Antibiotic Overuse and Resistance: An Awareness Study

 

Shivani M. Desai*, Vaishali R. Undale

Department of Pharmacology, Dr. D. Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri,

Pune-411018 Dist.-Pune (M.S.) India.

 

ABSTRACT:

Antibiotics, first-line treatment for microbes-induced illnesses, indiscriminate use of which has led to increased resistance problems. Pharmacy students who are directly involved in drug distribution system should have sound knowledge about antibiotics and their resistance. The primary objective of this study was to assess awareness on antibiotics and its resistance in pharma students. The study was carried out in November 2017. Questionnaire was prepared, validated, and filled by students. Knowledge and attitude towards antibiotic use and their resistance was studied. First year and final year B. Pharm students were the study participants. Intra-college data comparison was done with first year and final year students from one college, and inter-college comparison was done between final year students from five colleges in Pune. Data was collected and analysed for statistical significance using GraphPad Prism-7. The study revealed that knowledge of antibiotics and its resistance is better in the final year students as compared to first year. Also, the inter-college data showed that college A has better knowledge than the other colleges. However, results were not satisfactory. Pharma students, who may play an important role in treatment of microbial illnesses, do not have accurate knowledge about antibiotic use and its resistance. Appropriate knowledge can help them preventing emergence of resistance. Hence, special sessions on antibiotics use and resistance should be conducted in pharma colleges for lowering resistance risk.

 

 

 

INTRODUCTION:

Antibiotic resistance means the microorganisms are able to survive and resist the exposure to antimicrobial drugs. The resistant genes can be genetically transferred from one microorganism to the other¹. Though a few antibiotics are known, antibiotic resistance is a potential issue that needs to be critically ascertained. The resistance to antibiotics is a protective mechanism which the microorganisms possess to survive². Antibiotic resistance is a global problem and may occur due to spontaneous deoxyribonucleic acid (DNA) mutation, transformation, or plasmid transfer^2,3. The Centres for Disease Control and Prevention, the National Institute of Allergy and Infectious Diseases, and the Food and Drug Administration state antibiotic resistance as one of the world’s most insistent health problems².

 

 

It compromises the treatment of various infectious diseases such as gonorrhea, tuberculosis, bacterial pneumonia, and staphylococcal, enterococcal, and streptococcal infections. The heavy use of antibiotics in critically ill patients may lead to further bacterial gene mutations causing more drug resistance.

 

There are various harmful end results of antibiotic resistance, such as, increasing the severity of disease, increasing health care costs, and increasing the death rates due to certain diseases. Above 70% of the hospital-acquired infections causing bacteria are resistant to a minimum of one of the drugs which are most commonly employed for its treatment. Whereas, some bacteria are resistant to all the approved antibiotics and hence, the experimental and potentially toxic drugs are used for the treatment². It occurs due to the overuse and misuse of antibiotics³. Thus, misuse and irrational use of antibiotics should be prohibited by imparting a thorough knowledge of the antibiotics and their indications². The general population can help to reduce the incidences of antibiotic resistance by taking various actions such as preventing infections, using antibiotics only when prescribed, completing the full prescription, avoid the use of left-over antibiotics, and not sharing antibiotics with others³. The immediate solution to antibiotic resistance is the rationalization of antibiotic use. Thus, the education and knowledge of healthcare professionals as well as the general public is vitally important⁴. Therefore, this study was aimed to assess the patient awareness about antibiotics usage.

 

MATERIAL AND METHODS:

Sample Population:

The study was conducted among the first year and final year B. Pharm. This study was of intra as well as inter college design. The knowledge of first year students was compared with the knowledge of final year students from the same college, also, there was comparison of knowledge between the final year students from five colleges in Pune.

 

Data Collection:

The questionnaire (Appendix 1) was prepared, validated and filled by the students to evaluate the knowledge and attitude towards antibiotic use and their resistance. It was then verified for content validity with the people who were not participating in the study. The participants were verbally informed about the survey. The questionnaire was given to the participants. The questionnaire contained four sections, which included questions about socio-demographics, knowledge about antibiotics, their personal experience with antibiotic, and knowledge on antibiotic resistance.

