INTRODUCTION:

Antibiotics are substances produced by a microbe, especially a fungus, which can inhibit or kill other microbes. Antibiotics are essential drugs and can be used to eradicate various infectious diseasese¹. Antibiotics are one of the most frequently prescribed, sold, and used drugs worldwide. Frequent use of antibiotics inappropriate results in increased germ resistance to antibiotics². Antibiotic resistance has become a problem worldwide.

According to the Minister of Health of the Republic of Indonesia³, Indonesia was ranked 8th out of 27 countries with a high burden of drug resistance to Multidrug Resistance (MDR) in the world based on World Health Organization (WHO) 2009 data.

Research conducted by Lim and Teh in Putrajaya, Malaysia, states that 83% of respondents do not know that antibiotics do not work to fight viral infections, and 82% of respondents do not know that antibiotics cannot treat coughs and flu³. Some respondents' statements included stopping the use of antibiotics when the symptoms improved and taking fewer antibiotics than the doctor prescribed would be healthier than taking all the antibiotics prescribed⁴.

Research conducted by Widayati in Yogyakarta stated that around 71% do not have Moderately precise knowledge about the use of antibiotics, more than half believe antibiotics can prevent the disease from getting worse (74%). Low than half believe that antibiotics do not affect. Another study conducted in Lithuania stated that more than 61.1% of respondents had low knowledge of antibiotics⁶. Nearly half of respondents considered antibiotics to be effective against viral infections (26%) or bacterial and viral infections (21.7%). As many as 47.7% felt the common cold was an appropriate indication for antibiotic use⁷.

Based on the results of a previous study conducted in Jordan taken from a random sample of 1,141 adults, 67.1% believed that antibiotics treat colds and coughs. 28.1% of antibiotics were abused as analgesics. A total of 11.9% of the women showed knowledge that antibiotics during pregnancy and breastfeeding are safe for consumption, and 55.6% used them as prophylaxis against infection. 49.0% used antibiotics without consulting a doctor, while 51.8% used antibiotics based on relative recommendations. Also, 22.9% of physicians prescribe antibiotics by telephone, and ≥ 50.0% routinely prescribe antibiotics to treat common cold symptoms⁸.

Public misconceptions about using antibiotics can potentially lead to inappropriate treatment, where people believe antibiotics are "extraordinary drugs" or "powerful drugs" that can prevent and cure every symptom or disease. Knowledge and belief are factors that can influence individual antibiotic use behavior. By itself, knowledge is not Moderate to change behavior but plays a vital role in shaping opinions and attitudes. The consequences of using antibiotics with Low experience have the potential to lead to misunderstandings about their use. Given that the inappropriate use of antibiotics in the community continues to be a problem in every country, the provision of knowledge information related to the correct use of antibiotics is enforced. However, the condition of such information is still relatively rare, especially in Indonesia.

MATERIAL AND METHODS:

Type of Research:

This type of research is a descriptive study with a cross-sectional method supported by primary data, in the form of data obtained directly through filling out questionnaires answered by respondents.

Time, Place, Population and Sampel of Research:

The research was conducted in December 2017. The location of the research data collection was located in Panyabungan District, Mandailing Natal Regency, Indonesia. Through filling out questionnaires by respondents directly. Panyabungan Kota sub-district consists of 14 villages and seven sub-districts with a population of 15,117 people and total of sampel 198 people.

Evaluation of Knowledge, Perception, Belief:

Evaluation of Knowledge:

In the assessment of the knowledge, there are 14 (fourteen) question questions; each correct answer on the questionnaire is given a value of 2, wrong answers are given a value of 0, and not knowing is given a value of 0. The measurement scale for knowledge can be categorized:

a. good, if the value of the respondent is 22-28 (> 75%)

b. Moderate, if the respondent's value is 15-21 (50% - 75%)

c. Low, if the respondent's value is 0 - 15 (<50%)

Evaluation of Perception:

In the perception assessment consisting of 5 statements, each statement strongly disagrees given a value of 5, disagree is given a value of 4, is not sure that it is given a value of 3, agrees to be given a value of 2, and strongly agrees will be given a value of 1. The measurement scale for perception can be categorized:

a. good, if the respondent's value is 20-25 (> 75%)

b. enough, if the respondent's value is 12-19 (50% - 75%)

c. Low, if the respondent's value is 0 - 11 (<50%)

