Inappropriate Use of Antibiotics in the General Population

Main Article Content

Amal saleh faraj
Sumaya Ahmed Almefleh
Nouf Akash Almatrafi
Maryam hassan Nassar joufi
Maryam mohammad ghobean
Basmah mohammad omar jobahi
Fayez Khalaf Alrashidi
Bader Yahya Alaskar
Khalid Mohammed Alasmari
Muteb Ayidh Aldurum
Naif Eid Alosaimi

Abstract

Background: Antibiotic resistance is a significant and growing threat to global health. While the vast majority of antimicrobial use occurs in communities where antibiotics are available without a prescription, we were unable to locate any studies examining community-level factors that influence the inappropriate use of antibiotics in settings where nonprescription antibiotic use is common.


Methods: This qualitative study was conducted from 1 April to 5 May 2019 and consisted of in-depth, semi-structured interviews with adult household heads recruited via purposive and snowball sampling techniques. Participants with diverse educational and medical backgrounds were chosen. We utilized a thematic analysis methodology to investigate the community's knowledge and usage of antibiotics in the sampled population.


Results: Interviews were conducted with 18 participants with a median age of 35 years. The majority were female (77.7%), had completed at least secondary school (83.4%), and were unemployed (61.1%). We discovered that participants were familiar with the term "antibiotics" but had limited understanding of the indications and hazards of antibiotics, including the risk of antibiotic resistance. Antibiotic misuse was prevalent, as was self-medication with non-prescribed medications for a variety of non-indicated conditions, such as menstruation. The most frequently reported reason for not visiting a health facility for appropriate health care was limited income.


Conclusion: Lack of adequate knowledge of antibiotic use, indications, and risks, prevalent self-medication, and financial barriers to accessing appropriate health care all contribute to pervasive inappropriate antibiotic use. To reduce the inappropriate use of antibiotics, both community education and structural interventions addressing poverty are required

Article Details

How to Cite
Amal saleh faraj, Sumaya Ahmed Almefleh, Nouf Akash Almatrafi, Maryam hassan Nassar joufi, Maryam mohammad ghobean, Basmah mohammad omar jobahi, Fayez Khalaf Alrashidi, Alaskar, B. Y. ., Alasmari, K. M., Aldurum, M. A. ., & Alosaimi, N. E. (2023). Inappropriate Use of Antibiotics in the General Population. International Journal of Pharmaceutical and Bio Medical Science, 3(07), 350–357. https://doi.org/10.47191/ijpbms/v3-i7-07
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References

I. J ON. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations May 2016.

II. Krockow EM, Tarrant C. The international dimensions of antimicrobial resistance: Contextual factors shape distinct ethical challenges in South Africa, Sri Lanka and the United Kingdom. Bioethics. 2019; 33(7):756–65. Epub 2019/07/03. https://doi.org/10.1111/bioe.12604 PMID: 31264232

III. World Health Organization. Sixty-Eighth World Health Assembly [Internet]. 2015.

IV. World Health Organization. WHO Country progress in the implementation of the global action plan on antimicrobial resistance: WHO, FAO and OIE global tripartite database [Internet]. 2019.

V. World Health Organisation. Global Antimicrobial Resistance Surveillance System: Manual for Early Implementation [Internet]. 2015. p. 1–44.

VI. Tenover FC. Mechanisms of antimicrobial resistance in bacteria. Am J Med. 2006; 119(6 Suppl 1):S3– 10; discussion S62-70. Epub 2006/06/01. https://doi.org/10.1016/j.amjmed.2006.03.011 PMID: 16735149.

VII. Goossens H, Ferech M, Vander Stichele R, Elseviers M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005; 365(9459):579–87. Epub 2005/ 02/15. https://doi.org/10.1016/S0140-6736(05)17907-0 PMID: 15708101.

