: 44 quantitative, 5 qualitative and 5 mixed-methods studies. Despite a high AMR awareness, public perception/misconception of antibiotic efficacy and easy access to antibiotics for self-limiting conditions drive inappropriate demand and use in the community including primary care setting. Providers' prescribing behaviours are influenced by financial incentives, lack of diagnostic capacity and concerns over complications.

CONCLUSIONS

Inappropriate outpatient and community antibiotic use is influenced by non-biomedical factors at the individual, community, health system and societal levels in mainland China, contributing to a high antibiotic use rate. This study calls for context-tailored One Health interventions, restrictive antibiotic drug policy and multifaceted antibiotic stewardship programmes that simultaneously address drivers of inappropriate use from both the supply-side and demand-side within and beyond clinical settings.

PROSPERO REGISTRATION NUMBER

CRD42019139591.

Prevalence and patterns of self-medication with antibiotics among visitors of central polyclinic of Kabul, Afghanistan

Objectives

Self-medication with antibiotics is a common public health problem worldwide. It is the main driving factor for the development of microbial resistance. The world is facing the challenge of losing effective antibiotics. The study aim is to determine the prevalence and related factors of self-medication with antibiotics among visitors of a clinic in Kabul, Afghanistan.

Methods

A cross-sectional questionnaire-based survey on a sample of 384 consecutively selected visitors of the Central Polyclinic of Kabul, Afghanistan, was conducted.

Key findings

Approximately 34.9% of the sample self-medicated with antibiotics in the past 12 months. Amoxicillin was the most common antibiotic used for self-medication. The sore throat was a common health problem, and previous experience was the source of recommendation for self-medication. The most common reasons for self-medication with antibiotics were cost-saving, previous experience and lack of time.

Conclusions

Self-medication with antibiotics was prevalent among visitors to the clinic. Patterns of self-medication with antibiotics indicate the inappropriate practice of medicines. Pharmacists, friends and family approve the self-medication with antibiotics.

The General Population's Inappropriate Behaviors and Misunderstanding of Antibiotic Use in China: A Systematic Review and Meta-Analysis

The general population has increasingly become the key contributor to irrational antibiotic use in China, which fuels the emergence of antibiotic resistance. This study aimed to estimate the prevalence of the general population’s irrational use behaviors of antibiotics and identify the potential reasons behind them. A systematic review and meta-analysis were performed concerning four main behaviors relevant to easy access and irrational use of antibiotics and common misunderstandings among the population about antibiotics. Four databases were searched, and studies published before 28 February 2021 were retrieved. Medium and high-level quality studies were included. Random effects meta-analysis was performed to calculate the prevalence of the general population’s irrational behaviors and misunderstandings relevant to antibiotic use. A total of 8468 studies were retrieved and 78 met the criteria and were included. The synthesis showed the public can easily obtain unnecessary antibiotics, with an estimated 37% (95% CI: 29–46) of the population demanding antibiotics from physicians and 47% (95% CI: 38–57) purchasing non-prescription antibiotics from pharmacies. This situation is severe in the western area of China. People also commonly inappropriately use antibiotics by not following antibiotic prescriptions (pooled estimate: 48%, 95% CI: 41–55) and preventatively use antibiotics for non-indicated diseases (pooled estimate: 35%, 95% CI: 29–42). Misunderstanding of antibiotic use was also popular among people, including incorrect antibiotic recognition, wrong antibiotic use indication, inappropriate usage, and ignorance of potential adverse outcomes. Over-and inappropriate use of antibiotics is evident in China and a multifaceted antibiotic strategy targeted at the general population is urgently required.