 

Data Management and Statistical Analysis:

The data collected from questionnaire were entered in the Excel and transferred to GraphPad Prism-7 for analysis.

 

Ethical considerations:

The participants were contacted prior to the study and were explained the study details. They gave verbal consent to participate.

 

RESULTS:

One hundred and fifty participants were encompassed in this study among which 145 completed the survey. The demographic details of the participants are summarized in Table 1(a) and 1(b). The average age of first year students is 18 years and that of final year students is 22 years, and maximum candidates belongs to urban localities.

 

Table 1(a): Demographic details of first year and final year students (intra-college data)

Variable	First Year	Final Year
Age (Average age in years)	18.04	22.8
Sex
Male	13	7
Female	12	18
Life style until now
Urban	21	16
Rural	4	9
Current Location
Home	18	5
College Hostel	0	0
Private Hostel	3	7
Paying Guest	4	13

 

Table 1(b): Demographic details of final year students (inter-college data)

Variable	A	B	C	D	E
Age (Average age in years)	22.8	21.58	21.21	21.6	22
Sex
Male	7	15	8	14	25
Female	18	19	15	9	0
Life style until now
Urban	16	16	19	2	22
Rural	9	8	4	21	3
Current Location
Home	5	8	17	21	11
College Hostel	0	0	0	0	2
Private Hostel	7	9	4	1	7
Paying Guest	13	7	2	1	5

 

The evaluation of antibiotic knowledge among the participants was evaluated based on eight question. Table 2(a) and 2(b) summarizes intra-college and inter-college data of the participants about their antibiotic knowledge. The figures in the tables represent the percentage of participants who have given correct answers.

 

 

 

Table 2(a): Antibiotic knowledge of first year and final year students (intra-college data)

 

 

 

The difference between antibiotics and antimicrobials was known only be 92% of first and final year students, and only 80% of them could give the correct examples of antibiotics. Only 60% of final year candidates knew that antibiotics cannot treat viral infections, whereas only 40% of first year candidates were aware of this fact. Only 68% of candidates from both the groups feel that completing the antibiotic prescription is mandatory.

The inter-college data was not satisfactory. Only 60% of group A were aware that antibiotics cannot be used to treat viral infections, whereas no candidate from group D was aware about this fact. Also, only 44% of group D candidates felt that one should complete the antibiotic prescription.

 

 

Fig. 1(a): Intra-college data: Antibiotic Knowledge                                     Fig. 1(b): Inter-college data: Antibiotic Knowledge

 

Table 2(b): Antibiotic knowledge of first year and final year students (intra-college data)

 

 

Fig. 1(c): Cumulative inter-college data: Antibiotic Knowledge

 

 

 

 

 

 

 

In graph 1(c), the cumulative inter-college shows that only 23.2% candidates are aware that antibiotics are ineffective against viruses.

 

The knowledge about antibiotic resistance is displayed in table 3(a) and 3 (b). It is a matter of concern that only 28% of candidates from first and final year have knowledge about antibiotic resistance. The knowledge about cross resistance is very poor in the candidates, 12% first year and 8% final year candidates could correctly define it. Final year candidates (68%) better knowledge about consequences of irrational use of antibiotics as compared to first year candidates (44%); this knowledge is not satisfactory in both the groups. 64% final year candidates feel that antibiotic resistance is a global problem, whereas only 12% of first year candidates feel this.

 

 

 

 

 

Table 3(a): Resistance knowledge of first year and final year students (intra-college data)

 

Fig. 2(a): Intra-college data: Resistance Knowledge                                     Fig. 2(b): Inter-college data: Resistance Knowledge

 

Table 3(b): Resistance knowledge of final year students (inter-college data)

 

It is upsetting to know that final year students from different colleges have poor knowledge about antibiotic resistance (48% from group B and 4% from group E). Only 12% of group B could correctly define cross resistance, and no candidate from group D and E knew about cross resistance. Group B candidates (96%) better knowledge about consequences of irrational use of antibiotics as compared to group D candidates (16%). 80% of group B candidates feel that antibiotic resistance is a global problem, whereas only 40% of group E candidates feel this.