Evaluation of Belief:

In the trust assessment consisting of 4 statements, each statement strongly disagree given a value of 5, disagree is given a value of 4, is not sure that it is given a value of 3, agrees is given a value of 2, and strongly agrees is given a value of 1, the measurement scale for trust can be categorized:

a. good, if the value of the respondent is 16-20 (> 75%)

b. Moderate, if the respondent's value is 10 - 15 (50% - 75%)

c. Low, if the respondent's value is 0 - 9 (<50%)

Validity and Reliability:

The validity test is used to measure whether a questionnaire is valid or not; a questionnaire is declared valid if the questionnaire's questions can reveal something that will be measured by the questionnaire. A reliability test is a tool for measuring a questionnaire, which is an indicator of a variable. A questionnaire is reliable or reliable if a person's answer to a statement is consistent from time to time. To find out whether a variable is reliable or not, a statistical test is carried out by looking at the Wilcoxon rank test value, where the reliability requirement is p value> α (0.05)⁹.

Analysis of Data:

This bivariate analysis is used to determine the relationship between the independent variable and the dependent variable. In this study, bivariate analysis was carried out by using the Chi-square test, where the test conditions have been met in the research data. If the p-value <0.1, it can be concluded that there is a relationship between the variables studied. Meanwhile, if the p value> 0.1 means that the statistical calculation results are not significant or there is no significant relationship between the variables studied.

RESULT AND DISCUSSION:

Demographics of Respondents

This research was conducted in Panyabungan Kota District, Mandailing Natal Regency. With demographic data of respondents consisting of gender, age, education, and occupation. The following is an illustration of the frequency distribution of the characteristics of the respondents in (Table 1).

A total of 198 respondents were involved in this study. Characteristics of respondents based on gender were women as many as 121 respondents (61.1%) while men were 77 respondents (38.8%). Based on the age, 91 respondents (45.9%) were aged between 19-30. Based on the most recent education, 60 respondents with high school education (30.3). Complete data can be seen in Table 1.

Respondents' Knowledge Level About Antibiotics:

For testing the level of public knowledge of usage antibiotics made several knowledge questions consisting of knowledge general about antibiotics. This result is useful as information to find out the extent of the respondent's knowledge regarding the importance of knowledge respondents regarding antibiotics (Tabel 2.).

Table 1: Distribution of Respondent Characteristics

Variabels	Total	Percentage (%)
Gender
Male	77	38,8
Female	121	61,1
Age
19-30	91	46,0
31-42	61	30,8
43-45	36	18,82
55-70	10	5,1
Educations
Primary School	38	19,2
Junior High School	43	21,7
Senior High School	59	29,8
Bachelor	58	29,3
Occupations
Government Employees	60	30,3
Entrepreneur	23	11,6
Housewife	16	8,1
Farmer	94	47,4
Student	5	2,5

Table 2: Distribution of respondents' knowledge of answers to antibiotics

No.	Questions	Yes (%)	No (%)	Unknown (%)
1.	Antibiotics are drugs used to kill bacteria	149 (75,2)	30 (15,1)	19 (9,5)
2.	Antibiotics can be used to treat diseases caused by viruses.	96 (48,4)	74 (37,3)	28 (14,1)
3.	Antibiotics can be used to treat colds and coughs.	111 (56,0)	63 (31,3)	25 (12,6)
4.	Antibiotics should be used as well have a fever	69 (34,8)	92 (46,4)	37 (18,6)
5.	Antibiotics can kill bacteria normal living in the channel digestion	83 (41,9)	84 (42,4)	31 (15,6)
6.	Normal bacteria live inside the digestive tract is good for health	103 (52,0)	56 (28,2)	39 (19,6)
7.	Antibiotics are drugs that are used as a pain reliever and fever	67 (33,8)	101 (51,0)	30 (15,1)
8.	Penicilin is antibiotic	112 (56,5)	51(25,7)	35 (17,6)
9.	Antibiotics can cause an allergic reaction	95 (47,9)	67 (33,8)	31(15,6)
10.	Antibiotics have side effects.	87 (43,9)	78 (39,3)	33 (16,6)
11.	Excessive or inappropriate use of antibiotics can cause the antibiotic to become inactive or resistant	102 (51,5)	53 (26,7)	43 (21,7)
12.	It doesn't matter if the antibiotics are stopped when the complaints have disappeared.	83 (41,9)	72 (36,3)	55 (27,7)
13.	Low than prescribed antibiotics is better than the total amount prescribed	51 (25,7)	92 (46,4)	55 (27,7)
14.	New or expensive antibiotics are better	50 (25,2)	104 (52,5)	44 (22,2)