Survey of the Knowledge and Use of Antibiotics among Medical and Veterinary Health Professionals and Students in Portugal

Antimicrobial resistance (AMR) is an urgent and complex problem worldwide, exacerbated by the frequently inappropriate use of antibiotics. The purpose of this study was to survey the levels of knowledge and awareness about antibiotic use and stewardship, among human and veterinary health professionals or students in Portugal, and the associations between antibiotic knowledge factors and socio-professional groups. In cross-sectional survey design, a total of 449 online structured questionnaires were completed in 2018-2019. The statistical analysis was performed dividing the respondents into four groups, A (undergraduate students), B (PhD students and researchers), C (lecturers), and D (technicians and other occupation). Among all respondents, 17% (n = 75) revealed some gap in knowledge about antibiotic resistance and the antibiotics that should be administered for different infection types (bacterial, viral, or fungal). Of the 159 pet owners among the respondents, only half had administered antibiotics to their animal and 64% (n = 102) knew that veterinary prescription is mandatory when administering antibiotics to animals. All groups statistically agreed that the AMR is a major public health problem and the antibiotics should be administrated for bacterial infections and used until the whole pack has been finished (p = 0.00). As expected, only groups B and C demonstrated a higher level of knowledge to recognize the antibiotic name and their active ingredient than undergraduate students (p = 0.00). About the antibiotic use on pets, only group B was statistically significant to no used antibiotics on their pets (p = 0.00). However, groups A, C, and D were statistically significant for the knowledge about the mandatory veterinarian prescription and groups C and D were significantly statistics for fully aware of the transmission of bacteria between animals and humans. In conclusion, in matters related to AMR, the behavior, education, and training of the general public and health professionals, including those who prescribe antibiotics for humans and animals, need to be improved.

Self-Medication with Antibiotics for Protection against COVID-19: The Role of Psychological Distress, Knowledge of, and Experiences with Antibiotics

Self-medication with antibiotics is a major contributing factor to antimicrobial resistance. Prior research examining factors associated with antibiotic self-medication has focused on an individual’s knowledge about antibiotics, antibiotic usage practices, accessibility to antibiotic medication, and demographic characteristics. The role of psychological distress associated with perceived health risks in explaining antibiotic self-medication is less understood. This study was designed to address this knowledge gap in the context of the COVID-19 pandemic in Australia. An online survey of 2217 participants was conducted at the height of the initial outbreak and revealed that 19.5% of participants took antibiotics to protect themselves from COVID-19. Multivariate logistic analysis examined the predictors of taking antibiotics for protection against COVID-19. An integrative framework developed from the results illustrates potential pathways and facilitating factors that may contribute to prophylactic self-medication with antibiotics. Specifically, COVID-19 pandemic-induced psychological distress was significantly positively related to self-medication. Preventive use of antibiotics was also facilitated by a lack of understanding about antibiotics, inappropriate antibiotics usage practices, the nature of the patient-doctor relationship, and demographic characteristics. The findings highlight that to combat antimicrobial resistance due to self-medication, interventions need to focus on interrupting entrenched behavioural responses and addressing emotional responses to perceived health risks.

Impact of European pet antibiotic use on enterococci and staphylococci antimicrobial resistance and human health

Due to the inappropriate use of antibiotics described in both human and veterinary medicine, there is emerging evidence of antimicrobial-resistant organisms isolated from humans and pets, forming a multifaceted problem. Although the true magnitude of antimicrobial resistance in pets and other animals, as well as humans, are not fully known; pets, in particular dogs and cats, can contribute to the spread of antimicrobial resistance due to close contact with humans and their status as a family member in urban households. This review summarizes and highlights the current data concerning the antibiotic use on pets, and the European distribution of the increasing prevalence of multiresistant bacterial pathogens, such as enterococci and methicillin-resistant staphylococci on pets, as well as its implications for public health.

Parental self-medication with antibiotics for children promotes antibiotic over-prescribing in clinical settings in China

Background

Self-medication with antibiotics (SMA) is one of the most dangerous inappropriate antibiotic use behaviors. This study aims to investigate the impact of parental SMA for children before a consultation on their doctor’s subsequent antibiotic prescribing behavior, including intravenous (IV) antibiotic use in the clinical setting of China.

