Download - Antibiotics to cure or harm
05/01/2023 1
Antibiotics to cure or harm: Concept of Antibiotic Resistance
among Health Professional Students in Nepal
Principal Investigator:Nayak SandeepAssistant ProfessorDept of Preventive and Community Dentistry M.B.Kedia Dental College and Teaching HospitalTribhuvan University, [email protected]
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ContentsIntroduction
Need for the study
Objective
Methods
Results & Discussion
Conclusion & Recommendations
References
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Introduction
Antibiotics are the most frequently prescribed drugs, but they are often misused. 1-2
This contributes to the spread of resistant strains of bacteria. 3
Main causes for antibiotic misuse is linked to Wrong prescribing behavior amongst physicians 4-6
Patient’s wrong habit and their lack of awareness 7-13
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Need for the study
Health Professional Students are integral component of the health care delivery system.
They get opportunity to interact with patients during their clinical posting.
Educational initiatives on the correct use and prescription of antibiotic drugs, should be address to the new generation of health professional students.
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Objective To evaluate the knowledge, attitude and practice of health
professional students about Antibiotic usage Antibiotic resistance
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Research Approach
Research Design
Sample and Sampling Technique
Data Collection
Tools
Data Analysis
Questionnaire based Survey
Approach
Institutional based
Cross-Sectional Study
Sample size:176 HPS
Sample Technique:
Convenience Sampling
Questionnaire based on-
1. Demographic2. KAP of Antibiotic
Analysis was done using
SPSS version 16.
Figure 1: Framework of Research Methodology
Research Methodology
*HPS: Health Professional Students KAP: Knowledge Attitude Practice
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Graph 1: Knowledge on Antibiotic (N=176)
Antibiotic cure bac-terial infection
Antibiotic cure viral infection
0
10
20
30
40
50
60
70
80
90
100 90.9
30.1
7.4
60.8
1.79.1
Yes No Don't know
Perc
enta
ge
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Graph 2: Antibiotic resistance bacteria can spread to humans through (N=171)
Contact with a person Contact with something Contact with animal/food/water
All options0
10
20
30
40
50
60
70
8.189.350000000000
01
21.63
60.81
Perc
enta
ge
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Graph 3: Indiscriminate and Injudicious use of antibiotic (N=176)
Perc
enta
ge
Increased adverse effect Additional burden of medical cost
Prolonged of cure time0
10
20
30
40
50
60
70
80
9084.7
60.3
40.9
5.6
24.433
9.715.3
26.1
Yes
No
Don't know
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Graph 4: Attitudes on antibiotic (N=176)
Consult doctor Abused of antibiotic Antibiotic resistance affect health
0
10
20
30
40
50
60
70
80
90
87.5
69.9 76.1
Perc
enta
ge
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Table 1: Practice of Antibiotic use (N=176)Doctor prescribes a course of antibiotic for you. After taking 2–3 doses you start feeling better
Always(%)
Usually(%)
Sometimes (%)
Never (%)
Stop taking further treatment 5.7 12.5 31.2 50.6
Save remaining antibiotics for the next time you get sick
8.0 11.4 24.4 56.2
Discard remaining, leftover medication 9.7 13.6 38.1 38.6
Give leftover antibiotics to your friend/roommate if they get sick
10.8 17.6 38.1 33.5
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Graph 5: Antibiotic resistance is serious global public health issue (N=176)
Yes No Don't know0
10
20
30
40
50
60
70
8070.5
15.3 14.2
Perc
enta
ge
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Graph 6: Necessary action for enhancing concept and practice on antibiotic (N=176)
Education Course on rational use Campaign0
10
20
30
40
50
60
70
80
90
100
98.3 96
73.9
Perc
enta
ge
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Table 2: DiscussionVariables Present
studyPrevious study
Authors Place Year
Consult doctor 87.50% 40.10%92.80%81.38%
Tarao MS et. alKhan A AK et. alScaioli G et. al
IndiaIndiaItaly
201520132013
Stop taking further treatment
5.70% 5.90%12.70%21.60%
Tarao MS et. alMahajan M et. al Khan A AK et. al
IndiaIndiaIndia
201520142013
Abuse of Antibiotics 69.90% 76.10% Tarao MS et. al India 2015
Antibiotic resistance affect health
76.10% 83.60% Tarao MS et. al India 2015
Antibiotic resistance is serious public health issue
70.50% 93.00%96.51%90.70%
Tarao MS et. alMahajan M et. alKhan A AK et. al
IndiaIndiaIndia
201520142013
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Conclusion The level of knowledge and attitude about antibiotics and its resistance amongst the health professional students is high, however, practice of antibiotics is still poor.
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Recommendations Government level
Further research at national level Policy- guidelines for the sale of antibiotics Campaign on rational use of antibiotics
Nepal Medical Council Guidelines on prescription and rational use of antibiotics
University / College level Inclusion in curriculum Change behavior of students against antibiotic usage Interventions for usage of antibiotic – training and awareness
Hospital and Community level Personal measures to reduce antibiotic resistance Educate patients and general population on rational use of antibiotic
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Acknowledgement
We are grateful to the Principals of M. B. Kedia Dental College and Teaching Hospital, and Birgunj Nursing Campus, Birgunj for giving permission of this study.
