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Bepari AK, Rabbi G, Shaon HR, Khan SI, Zahid ZI, Dalal K, Reza HM. Factors Driving Antimicrobial Resistance in Rural Bangladesh: A Cross-Sectional Study on Antibiotic Use-Related Knowledge, Attitude, and Practice Among Unqualified Village Medical Practitioners and Pharmacy Shopkeepers. Adv Ther 2023; 40:3478-3494. [PMID: 37291375 PMCID: PMC10329962 DOI: 10.1007/s12325-023-02547-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Inappropriate antibiotic use in community settings significantly contributes to antimicrobial resistance (AMR) globally, compromising the quality of life and threatening public health. This study aimed to identify AMR contributing factors by analyzing the knowledge, attitude, and practice (KAP) of the unqualified village medical practitioners and pharmacy shopkeepers in rural Bangladesh. METHODS We performed a cross-sectional study where the participants were pharmacy shopkeepers and unqualified village medical practitioners aged ≥ 18 years and living in Sylhet and Jashore districts in Bangladesh. Primary outcome variables were knowledge, attitude, and practice of antibiotic use and AMR. RESULTS Among the 396 participants, all were male aged between 18 and 70 years, 247 were unqualified village medical practitioners, and 149 were pharmacy shopkeepers, and the response rate was 79%. Participants showed moderate to poor knowledge (unqualified village medical practitioners, 62.59%; pharmacy shopkeepers, 54.73%), positive to neutral attitude (unqualified village medical practitioners, 80.37%, pharmacy shopkeepers, 75.30%), and moderate practice (unqualified village medical practitioners, 71.44%; pharmacy shopkeepers, 68.65%) scores regarding antibiotic use and AMR. The KAP score range was 40.95-87.62%, and the mean score was statistically significantly higher for unqualified village medical practitioners than pharmacy shopkeepers. Multiple linear regression analysis suggested that having a bachelor's degree, pharmacy training, and medical training were associated with higher KAP scores. CONCLUSION Our survey results demonstrated that unqualified village medical practitioners and pharmacy shopkeepers in Bangladesh possess moderate to poor knowledge and practice scores on antibiotic use and AMR. Therefore, awareness campaigns and training programs targeting unqualified village medical practitioners and pharmacy shopkeepers should be prioritized, antibiotic sales by pharmacy shopkeepers without prescriptions should be strictly monitored, and relevant national policies should be updated and implemented.
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Affiliation(s)
- Asim Kumar Bepari
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Golam Rabbi
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Habibur Rahman Shaon
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Sabrin Islam Khan
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Zahidul Islam Zahid
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Koustuv Dalal
- Division of Public Health Science, Institute of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
| | - Hasan Mahmud Reza
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh.
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Emmott R, Barber SK, Thompson W. Antibiotics and toothache: a social media review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:210-217. [PMID: 33880539 DOI: 10.1093/ijpp/riaa024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/24/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Antibiotics are inappropriate for the treatment of toothache, yet many seek them. Social media allows users to express their opinions, share experiences and offer support. This study used social media to investigate the public's experiences of, and attitudes towards, antibiotics for toothache. METHODS A systematic search of posts on Facebook and Twitter was undertaken. Eligibility criteria were applied to select relevant social media posts for thematic analysis of word content. An inductive descriptive coding system was developed from the data and exemplary quotes were identified to illustrate the themes and subthemes identified. Key findings Searches identified 174 posts, of which 144 were selected for analysis. Five themes were identified: experience and expectations, self-care and professional treatment, access to dental care, quality of life and coping strategies. The belief that antibiotics are an appropriate treatment for a toothache was widespread. Antibiotic-seeking behaviour was related to access to professional dental care, including avoiding dental appointments due to dental anxiety and the perceived affordability of dentistry. A range of strategies to cope with the severe impact toothache was having on people's quality of life were identified, from prayer to antibiotics. CONCLUSIONS Social media is used extensively to seek antibiotics, avoid dental treatment and provide support to people with toothache. A general belief that antibiotics are an appropriate and necessary treatment for toothache exists. This improved understanding about the factors driving antibiotic-seeking behaviour provides new targets for the development of approaches to tackling antibiotic resistance, by reducing unnecessary antibiotic use in dental clinics and beyond.
