Perceptions of medical students towards antibiotic prescribing for upper respiratory tract infections in Saudi Arabia

Survey of the Knowledge, Attitudes and Practice towards Antibiotic Use among Prospective Antibiotic Prescribers in Serbia

The complex issue of antibacterial resistance (ABR) requires actions taken with the One Health approach, involving both human and veterinarian medicine. It can spread from animals to humans through the food chain or through direct contact. Health profession students, as the future antibiotic providers, can greatly impact antibiotic-related issues in the future. The study was conducted to evaluate knowledge, attitudes and practice of future antibiotic prescribers in relation to judicious use of antibiotics. This cross-sectional, questionnaire-based study was performed on 400 students of health professions who were allowed to prescribe antibiotics of the University of Novi Sad, Serbia. Students of medicine and students of dentistry showed a significantly higher knowledge score compared to students of veterinary medicine (p = 0.001). Multivariate regression identified predictors of adequate antibiotic knowledge: being a female student (B = 0.571; p = 0.020), higher grade average (B = 1.204; p = 0.001), students of medicine (B = 0.802; p = 0.006) and dentistry (B = 0.769; p = 0.026), and students who used a complete package of antibiotics during the last infection (B = 0.974; p = 0.001) or for the period recommended by the doctor (B = 1.964; p = 0.001). Out of the total sample, self-medication was reported among 42.8% of students. The identified predictors of self-medication were: more frequent (B = 0.587; p = 0.001) and irregular (B = 0.719; p = 0.007) antibiotic use, taking antibiotics until symptoms disappeared (B = 2.142; p = 0.001) or until the bottle was finished (B = 1.010; p = 0.001) during the last infection. It seems prudent to reevaluate the educational curricula regarding antibiotic use and ABR of prospective prescribers in Serbia.

Impact of Infectious Diseases training in the perception of antibiotic resistance and rational use of antibiotics among Spanish medical students - a cross-sectional study

BACKGROUND

Antibiotic resistance is one of the main public health problems worldwide. One key tool to optimize antibiotic prescription is medical training. The aim of this study is to compare the impact of training in infectious diseases on students' knowledge of the antibiotic resistance problem and the rational use of antibiotics.

METHODS

We performed a cross-sectional study in the medical school of the University of Navarra. We conducted an anonymous in situ survey of students in each year of training. Data were analyzed grouping the students as follows: GROUP 1: first three years of education, no training in Clinical Microbiology (CM) or in Infectious Diseases (ID); GROUP 2: fourth-year students, training in CM but not ID; GROUP 3: Fifth and sixth-year students who have completed the training in CM and ID. Chi-square test (or Fisher's exact test when appropriate) was performed to evaluate potential associations. Wilcoxon's test was used to compare the median correct answers between groups. We used Spearman's test for correlation between year of training and performance in questionnaire.

RESULTS

A total of 994 students respond to the survey, 80.4% of the eligible students. Almost all students who had completed infectious diseases training perceive antibiotic resistance as an important problem in comparison with students who had not completed the formation (99.5% in group 3 vs 94.5% in group 1, p = 0.02). Knowledge of antibiotic stewardship underwent a statistically significant change after training in infectious diseases (from 9.2% in group 1 to 52.2% in group 3, p < 0.001). In the training questions block we also found an increase in the average number of correct answers (21.4% in group 1 vs 44.7% in group 3, p < 0.001). When comparing the results of subgroups 3A and 3B we found a significant loss of knowledge as we moved away from training (49% vs 40.9%, p < 0.001).

CONCLUSIONS

The training of medical students is the key to improving both perception and knowledge of infectious diseases. However, we have an opportunity for educational improvement as far as infectious diseases are concerned, regarding both the acquisition of knowledge and its loss as time lapses after training.

Understanding of Future Prescribers About Antimicrobial Resistance and Their Preparedness Towards Antimicrobial Stewardship Activities in Pakistan: Findings and Implications

Background: Insufficient antimicrobial-related training for physicians during their undergraduate education could have a negative impact on their prescribing. Unlike previous studies, this study not only explored the understanding and perception of Pakistani medical students about antibiotics and resistance, but also their preparedness towards antimicrobial stewardship programs.

Methods: An online cross-sectional study was undertaken with final-year medical students using a validated questionnaire from January 2021 to May 2021. Descriptive and inference statistics were applied for data analysis.

Results: Of 411 students, only 6.3% had undergone antimicrobial resistance (AMR) training. 16.1% of students believed that antibiotics are effective for viral ailments. More than half of the students agreed that AMR is a major healthcare problem in Pakistan (65.9%). Most students viewed poor infection control practices (66.9%), the use of too many broad-spectrum antibiotics (68.4%) for a longer duration (62.8%) with inadequate doses (67.9%) as the causes of AMR. The student’s preparation was insufficient in interpreting microbiological and pathological results (26.3%), selecting the correct antibiotics (22.1%), and awareness of the antibiotic spectrum (20.9%). The median preparedness score showed significant differences with sex (p = 0.049), age (p < 0.001), institute type (p = 0.014), and family income (p = 0.006).