Table 7: Regression and Optical characteristics of ATN and LOS

Category	Number	Percentage (%)
Good	11	5,6
Moderate	148	74,7
Low	39	19,7
Total	198	100%

Table 6 and 7 shows the statements related to public beliefs about antibiotics. Based on the results of the study, it was found that as many as 40.8% of respondents had the wrong belief that antibiotics could cure any disease, 29.7% were unsure, and only 29.2% stated that antibiotics were not drugs that could cure any disease. More than 50% of respondents believed that antibiotics could be used as a medicine to prevent the disease from getting worse, 32.3% were unsure, and 14.1% disagreed. As many as 48.4% of respondents had confidence that powdered antibiotics could be used as wound medicine, 32.3% of respondents were unsure, and only 19.1% disagreed. If the skin wound is caused by an infection, it must be treated with antibiotics, and then an appropriate antibiotic is used in the form of an ointment. Based on the research, it was found that 26.2% agreed that antibiotics had no side effects; only 39.8% of the respondents believed that antibiotics also had side effects. This is not much different from a study in Yogyakarta which showed that 40% believed that antibiotics could cure any disease, as well as the statement that antibiotics could be used as skin wounds, and 24% believed that antibiotics had no side effects. This shows that public confidence in these antibiotics can lead to antibiotic resistance¹⁴.

Based on the data analysis carried out, most respondents' attitudes were in a good category as 11 respondents, 5.6%. Meanwhile, in the moderate category, 148 respondents were 74.7%, and in the low category, 39 respondents were 19.7%. These results illustrate the public's trust in the use of antibiotics in Panyabungan Kota sub-district.

The relationship between the characteristics of the respondents and the level of knowledge

This analysis indicates whether there is a relationship between each characteristic of respondents with the level of knowledge. More data can be seen in Table 8

Table 8: The relationship between the characteristics of the respondents and the level of knowledge

Variabels	The level of knowledge			P value
	Good	Moderate	Low	P value
Gender
Male	21	31	25	0,049
Female	54	61	29	0,049
Age
19-30	38	36	17	0,038
31-42	25	20	16
43-45	9	9	18
55-70	3	4	3
Educations
Primary School	12	11	15	0,000
Junior High School	7	18	18
Senior High School	14	24	21
Bachelor	42	16	3
Occupations
Government Employees	8	39	6	0,000
Entrepreneur	19	31	44
Housewife	42	18	0
Farmer	1	4	0
Student	5	7	0

In Table 8, the comparison of gender characteristics between men and women, it can be seen that the comparison of attitudes about antibiotics between the two characteristics shows a difference, namely that women's knowledge has a better level of knowledge. The correlation between gender and knowledge obtained a significant P value of 0.049 (<0.1), which indicates a significant relationship between the sex of the respondent and the level of knowledge.

In the correlation between age and knowledge level, 18-30-year-olds have a good level of knowledge. The correlation between age and knowledge obtained a significant P value of 0.038 (<0.1), which indicates a relationship indicating a significant relationship between the age of the respondent and the level of knowledge.

The correlation between the last education and the level of knowledge shows that the last education bachelor has better knowledge, followed by Senior high school, Junior High School and the lowest is Primary schools. This indicates that a person's high level of education will affect the level of knowledge they get. According to Suhardi (2009), one of the factors that influence a person's knowledge is education. The higher a person's education, the easier the person will receive information to obtain more knowledge. The correlation between the last education and the level of knowledge got a significant value of P 0.000 (<0.1), which indicates a significant relationship between the respondent's last education and the level of knowledge.