Lastly, but most importantly we are thankful to all the participants for being volunteering participating for this study.
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References1. Chambers HF. General principles of antimicrobial therapy. In Goodman & Gilman's The Pharmacological
Basis of Therapeutics 11th edition. Editors: Brunton L, Parker K, Blumenthal D, Buxton I. New York, USA, Mc Graw Hill. 2006; pp.1095–110.
2. World Health Organization (2014). Antimicrobial Resistance. Global Report on Surveillance. Geneva: World Health Organization, 2014. Available: http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf. Accessed 01 October 2015.
3. Centers for Disease Control and Prevention (CDC) (2013) Antibiotics Aren't Always the Answer. Available: http://www.cdc.gov/Features/GetSmart/. Accessed: 01 October 2015.
4. Tonkin-Crine S, Yardley L, Little P. Antibiotic prescribing for acute respiratory tract infections in primary care: a systematic review and meta-ethnography. J Antimicrob Chemother. 2011; 66(10): 2215–2223.
5. Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. BMJ. 1998; 317(7159): 637–642.
6. Kumar S, Little P, Britten N. Why do general practitioners prescribe antibiotics for sore throat? Grounded theory interview study. BMJ. 2003; 326(7381): 138.
7. World Health Organization (2012). The evolving threat of antimicrobial resistance. Options for action. Geneva: World Health Organization, 2012. Available: http://whqlibdoc.who.int/publications/ 2012/9789241503181_eng.pdf. Accessed: 01 October 2015.
8. Cars O, Mölstad S, Melander A. Variation in antibiotic use in the European Union. Lancet. 2001; 357 (9271): 1851–1853.
9. Corbett KK, Gonzales R, Leeman-Castillo BA, Flores E, Maselli J, Kafadar K. Appropriate antibiotic use: variation in knowledge and awareness by Hispanic ethnicity and language. Prev Med. 2005; 40 (2): 162–169.
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10. McNulty CAM, Boyle P, Nichols, Clappison P, Davey P. Don’t wear me out—The public’s knowledge of and attitudes to antibiotic use. J Antimicrob Chemother. 2007; 59(4): 727–738.
11. Grigoryan L, Burgerhof JG, Haaijer-Ruskamp FM, Degener JE, Deschepper R, Monnet DL, et al. Is self-medication with antibiotics in Europe driven by prescribed use? J Antimicrob Chemother. 2007; 59: 152–156.
12. European Commission. Special Eurobarometer 407. Antimicrobial Resistance. Report (2013) Available: http://ec.europa.eu/health/antimicrobial_resistance/docs/ebs_407_en.pdf Accessed 05 October 2015.
13. Gualano MR, Gili R, Scaioli G, Bert F, Siliquini R; General population's knowledge and attitudes about antibiotics: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2015; 24(1):2–10.
14. Khan A K A, Banu G, K K R. Antibiotic Resistance and Usage - A Survey on the Knowledge, Attitude, Perceptions and Practices among the Medical Students of a Southern Indian Teaching Hospital. J Clin Diagn Res. 2013; 7(8): 1613–1616.
15. Scaioli G, Gualano MR, Gili R, Masucci S, Bert F, Siliquini R. Antibiotic Use: A cross-sectional survey Assessing the Knowledge, Attitudes and Practices amongst Students of a School of Medicine in Italy. Journal.pone. 2015.
16. Tarao MS, Nulla Polly, Zingpi M, Agatha G. A study on the Knowledge, Attitude, Perceptions and Practices of Antibiotic Usage and Resistance the medical students of JNIMS, Manipur. J of Evidence Based & Hltcare. 2015; 2(34).
17. Mahajan M, Dudhgaonkar S, Deshmukh S. A Questionnaires based survey on the Knowledge, Attitude and Practices about Animicrobial Resistance and Usage among the Second year MBBS Students of a Teaching tertiary care Hsopital in Central India. International Journal of Pharmacological Reseacrh. 2014; 4(4):175-179.
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Causes of Antibiotic Resistance
Important Unimportant
Unsure`
Use of antibiotics for self-limited non bacterial infections
89 (50.6) 48 (27.3) 39 (22.2)
Use of antibiotics with a broader than necessary spectrum
72 (40.9) 59 (33.5) 45 (25.6)
Use of antibiotics for shorter than standard duration 75 (42.6) 79 (44.9) 22 (12.5)
Poor infection control measures 93 (52.8) 50 (28.4) 33 (18.8)
Use of antibiotics for self limited bacterial infections 114 (64.8) 48 (27.3) 14 (8.0)
Mutational and evolutionary changes in the micro organism
71 (40.3) 44 (25.0) 61 (34.7)
Lack of restrictions on antibiotic usage 82 (46.6) 64 (36.4) 30 (17.0)
Excessive antibiotic use in live stock (Animals reared for food)
49 (27.8) 74 (42.0) 53 (30.1)
Use of antibiotics for longer than standard duration 69 (39.2) 92 (52.3) 15 (8.5)
19.69