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Affiliation(s)
- Rachel Emmott
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Sophy K Barber
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Wendy Thompson
- Division of Dentistry, University of Manchester, Manchester, United Kingdom
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Nayiga S, Kayendeke M, Nabirye C, Willis LD, Chandler CIR, Staedke SG. Use of antibiotics to treat humans and animals in Uganda: a cross-sectional survey of households and farmers in rural, urban and peri-urban settings. JAC Antimicrob Resist 2020; 2:dlaa082. [PMID: 34223037 PMCID: PMC8210029 DOI: 10.1093/jacamr/dlaa082] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/07/2020] [Indexed: 12/28/2022] Open
Abstract
Background Use of antibiotics to treat humans and animals is increasing worldwide, but evidence from low- and middle-income countries (LMICs) is limited. We conducted cross-sectional surveys in households and farms in Uganda to assess patterns of antibiotic use among humans and animals. Methods Between May and December 2018, a convenience sample of 100 households in Nagongera (rural), 174 households in Namuwongo (urban) and 115 poultry and piggery farms in Wakiso (peri-urban) were selected and enrolled. Using the ‘drug bag’ method, participants identified antibiotics they used frequently and the sources of these medicines. Prevalence outcomes were compared between different sites using prevalence ratios (PRs) and chi-squared tests. Results Nearly all respondents in Nagongera and Namuwongo reported using antibiotics to treat household members, most within the past month (74.7% Nagongera versus 68.8% Namuwongo, P = 0.33). Use of metronidazole was significantly more common in Namuwongo than in Nagongera (73.6% versus 40.0%, PR 0.54, 95% CI: 0.42–0.70, P < 0.001), while the opposite was true for amoxicillin (33.3% versus 58.0%, PR 1.74, 95% CI: 1.33–2.28, P < 0.001).Veterinary use of antibiotics within the past month was much higher in Wakiso than in Nagongera (71.3% versus 15.0%, P < 0.001). At both sites, oxytetracycline hydrochloride was the most frequently used veterinary antibiotic, but it was used more commonly in Wakiso than in Nagongera (76.5% versus 31.0%, PR 0.41, 95% CI: 0.30–0.55, P < 0.001). Conclusions Antibiotics are used differently across Uganda. Further research is needed to understand why antibiotics are relied upon in different ways in different contexts. Efforts to optimize antibiotic use should be tailored to specific settings.
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Affiliation(s)
- Susan Nayiga
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda.,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Miriam Kayendeke
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Christine Nabirye
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Laurie Denyer Willis
- Department of Politics and International Studies, University of Cambridge, The Alison Richard Building, 7 West Road, Cambridge CB3 9DT, UK
| | - Clare I R Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Sarah G Staedke
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Thompson W, McEachan R, Pavitt S, Douglas G, Bowman M, Boards J, Sandoe J. Clinician and Patient Factors Influencing Treatment Decisions: Ethnographic Study of Antibiotic Prescribing and Operative Procedures in Out-of-Hours and General Dental Practices. Antibiotics (Basel) 2020; 9:antibiotics9090575. [PMID: 32899670 PMCID: PMC7558392 DOI: 10.3390/antibiotics9090575] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
Operative treatment is indicated for most toothache/dental abscesses, yet antibiotics instead of procedures are often prescribed. This ethnographic study aimed to identify clinician and patient factors influencing urgent dental care for adults during actual appointments; and to identify elements sensitive to context. Appointments were observed in out-of-hours and general dental practices. Follow-up interviews took place with dentists, dental nurses, and patients. Dentist and patient factors were identified through thematic analysis of observation records and appointment/interview transcripts. Dentist factors were based on a published list of factors influencing antibiotic prescribing for adults with acute conditions across primary health care and presented within the Capability-Opportunity-Motivation-Behaviour model. Contextually sensitive elements were revealed by comparing the factors between settings. In total, thirty-one dentist factors and nineteen patient factors were identified. Beliefs about antibiotics, goals for the appointment and access to dental services were important for both dentists and patients. Dentist factors included beliefs about the lifetime impact of urgent dental procedures on patients. Patient factors included their communication and negotiation skills. Contextual elements included dentists’ concerns about inflicting pain on regular patients in general dental practice; and patients’ difficulties accessing care to complete temporary treatment provided out of hours. This improved understanding of factors influencing shared decisions about treatments presents significant opportunity for new, evidence-based, contextually sensitive antibiotic stewardship interventions.