VIII. Jamhour A, El-Kheir A, Salameh P, Hanna PA, Mansour H. Antibiotic knowledge and self-medication practices in a developing country: A cross-sectional study. Am J Infect Control. 2017; 45(4):384–8. Epub 2017/01/15. https://doi.org/10.1016/j.ajic.2016.11.026 PMID: 28087169.

IX. Bax RP, Anderson R, Crew J, Fletcher P, Johnson T, Kaplan E, et al. Antibiotic resistance—what can we do? Nature Medicine. 1998; 4(5):545–6. https://doi.org/10.1038/nm0598-545 PMID: 9585218

X. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010; 340: c2096. https://doi.org/10.1136/bmj.c2096 PMID: 20483949

XI. Omulo S, Thumbi SM, Njenga MK, Call DR. A review of 40 years of enteric antimicrobial resistance research in Eastern Africa: what can be done better? Antimicrob Resist Infect Control. 2015; 4:1. Epub 2015/02/27.

https://doi.org/10.1186/s13756-014-0041-4 PMID: 25717374

XII. Cambaco O, Alonso Menendez Y, Kinsman J, Sigau´que B, Wertheim H, Do N, et al. Community knowledge and practices regarding antibiotic use in rural Mozambique: where is the starting point for prevention of antibiotic resistance? BMC Public Health. 2020; 20(1):1183.

https://doi.org/10.1186/s12889-020- 09243-x PMID: 32727445

XIII. Ce´spedes A, Larson E. Knowledge, attitudes, and practices regarding antibiotic use among Latinos in the United States: review and recommendations. Am J Infect Control. 2006; 34(8):495–502. Epub 2006/10/04. https://doi.org/10.1016/j.ajic.2006.01.005 PMID: 17015154.

XIV. Napolitano F, Izzo MT, Di Giuseppe G, Angelillo IF. Public knowledge, attitudes, and experience regarding the use of antibiotics in Italy. PLoS One. 2013; 8(12):e84177. Epub 2014/01/01. https://doi.org/10. 1371/journal.pone.0084177 PMID: 24376793

XV. Awad AI, Aboud EA. Knowledge, attitude and practice towards antibiotic use among the public in Kuwait. PloS one. 2015; 10(2):e0117910–e. https://doi.org/10.1371/journal.pone.0117910 PMID: 25675405.

XVI. Franco BE, Altagracia Martı´nez M, Sa´nchez Rodrı´guez MA, Wertheimer AI. The determinants of the antibiotic resistance process. Infect Drug Resist. 2009; 2:1–11. Epub 2009/01/01. PMID: 21694883

XVII. Cortez J, Rosa´rio E, Pires JE, Taborda Lopes J, Francisco M, Vlieghe E, et al. Antimicrobial storage and antibiotic knowledge in the community: a cross-sectional pilot study in north-western Angola. Int JInfect Dis. 2017; 60:83–7. Epub 2017/05/27. https://doi.org/10.1016/j.ijid.2017.05.011 PMID: 28546075.

XVIII. Nga do TT, Chuc NT, Hoa NP, Hoa NQ, Nguyen NT, Loan HT, et al. Antibiotic sales in rural and urban pharmacies in northern Vietnam: an observational study. BMC Pharmacol Toxicol. 2014; 15:6. Epub 2014/02/22. https://doi.org/10.1186/2050-6511-15-6 PMID: 24555709

XIX. Duffy E, Ritchie S, Metcalfe S, Van Bakel B, Thomas MG. Antibacterials dispensed in the community comprise 85%-95% of total human antibacterial consumption. J Clin Pharm Ther. 2018; 43(1):59–64. Epub 2017/08/24.

https://doi.org/10.1111/jcpt.12610

PMID: 28833324.