Methods

A cross-sectional survey was conducted between June 2017 and April 2018 in three provinces of China. A total of 9526 parents with children aged 0–13 years were investigated. Data from 1275 parents who had self-medicated their children and then visited a doctor in the past month were extracted and analyzed.

Results

One-third (410) of the studied children had parental SMA before the consultation and 83.9% of them were subsequently prescribed antibiotics by doctors. Children with parental SMA were more likely to be prescribed antibiotics (aOR = 7.79, 95% CI [5.74–10.58]), including IV antibiotics (aOR = 3.05, 95% CI [2.27–4.11]), and both oral and IV antibiotics (aOR = 3.42, 95% CI [2.42–4.84]), than children without parental SMA. Parents with SMA behaviors were more likely to request antibiotics (aOR = 4.05, 95% CI [2.59–6.31]) including IV antibiotics (aOR = 2.58, 95% CI [1.40–4.76]), and be fulfilled by doctors (aOR = 3.22, 95% CI [1.20–8.63]).

Conclusions

Tailored health education for parents is required in both community and clinical settings to discourage parental SMA for children. The doctors should not prescribe unnecessary antibiotics to reinforce parents’ SMA behaviors. We recommend expanding the current IV antibiotics ban in outpatient settings of China to cover outpatient pediatrics.

Knowledge, attitudes and practices in relation to antimicrobial resistance amongst Chinese public health undergraduates

OBJECTIVES

The aim of this study was to assess knowledge, attitudes and practices amongst public health undergraduates in relation to antimicrobial resistance (AMR) in China.

METHODS

A cross-sectional survey was conducted amongst all final-year public health undergraduates from 18 universities across China. A structured questionnaire was used to collect information on AMR-related knowledge, attitudes and practices, whilst multivariable linear and logistic regressions were employed to detect associations among these three aspects.

RESULTS

A total of 1115 participants were included in this study. The mean ± standard deviation AMR knowledge score was 7.68 ± 2.56. Moreover, 75.2% of students had performed incorrect antimicrobial practice. Studying in a key university [slope = 1.49, 95% confidence interval (CI) 0.71-2.27], being male (slope = 0.36, 95% CI 0.02-0.70), having clinical experience (slope = 1.71, 95% CI 1.13-2.30) and having an affirmative attitude towards AMR were positively associated with knowledge score. Knowledge score was also positively associated with AMR practice (odds ratio = 1.07, 95% CI 1.00-1.13).

CONCLUSIONS

A knowledge gap in relation to AMR was determined among Chinese public health students. This gap is associated with attitudes towards AMR and in turn influences antimicrobial use. It is clear that additional measures are needed in the curriculum, including additional AMR-specific clinical practices.

University Students' Antibiotic Use and Knowledge of Antimicrobial Resistance: What Are the Common Myths?

We aimed to assess antibiotic usage and knowledge regarding antibiotics and antimicrobial resistance (AMR) among undergraduate students of the Universiti Brunei Darussalam (UBD), public university located in Brunei Darussalam. A cross-sectional study was performed using a self-administered questionnaire. The questionnaire was adapted from the World Health Organization’s (WHO) “Antibiotic resistance: Multi-country public awareness” survey distributed online. Students at the UBD were invited to participate in the online survey through internal email. The questionnaire consisted of five sections: demographic information, antibiotic usage, knowledge on antibiotics, antibiotic resistance (AMR), and use of antibiotics in agriculture. The data were analyzed descriptively and appropriate inferential statistics were used accordingly. A total of 130 students returned a completed questionnaire. The result of the study found that 51% (n = 66) of the students had good level of knowledge of antibiotic and antimicrobial resistance with a mean total knowledge score of nine out of 14. Of note, 76% (n = 99) of the respondents mistakenly believed that antibiotic resistance is the result of the body becoming resistant to antibiotics. Only 14% (n = 18) of the respondents were found to have poor knowledge on antibiotics and antimicrobial resistance in the study. Misconceptions in regards to the use of antibiotics for conditions related to viral illnesses like cold and flu (41%, n = 53) were noticed among the respondents in our study. Thus, improving knowledge on antibiotics is crucial to address these beliefs.