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Affiliation(s)
- Wendy Thompson
- Division of Dentistry, University of Manchester, Manchester M13 9PL, UK
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
- Correspondence: ; Tel.: +44-7837-190387
| | - Rosemary McEachan
- Bradford Institute for Health Research, Bradford BD9 6RJ, UK;
- Faculties of Life Sciences & Health Studies, University of Bradford, Bradford BD7 1DP, UK
| | - Susan Pavitt
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
| | - Gail Douglas
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
| | - Marion Bowman
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
| | - Jenny Boards
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
| | - Jonathan Sandoe
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
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Hossain A, Hossain SA, Fatema AN, Wahab A, Alam MM, Islam MN, Hossain MZ, Ahsan GU. Age and gender-specific antibiotic resistance patterns among Bangladeshi patients with urinary tract infection caused by Escherichia coli. Heliyon 2020; 6:e04161. [PMID: 32548331 PMCID: PMC7286969 DOI: 10.1016/j.heliyon.2020.e04161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/29/2019] [Accepted: 06/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background In Bangladesh, treatment for urinary tract infection has become increasingly difficult due to antibiotic resistance. In addition, the prescription of age and gender-specific drugs is still far from being practiced in Bangladesh. We are examining trends of antibiotic resistance per age and gender in patients with urinary tract infection (UTI) caused by the most frequent agent, Escherichia coli. Methods We determined the resistance of 1663 E. coli isolates obtained from urine cultures. A sensitivity study using the Kirby-Bauer method was carried out to identify the antibiotic resistance trends. Results Imipenem with 1.9% resistance of all isolates found to be the lowest percentage of resistance. Meropenem (2.8%), amikacin (2.8%), colistin (2.9%), and nitrofurantoin (15.8%) showed low resistance percentages. The sensitivity analysis suggests that age and gender (area under curve = 0.67) should be taken into consideration to prescribe amikacin. The increasing odds ratios (OR) by age groups suggest that amikacin is a less effective agent for older patients with UTIs. Moreover, nitrofurantoin (OR = 1.45, 95% confidence interval (CI) = 1.07–1.95) and colistin (OR = 2.09, CI = 1.13–3.76) were less effective against isolates obtained from males compared to isolates obtained from females. Meropenem was effective against bacteria obtained from all age groups and genders. On the other hand, efficacy of imipenem was lower in isolates obtained from adults older than 40 years (OR: 0.44 for < = 18 years, OR = 0.47 for 19–40 years, OR = 0.86 for 41–60 years; reference: > = 61 years). Conclusion In Bangladesh, meropenem, imipenem, amikacin, colistin, and nitrofurantoin are suitable therapeutic alternatives against urinary tract pathogens. Among the oral agents, amikacin, colistin, and nitrofurantoin should be prescribed, taking consideration of age and gender. These results will assist physicians in prescribing effective primary care antibiotics for UTI patients and encouraging the implementation of health policies for a safe prescription of antibiotics.
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Affiliation(s)
- Ahmed Hossain
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh.,NSU Global Health Institute, Dhaka 1229, Bangladesh
| | | | - Aneeka Nawar Fatema
- Center for Climate Change and Environmental Research, BRAC University, Dhaka, Bangladesh
| | - Abrar Wahab
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh.,NSU Global Health Institute, Dhaka 1229, Bangladesh
| | - Mohammad Morshad Alam
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh.,NSU Global Health Institute, Dhaka 1229, Bangladesh
| | | | | | - Gias U Ahsan
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
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Affiliation(s)
- Rebecca E Glover
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - John Manton
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Sam Willcocks
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard A Stabler
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, UK
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Bond CM. Prendre le taureau par les cornes : pourquoi les pharmaciens doivent être à la tête des initiatives consacrées à la gestion des antibiotiques. Can J Hosp Pharm 2019; 72:261-262. [PMID: 31452536 PMCID: PMC6699863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Christine M Bond
- , B. Pharm., Ph. D., M. Ed., travaille au Pharmacy, Centre of Academic Primary Care de l'Université d'Aberdeen, Foresterhill, Aberdeen, Écosse. Elle est également rédactrice adjointe du Journal canadien de la pharmacie hospitalière
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Bond CM. Grasping the Nettle: Why Pharmacists Must Lead Antibiotic Stewardship Initiatives. Can J Hosp Pharm 2019; 72:259-260. [PMID: 31452535 PMCID: PMC6699861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Christine M Bond
- , BPharm, PhD, MEd, is Emeritus Professor, Centre of Academic Primary Care, University of Aberdeen, Foresterhill, Aberdeen, Scotland. She is also an Associate Editor with the Canadian Journal of Hospital Pharmacy
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Yeung EYH. Antibiotic use: don't blame doctors for trying to manage patient expectations. BMJ 2019; 365:l1895. [PMID: 31043371 DOI: 10.1136/bmj.l1895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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