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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, Nepalphysiosandeep@gmail.com

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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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Thank You!!!

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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