Cleaning up China's Medical Cabinet-An Antibiotic Take-Back Programme to Reduce Household Antibiotic Storage for Unsupervised Use in Rural China: A Mixed-Methods Feasibility Study

: Background: Antibiotic misuse and unsafe disposal harm the environment and human health and contribute to the global threat of antimicrobial resistance. Household storage of antibiotics for unsupervised use and careless disposal of medications is a common practice in China and most low- and middle-income countries. Currently, few interventions are available to address this challenge.

OBJECTIVE

This study assesses the feasibility and acceptability of an evidence-based, theory-informed, community-based take-back programme for disposing household's expired, unwanted, or unused antibiotics in rural China.

METHODS

We adopted the RE-AIM framework and the community-based participatory research principles in the development, implementation, and evaluation of the intervention. The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) and Medical Research Council's frameworks were employed in analysing and reporting evaluation results. A mixed-methods, controlled pre-and post-test design was used for 1) quantitative surveying of a representative community panel of 50 households, and 2) qualitative semi-structured stakeholders' interviews to explore intervention and study design feasibility and acceptability at three phases: pre-intervention, intervention, and post-intervention. Quantitative and qualitative data from a similar village-serving as a control-were also collected.

RESULTS

All a priori feasibility objectives were met: Conversion to consent was 100.0% (100 screened, approached, recruited, and consented). All participants completed the pre-intervention assessment, and 44/50 households in the intervention village completed the post-intervention assessment. The programme, embedded in existing social and physical infrastructure for dissemination, directly reached over 68.2% (30/44) of its target audience. Stakeholders reported the intervention and study design as feasible and acceptable.

CONCLUSIONS

This study illustrates the feasibility, acceptability, and potential efficacy of community-based antibiotic take-back programmes in China to encourage safe disposal and decrease the availability of expired, unwanted, or unused antibiotics in the household for unsupervised use.

Substance Abuse and Public Health: A Multilevel Perspective and Multiple Responses

Substance abuse has been a thorny public health concern throughout human history. Manifestly, prevention and treatment are the two main strategies commonly adopted to tackle the problem of substance abuse. They are in fact cross-disciplinary, and they relate to the various domains of heredity, biology, psychology, cognitive science, family, social development and cultural structures. This special issue, "Substance Abuse, Environment and Public Health," has published empirical studies from different regions and countries globally to enhance the international exchange of latest views and findings on the etiology, processes and influences of substance abuse across different domains, through which a multilevel perspective is considered more helpful for analyzing its complex nature, courses and consequences. This in turn suggests the possible need to employ multiple responses dynamically and integratively in the prevention and treatment of substance abuse.

Influence of leftover antibiotics on self-medication with antibiotics for children: a cross-sectional study from three Chinese provinces

OBJECTIVES

To investigate leftover antibiotics and their influence on self-medication with antibiotics (SMA) for Chinese children, and further explore the different influences of leftovers from two main sources: previous prescriptions and pharmaceutical purchases.

DESIGN

A cross-sectional questionnaire study.

SETTING

The participants were approached through kindergartens and primary schools as well as in vaccination clinics.

PARTICIPANTS

A total of 9526 parents from three Chinese provinces whose children were aged 0-13 years completed the survey.

OUTCOME MEASURES

The prevalence of keeping antibiotics at home for children and the proportion of leftover antibiotics from two main sources were measured by a self-administrated questionnaire. Logistic regression models were established to examine the association between keeping antibiotics at home and SMA for children, specifically the risks of leftovers from two main sources.

