Antibiotic Use Awareness and Practices in the Indian Community During Later Stages of COVID-19 Pandemic: A Cross-Sectional Survey

Authors

  • Hiyanoor Ghosh Third-year Medical Student. Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
  • Kanchan Gupta MBBS, MD (Pharmacology). Professor, Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

DOI:

https://doi.org/10.5195/ijms.2023.2345

Keywords:

Drug Resistance, Microbial, Antimicrobial Stewardship, Health Knowledge, Attitudes, Practices, COVID 19

Abstract

BACKGROUND: Irrational prescription of, and self medication with antibiotics is a rampant problem in LMIC'S like India. The prescription of antibiotics for symptoms similar to Covid-19 infection has aggravated the problem of antibiotic overuse, further worsening antimicrobial resistance. This study aims at understanding not only the extent of overuse, but also the social patterns and causes of overprescription or self medication of antibiotics in India.

METHODS: A cross-sectional survey of the knowledge, attitude and practices on antibiotic use was conducted from September to October, 2022, using a Google form questionnaire. A virtual snowball technique was used to recruit respondents.  

RESULTS: A total of 309 responses were received (56% female and 44% male). 59.5% of the respondents were between 15 to 30 years. Surprisingly, inspite of a majority of respondents (around 70%) having a health sciences background, 67.8% of respondents falsely believe that antibiotics speed up recovery from most coughs and colds. 94.8% of respondents had used antibiotics in the last one year.17.2% of respondents had taken antibiotics without the prescription of a doctor. The most common antibiotic used on prescription and self medication was Azithromycin. Only 20.7% of respondents took antibiotics on suspicion of having Covid-19, with the most common one being Azithromycin.

CONCLUSION: The study brings to light trends in the awareness and usage of antibiotics with greater emphasis on the Indian medical community. The findings of this study can be used to formulate a more effective Antimicrobial Stewardship Programs to curb antibiotic overuse. The use of antibiotics for self-limiting indications like cough, cold and sore throat needs to be restricted through stricter regulations. The study highlights that a greater knowledge on antibiotic use does not necessitate better attitude towards their cautious and rational use, nor does it guarantee a supportive attitude towards regulations on antibiotic dispensing. In spite of it's significant cardiovascular adverse drug reactions, Azithromycin was found to be the most commonly used antibiotic in our study. Relatively lower rate of self-medication with antibiotics was seen in our study, which might be due to a greater percentage of respondents with a healthcare background, thus exhibiting positive behavior practices on antibiotic use.

Metrics

Metrics Loading ...

References

Abat C, Gautret P, Raoult D. Benefits of antibiotics burden in low-income countries. Proc Natl Acad Sci U S A. 2018 Aug 28; 115(35):E8109-E8110. Doi: 10.1073/pnas.1809354115.

Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A. 2018 Apr 10; 115(15):E3463-E3470. Doi: 10.1073/pnas.1717295115.

Shallcross LJ, Davies DS. Antibiotic overuse: a key driver of antimicrobial resistance. Br J Gen Pract. 2014 Dec; 64(629):604-5. doi: 10.3399/bjgp14X682561.

World Health Organization. Antimicrobial resistance. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. Last Updated: 2021 17 Nov. Cited: 2022 23 Sept.

World Health Organization. Antimicrobial resistance: global report on surveillance. Available from: https://apps.who.int/iris/handle/10665/112642. Last Updated: 2014. Cited: 2022 23 Sept.

Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022 Feb 12; 399(10325):629-655. doi: 10.1016/S0140-6736(21)02724-0.

Liu Q, Jing W, Liu M, Liu J. Health disparity and mortality trends of infectious diseases in BRICS from 1990 to 2019. J Glob Health. 2022 Mar 26; 12:04028. doi: 10.7189/jogh.12.04028.

Klein EY, Tseng KK, Pant S, Laxminarayan R. Tracking global trends in the effectiveness of antibiotic therapy using the Drug Resistance Index. BMJ Glob Health. 2019 Apr 11; 4(2):e001315. doi: 10.1136/bmjgh-2018-001315.

Sulis G, Batomen B, Kotwani A, Pai M, Gandra S. Sales of antibiotics and hydroxychloroquine in India during the COVID-19 epidemic: An interrupted time series analysis. PLoS Med. 2021 Jul 1; 18(7):e1003682. doi: 10.1371/journal.pmed.1003682.

Kotwani A, Joshi J, Lamkang AS. Over-the-Counter Sale of Antibiotics in India: A Qualitative Study of Providers' Perspectives across Two States. Antibiotics (Basel). 2021 Sep 17; 10(9):1123. doi: 10.3390/antibiotics10091123.

Indian Council of Medical Research (ICMR). Antimicrobial Stewardship Program Guidelines. Available from: https://main.icmr.nic.in/sites/default/files/guidelines/AMSP_0.pdf. Cited: 2022 24 Sept.