XX. Afari-Asiedu S, Oppong FB, Tostmann A, Ali Abdulai M, Boamah-Kaali E, Gyaase S, et al. Determinants of Inappropriate Antibiotics Use in Rural Central Ghana Using a Mixed Methods Approach. Front Public Health. 2020; 8:90. Epub 2020/04/09. https://doi.org/10.3389/fpubh.2020.00090 PMID: 32266200

XXI. World Health Organization. Antimicrobial resistance in the African Region: Issues, challenges and actions proposed. 2017.

XXII. Ministère de la Sante´ Publique, Secre´tariat Ge´ne´ral. Rapport Narratif: Profil Pharmaceutique de la Re´publique De´mocratique du Congo 2011. [Ministry of Public Health, General Secretariat. Narrative report: Pharmaceutical profile of the Democratic Republic of Congo 2011] https://www.who.int/ medicines/areas/coordination/drc_pharmaceutical_profile.pdf

XXIII. Barroy H, Andre F, Mayaka S, Samaha H. Investing in Universal Health Coverage: Opportunities and Challenges for Health Financing in the Democratic Republic of Congo. 2014. World Bank, Washington, DC. © World Bank.

https://openknowledge.worldbank.org/handle/10986/23880 License: CC BY 3.0 IGO.

XXIV. Didier B, Sandra M, Nadège T, Benido I, Bertrand S, Richard M, et al. BMC Infectious Diseases. 2021.

XXV. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006; 3(2):77–101.

https://doi.org/10.1191/1478088706qp063oa PMID: 32100154

XXVI. Horumpende PG, Sonda TB, van Zwetselaar M, Antony ML, Tenu FF, Mwanziva CE, et al. Prescription and non-prescription antibiotic dispensing practices in part I and part II pharmacies in Moshi Municipality, Kilimanjaro Region in Tanzania: A simulated clients approach. PLoS One. 2018; 13(11):e0207465. Epub 2018/11/22. https://doi.org/10.1371/journal.pone.0207465 PMID: 30462700

XXVII. Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. The Lancet Infectious Diseases. 2011; 11(9):692–701. https:// doi.org/10.1016/S1473-3099(11)70054-8 PMID: 21659004

XXVIII. Mbutiwi Ikwa Ndol Fiston, Lepira Bompeka Franc¸ois, Dramaix-Wilmet Michèle et al., « L’autome´dication chez des patients rec¸us aux urgences me´dicales des Cliniques Universitaires de Kinshasa », Sante´ Publique, 2013/2 (Vol. 25), p. 233–240.

XXIX. USAID/World Bank Group. Democratic Republic of the Congo Private Health Sector Assessment. 2017. https://www.shopsplusproject.org/sites/default/files/resources/Democratic Republic of the Congo Private Health Sector Assessment.pdf

XXX. Suleman S, Ketsela A, Mekonnen Z. Assessment of self-medication practices in Assendabo town, Jimma zone, southwestern Ethiopia. Res Social Adm Pharm. 2009; 5(1):76–81. Epub 2009/03/17. https://doi.org/10.1016/j.sapharm.2008.04.002 PMID: 19285292.

XXXI. Donkor ES, Tetteh-Quarcoo PB, Nartey P, Agyeman IO. Self-medication practices with antibiotics among tertiary level students in Accra, Ghana: a cross-sectional study. Int J Environ Res Public Health. 2012; 9(10):3519–29. Epub 2012/12/04. https://doi.org/10.3390/ijerph9103519 PMID: 23202760

XXXII. Hounsa A, Kouadio L, De Mol P. [Self-medication with antibiotics obtained from private pharmacies in Abidjan, Ivory Coast]. Med Mal Infect. 2010; 40(6):333–40. Epub 2009/12/03. https://doi.org/10.1016/j. medmal.2009.10.002 PMID: 19951830.

XXXIII. Awad AI, Eltayeb IB. Self-medication practices with antibiotics and antimalarials among Sudanese undergraduate university students. Ann Pharmacother. 2007; 41(7):1249–55. Epub 2007/06/15. https:// doi.org/10.1345/aph.1K068 PMID: 17565044.