On the correlation between work and knowledge level, which shows that civil servants have better knowledge. The correlation between work and knowledge obtained a significant value of P 0.000 (<0.1), which indicates a significant relationship between the respondent's job and the level of knowledge. In relation to the level of knowledge and work, work indirectly contributes to influencing a person's knowledge level. This is because work is closely related to social and cultural interaction factors, while social and cultural interactions are closely related to information exchange, and this will certainly affect a person's level of knowledge¹⁵.

From the results obtained, it can be concluded that from the four characteristics of the respondents, the latest education, occupation, age and gender affect the level of knowledge. In accordance with the results of Singgih Putra Ambada research in Surakarta, which shows that the last education category, the respondent's occupation, age, and gender affect the level of respondents' knowledge about antibiotics¹⁶. Study conducted by yogesh stated that self-medication of antibiotics on the basis of incomplete knowledge should be avoided and proper education must be required to those who are treating themselves with self-medication practice in order to avoid antibiotics resistance¹⁷. And also antibiotics resistance can cause Emergence of Superbugs (bacteria highly resistant to antimicrobial agents) has severely threatened therapeutic¹⁸. Our result showed that 31,0% agree that antibiotics are ineffective in treating coughs and colds, study conducted by patil also showed that 33% did not know that antibiotics are ineffective in treating coughs and colds¹⁹.

CONCLUSIONS:

The level of public knowledge on antibiotics use in the community in Panyabungan City District, Mandailing Natal District can be categorized as good 75 (37.9%), moderate category 69 (34.8%), and category Low 54 (27.3%) as a whole the level of knowledge is classified as good. The level of belief on antibiotics use in the community in Panyabungan District, Mandailing Natal District can be categorized as good 11 (5.6%), moderate category 148 (74.7%), and category low 39 (19.7%) overall, the level of belief is moderate. The level of community perceptions about antibiotics in the community in Panyabungan Kota District, Mandailing Natal Regency can be categorized as good 20 (10.1%), moderate category 138 (69.7%), and category low 40 (20.2%) the overall perception of society about is moderate.

ACKNOWLEDGEMENT:

The authors are grateful for faculty of pharmacy of universitas sumatera utara for the facilities.

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

REFERENCES:

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Received on 24.11.2020 Modified on 26.01.2021

Research J. Pharm. and Tech 2021; 14(12):6549-6554.

DOI: 10.52711/0974-360X.2021.01133

No.	Questions	Totally agree (%)	Agree (%)	Not Sure (%)	Disagree (%)	Totally Disagree (%)
1.	Whenever I have a cold or a cold, I will immediately use antibiotics	29 (14,6)	63 (31,8)	41 (20,7)	50 (25,2)	15 (7,5)
2.	I used to stop antibiotics when I felt better.	19 (9,5)	97 (48,9)	28 (19,1)	38 (19,1)	6 (3,0)
3.	If you have flu symptoms, I will ask the doctor to prescribe antibiotics	20 (10,1)	63 (31,8)	48 (24,2)	65 (32,8)	7 (3,5)
4.	If anyone in my family is sick, I usually give antibiotics.	14 (7,0)	64 (32,3)	48 (24,2)	65 (32,8)	7 (3,5)
5.	I used to keep the antibiotic antibiotics in stock.	18 (9,0)	66 (33,3)	45 (22,7)	53 (26,7)	16 (8,0)

No.	Questions	Totally agree (%)	Agree (%)	Not Sure (%)	Disagree (%)	Totally Disagree (%)
1.	I believe that antibiotics can cure any disease.	18 (9,0)	63 (31,8)	59 (29,7)	44 (22,2)	14 (7,0)
2.	I believe antibiotics can prevent the disease from getting worse.	7 (3,5)	99 (50)	64 (32,3)	27 (13,6)	1 (0,5)
3.	I believe wounds on the skin heal faster by sprinkling powder antibiotics on them	12 (6,0)	84 (42,4)	64 (32,3)	35 (17,6)	3 (1,5)
4.	I believe that antibiotics have no side effects.	17 (8,5)	36 (18,1)	66 (33,3)	59 (29,7)	20 (10,1)