 

Fig. 2(c): Cumulative inter-college data: Resistance Knowledge

 

In graph 2(c), the cumulative inter-college shows that only 5.6% candidates were able to correctly answer about cross resistance. Only 56% and 55.2% candidates feel that antibiotic resistance is an Indian and global problem, respectively.

 

Graph 3(a) and 3(b) represents the participants’ source of knowledge about antibiotics and its resistance. Books are the source of knowledge in maximum participants.

 

Fig. 3(a): Intra-college data: Knowledge source

 

Fig. 3(b): Inter-college data: Knowledge source

* Sources 1-7 represents physician, internet/web, faculty, books, friends, family member, and others. respectively

 

DISCUSSION:

Enhancing the antibiotic knowledge of the healthcare professionals as well as the general population is one of the most important steps towards preventing antimicrobial resistance.

 

European and some international studies about the knowledge of antibiotic use and resistance show an extensive ignorance about the ineffectiveness of antibiotic treatment in treating viral infections. Also, there is a lack of knowledge to differentiate the treatment for bacteria and viruses. This indicates a poor understanding of the fact that antibiotics are ineffective against viruses. Swedish and Kuwaitian studies confirm a poor public knowledge regarding the effectiveness of antibiotics against bacteria or viruses^5,6. The present study also approves these observations, as a high percentage of participants did not know the indications for antibiotic treatment. Inaccurate knowledge of antibiotic prescription is due to inadequate social awareness of antibiotic use and resistance⁴. Such ignorance was also highlighted in the Eurobarometer surveys, where a huge number of Europeans were uninformed about the ineffectiveness of antibiotics against cold and flu^7,8.

 

Therefore, proper information to the general population is much desirable to advance the antibiotic knowledge and the risks associated due to its misuse.

 

This study establish that the participants have many misconceptions as well as lack of awareness about antibiotic use and its resistance. Considering the increasing complication of infectious disease as well as antibiotic resistance, such investigations of the public health education and knowledge about antibiotics among the healthcare professionals should be carried out in a regular basis. Also, steps should be taken to develop and follow appropriate prescription policies and regulations. Finally, continuous training programs should be conducted to target specific areas of misuse and misconception of antibiotics.

 

ACKNOWLEDGEMENT:

The authors are grateful to the authorities of Dr. D. Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune for the facilities.

 

REFERENCES:

1.      Ketevan K, Cecilia SL, Gaetano M. Antibiotic use and resistance:  a cross-sectional study exploring knowledge and attitudes among school and institution personnel in Tbilisi, Republic of Georgia. BMC Res Notes 2015; 8:495. DOI 10.1186/s13104-015-1477-1. 1

2.      Maheshwari P, Praveen D, Ravichandiran V. A study on patients’ awareness on rational use of antibiotics and its resistance. Asian J Pharm Clin Res 2015;8(3):204-206.

3.      Antibiotic Resistance: Multi-country public awareness survey. World Health Organization. 2015.

4.      Mazińska B, Strużycka I, Hryniewicz W. Surveys of public knowledge and attitudes with regard to antibiotics in Poland: Did the European Antibiotic Awareness Day campaigns change attitudes? PLoS ONE 2017;12(2): e0172146. doi: 10.1371/journal.pone.0172146

5.      Andre 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; 65: 1292–1296. doi: 10.1093/jac/ dkq104 PMID: 20360063

6.      Awad AI, Aboud EA. Knowledge, attitude and practice towards antibiotic use among the public in Kuwait. PLoS One 2015; 10: e0117910. doi: 10.1371/journal.pone.0117910 PMID: 25675405

7.      TNS Opinion and Social. Special Eurobarometer 445: Antimicrobial Resistance. Brussels, Belgium, 2016.

8.      TNS Opinion and Social. Special Eurobarometer 407: Antimicrobial Resistance. Brussels, Belgium, 2013.

 

 

 

 

 

 

Received on 20.02.2019           Modified on 07.04.2019

Accepted on 19.05.2019         © RJPT All right reserved