XXXIV. Ocan M, Bwanga F, Bbosa GS, Bagenda D, Waako P, Ogwal-Okeng J, et al. Patterns and predictors of self-medication in northern Uganda. PLoS One. 2014; 9(3):e92323. Epub 2014/03/25. https://doi.org/ 10.1371/journal.pone.0092323 PMID: 24658124

XXXV. Hertz JT, Madut DB, Tesha RA, William G, Simmons RA, Galson SW, et al. Self-medication with nonprescribed pharmaceutical agents in an area of low malaria transmission in northern Tanzania: a community-based survey. Transactions of The Royal Society of Tropical Medicine and Hygiene. 2019; 113(4):183–8. https://doi.org/10.1093/trstmh/try138 PMID: 30597114

XXXVI. Afari-Asiedu S, Hulscher M, Abdulai MA, Boamah-Kaali E, Asante KP, Wertheim HFL. Every medicine is medicine; exploring inappropriate antibiotic use at the community level in rural Ghana. BMC Public Health. 2020; 20(1):1103. Epub 2020/07/16. https://doi.org/10.1186/s12889-020-09204-4 PMID: 32664902

XXXVII. Atif M, Sadeeqa S, Afzal H, Latif S. Knowledge, attitude and practices regarding antibiotics use among parents for their children. Int J Pharm SciRes. 2018; 9(5):2140–8.

XXXVIII. Afari-Asiedu S, Kinsman J, Boamah-Kaali E, Abdulai MA, Gyapong M, Sankoh O, et al. To sell or not to sell; the differences between regulatory and community demands regarding access to antibiotics in rural Ghana. J Pharm Policy Pract. 2018; 11:30. Epub 2018/12/20. https://doi.org/10.1186/s40545-018- 0158-6 PMID: 30564369

XXXIX. Planta MB. The role of poverty in antimicrobial resistance. J Am Board Fam Med. 2007; 20(6):533–9. Epub 2007/10/24.

https://doi.org/10.3122/jabfm.2007.06.070019 PMID: 17954860.

XL. World Health Organization. Overcoming antimicrobial resistance. World Health Organization report on infectious diseases. World Health Organization; 2000.

XLI. Anstey Watkins J, Wagner F, Xavier Go´mez-Olive´ F, Wertheim H, Sankoh O, Kinsman J. Rural South African Community Perceptions of Antibiotic Access and Use: Qualitative Evidence from a Health and Demographic Surveillance System Site. Am J Trop Med Hyg. 2019; 100(6):1378–90. Epub 2019/04/18. https://doi.org/10.4269/ajtmh.18-0171 PMID: 30994091

XLII. Yu M, Zhao G, Stålsby Lundborg C, Zhu Y, Zhao Q, Xu B. Knowledge, attitudes, and practices of parents in rural China on the use of antibiotics in children: a cross-sectional study. BMC Infect Dis. 2014; 14:112. Epub 2014/03/01.

https://doi.org/10.1186/1471-2334-14-112 PMID: 24576064

XLIII. Togoobaatar G, Ikeda N, Ali M, Sonomjamts M, Dashdemberel S, Mori R, et al. Survey of non-prescribed use of antibiotics for children in an urban community in Mongolia. Bull World Health Organ. 2010; 88(12):930–6. Epub 2010/09/03. https://doi.org/10.2471/BLT.10.079004 PMID: 21124718.

XLIV. World Health Organization. Guide to good storage practices forpharmaceuticals. 2003.

XLV. Office Fe´de´ral des Migrations. 2014. “Focus RD Congo Le système sanitaire à Kinshasa: me´dicaments et soins du VIH-sida, de l’hypertension arte´rielle, du diabète de type II et des troubles mentaux.” BerneWabern, Switzerland: Confe´de´ration suisse.

XLVI. World Health Organization. A study on the public health and socioeconomic impact of substandard and falsified medical products. Geneva: World Health Organization; 2017