World Health Organization. Clinical management of COVID-19. Available from: https://apps.who.int/iris/bitstream/handle/10665/332196/WHO-2019-nCoV-clinical-2020.5-eng.pdf. Last Updated: 2020 27 May. Cited: 2022 24 Sept

Hamers RL, van Doorn HR. Antibiotic consumption in low-income and middle-income countries. Lancet Glob Health. 2018 Jul; 6(7):e732. doi: 10.1016/S2214-109X (18)30270-5.

Awad AI, Aboud EA. Knowledge, attitude and practice towards antibiotic use among the public in Kuwait. PLoS One. 2015 Feb 12; 10(2):e0117910. doi: 10.1371/journal.pone.0117910.

Russom M, Bahta M, Debesai M, Bahta I, Kessete A, Afendi A et al. Knowledge, attitude and practice of antibiotics and their determinants in Eritrea: an urban population-based survey. BMJ Open. 2021 Sep 24; 11(9):e046432. doi: 10.1136/bmjopen-2020-046432.

Bhardwaj K, Shenoy S, Baliga S, Unnikrishnan B, Baliga BS. Knowledge, attitude, and practices related to antibiotic use and resistance among the general public of coastal south Karnataka, India–A cross-sectional survey Clin Epidem and Glob Hlth. 2021;11:100717. https:// doi. org/ 10. 1016/j. cegh. 2021. 100717.

Alkhalifah HM, Alkhalifah KM, Alharthi AF, Elzahrany YR, Aljuhani MA. Knowledge, attitude and practices towards antibiotic use among patients attending Al Wazarat health center. J Family Med Prim Care. 2022 Apr; 11(4):1299-1307. doi: 10.4103/jfmpc.jfmpc_1431_21. Epub 2022 Mar 18.

Akhtar, Z.; Mah-E-Muneer, S.; Rashid, M.M.; Ahmed, M.S.; Islam, M.A.; Chowdhury, S.; et al. Antibiotics Use and Its Knowledge in the Community: A Mobile Phone Survey during the COVID-19 Pandemic in Bangladesh. Antibiotics 2021, 10, 1052. https://doi.org/10.3390/antibiotics10091052

André M, Vernby A, Berg J, Lundborg CS. A survey of public knowledge and awareness related to antibiotic use and resistance in Sweden. J Antimicrob Chemother. 2010 Jun; 65(6):1292-6. doi: 10.1093/jac/dkq104.

Napolitano F, Izzo MT, Di Giuseppe G, Angelillo IF. Public knowledge, attitudes, and experience regarding the use of antibiotics in Italy. PLoS One. 2013 Dec 23; 8(12):e84177. doi: 10.1371/journal.pone.0084177.

Dandan Peng, Xiaomin Wang, Yannan Xu, Chenhui Sun & Xudong Zhou (2018) Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey, Global Health Action, 11:1, 1496973, DOI: 10.1080/16549716.2018.1496973

Gupta MK, Vohra C, Raghav P. Assessment of knowledge, attitudes, and practices about antibiotic resistance among medical students in India. J Family Med Prim Care. 2019 Sep 30; 8(9):2864-2869. doi: 10.4103/jfmpc.jfmpc_504_19.

Nguyen LS, Dolladille C, Drici MD, Fenioux C, Alexandre J, Mira JP et al. Cardiovascular Toxicities Associated With Hydroxychloroquine and Azithromycin: An Analysis of the World Health Organization Pharmacovigilance Database. Circulation. 2020 Jul 21; 142(3):303-305. doi: 10.1161/CIRCULATIONAHA.120.048238.

Langford BJ, So M, Raybardhan S, Leung V, Soucy JR, Westwood D et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect. 2021 Apr; 27(4):520-531. doi: 10.1016/j.cmi.2020.12.018.

Cho HJ, Hong SJ, Park S. Knowledge and beliefs of primary care physicians, pharmacists, and parents on antibiotic use for the pediatric common cold. Soc Sci Med. 2004 Feb; 58(3):623-9. doi: 10.1016/s0277-9536(03)00231-4.

World Health Organization. WHO AWaRe Antibiotic categorization. Available from: https://aware.essentialmeds.org/list. Last updated: 2019. Cited: 2022 27 Oct.

Khelgi A, Huchchannavar R, Mathew MM, Anandam S. Knowledge, attitude and practice regarding

antibiotic use and antimicrobial resistance among the rural public in Mangaluru, India. J Prev Epidemiol. 2022 Feb 12; 7(2):e26162. doi: 10.34172/jpe.2022.26162.

Yunita SL, Yang H-W, Chen Y-C, Kao L-T, Lu Y-Z, Wen Y-L et al. Knowledge and practices related to antibiotic use among women in Malang, Indonesia.Front. Pharmacol. 2022 Oct; 13:1019303. doi: 10.3389/fphar.2022.1019303

Downloads

Published

2023-12-19

How to Cite

Ghosh, H., & Gupta, K. (2023). Antibiotic Use Awareness and Practices in the Indian Community During Later Stages of COVID-19 Pandemic: A Cross-Sectional Survey. International Journal of Medical Students, 11, S97. https://doi.org/10.5195/ijms.2023.2345

Issue

Section

Abstracts of the WCMSR

Categories