RESULTS

Overall, 4580 (48.1%) reported keeping antibiotics at home for children. Among those who had leftovers, 2891 (63.1%) reported that their leftovers came from previous prescriptions and 1619 (35.3%) reported that their leftovers came from pharmaceutical purchases. Mothers, older age of child, higher household income, higher education level and medical background were significantly associated with keeping antibiotics at home. Keeping antibiotics at home was significantly associated with SMA for children (adjusted OR=4.91, 95% CI 3.84 to 6.28). Particularly, compared with parents who did not keep antibiotics at home, parents who kept leftover antibiotics from previous prescriptions and those whose leftovers came from pharmaceutical purchases were 3.80 (95% CI 2.89 to 5.00) and 6.45 (95% CI 4.89 to 8.51) times more likely to engage in SMA for children, respectively.

CONCLUSIONS

Keeping antibiotics at home for children was pervasive in China. Most leftovers came from previous prescriptions, while those from pharmacies had a higher risk of SMA for children.

Self-medication of antibiotics: investigating practice among university students at the Malaysian National Defence University

Background: Self-medication of drugs to alleviate symptoms is a common global behavior, helping relieve burdens on health services, but many drugs eg, antibiotics are prescription-only. Self-medication of antibiotics (SMA) is an irrational use of drugs, contributing to microbial resistance increasing health care costs and higher mortality and morbidity. This study aimed to assess SMA among university students. Methods: This was a cross-sectional study conducted among medical and non-medical students of the National Defence University of Malaysia. A validated instrument was used to gather data. Ethics approval was obtained. Random and universal sampling was adopted, and SPSS 21 was used for data analysis. Results: A total of 649 students participated in the study: 48.5% male and 51.5% female, 39.3% reported self-medicating with antibiotics. Penicillin, doxycycline, clarithromycin were the antibiotics most used with the majority reporting no adverse drug reactions. Cost savings and convenience were the principal reasons for SMA which were mainly obtained from local retail pharmacies. Despite medical students (particularly the more senior) having better knowledge of antibiotic use than non-medical students, 89% of all research participants responded that practicing SMA was a good/acceptable practice. Conclusion: SMA is common amongst Malaysian students and, despite understanding why SMA is unwise, even medical students self-medicate.

The Misconception of Antibiotic Equal to an Anti-Inflammatory Drug Promoting Antibiotic Misuse among Chinese University Students

Massive misuse of antibiotics is one of the most important reasons for antimicrobial resistance (AMR). Misconceptions of antibiotics contribute to antibiotic misuse behaviors. This study aims to examine whether university students hold the misconception that Antibiotic is a Xiaoyanyao (literally means anti-inflammatory drug in Chinese), and association between this misconception and antibiotic misuse behaviors. A cross-sectional study was conducted among university students using the cluster random sampling method in six universities of six regions in China (one university per region). The Chi-square test was used to assess the relationship between the misconception and antibiotic misuse behaviors. Logistic regression was conducted to identify the risk factors for antibiotic misuse behaviors. 11,192 of university students completed the entire questionnaire. There were 3882 (34.7%) students who were considered to have the misconception. Female students were more likely to have the misconception compared with males (36.7% vs. 32.6%, P < 0.001). Those students with a background of social science/humanities were more likely to have the misconception compared with those from science and medicine (44.1% vs. 30.3% vs. 20.1%, P < 0.001). Students came from rural areas compared with those from urban areas (37.5% vs. 32.5%, P < 0.001) were more likely to have the misconception. Students who had the misconception were 1.51 (95% CI 1.21–1.89, P < 0.001) times, 1.34 (95% CI 1.21–1.48, P < 0.001) times, and 1.36 (95% CI 1.24–1.50, P < 0.001) times more likely to report self-medication, request to obtain antibiotics, and take antibiotics prophylactically than those who did not have this misconception, respectively. The high proportion of university students’ misconception on Antibiotic is a Xiaoyanyao is worth more attention. Effective health education and interventions need to be promoted among university students and the whole population.