Conclusion: Pakistani medical students showed adequate understanding of antibiotics, but lacked preparedness for several components of ASPs, including interpretation of microbiological results and spectrum of antibiotics. More steps need to be taken to prepare medical students for AMR and stewardship initiatives adequately.

Awareness of rheumatic fever and rheumatic heart disease among the population in taif, Saudi Arabia 2020

Objective

Studies assessing knowledge about rheumatic fever (RF) and rheumatic heart disease (RHD) are scarce in KSA. The aim of this study was to assess the awareness about ARF and RHD among the population at Taif city, Saudi Arabia.

Methods

A cross-sectional study was done on 716 of residents of Taif city. A pre-designed questionnaire that collected data about the participants' demographic characters, their history of sore throat and medication used, participants' knowledge about cause and complications of sore throat, its relation to RHD, treatment, primary and secondary prevention of RHD.

Results

77% of the participants had a history of sore throat, of them 58.4% took antibiotics as a self-medication. A significant higher prevalence of previous history of sore throat was present among 42-50-year-old females, graduated, and those with an income above 10000 SR. Participants with an age of 18-24 years and graduated, had significantly higher percent of those who knew about: cause and complications of sore throat, sore throat is associated with heart diseases, and if treating sore throat can prevent heart disease. Females had a significantly higher percent of those who knew about: complications of sore throat, being extremely aware of that primary prevention of sore throat by using antibiotics such as penicillin and being extremely aware of secondary prevention of recurrence RF and decrease progression of RHD.

Conclusion

Raising awareness about ARF and RHD through health education programs is needed.

Knowledge, attitude, and practice regarding antibiotic use and resistance among medical students in Colombia: a cross-sectional descriptive study

BACKGROUND

This study was designed to describe the knowledge, attitude, and practice regarding antibiotic use and resistance among medical students in Medellín, Colombia.

METHODS

A cross-sectional study was conducted among medical students from three universities from September to December 2018. The sample size was calculated, the classrooms were visited, and those students who were willing to participate were invited to do so. The data collection instrument was constructed in three stages: i) the literature was systematically reviewed, ii) the items from the studies identified were extracted, and iii) item reduction was performed with exploratory factor analysis. Data were analyzed by calculating absolute and relative frequencies and means for quantitative variables. The indexes of knowledge, attitude, and practice were transformed to a scale from 0 (worst possible score) to 100. Comparisons were performed using the Mann-Whitney U test, Kruskall-Wallis H test, and linear regressions.

RESULTS

Five hundred and thirty-two medical students were included with a response rate of 96%. Of the total participants, 49.1% reported having used antibiotics within the past year. Regarding knowledge, only 18.2% had heard of the term "antimicrobial stewardship" and 69.3% were aware that empiric antibiotic therapy contributes to antibiotic resistance. Regarding attitude, 11.6% considered that antibiotics should be discontinued as soon as symptoms disappear and 24.6% stated that it is better to prescribe broad-spectrum antibiotics to ensure that the patient is cured. Regarding practice, 28.5% recognized that resistance is a multifactorial problem, but they do not act on it because they consider that individual actions would have little impact. The adjusted linear regression showed that the variables associated with knowledge, attitude, and practice were socioeconomic status, training cycle, university, previous experience of research or education, the general perception of the training received, and antibiotic consumption.

CONCLUSION

Knowledge, attitude, and practice differ widely depending on the university, training cycle, and socioeconomic status, and a significant proportion of students consider that the standard of training received at the university on antibiotics and bacterial resistance is poor or mediocre. These findings show that there is a need to strengthen the medical students' curriculum on antibiotics, mechanisms of antibiotic resistance, and the prudent use of antibiotics as an important strategy to combat problem-resistant public health, primarily in endemic countries.

Does the problem begin at the beginning? Medical students' knowledge and beliefs regarding antibiotics and resistance: a systematic review

Background

Studies have detected that prescribers display gaps in knowledge and inappropriate attitudes regarding antibiotics and resistances, but it is not known whether these are generated during professional practice or derive from the undergraduate stage of their education. Accordingly, the aim of this study was to identify medical students’ knowledge, beliefs and attitudes regarding antibiotic use and antibiotic resistance, and whether these change over the course of their time at medical school.

Methods

We conducted a search of the MEDLINE and EMBASE databases, and included studies that measured knowledge and/or beliefs and/or attitudes regarding antibiotic prescribing and/or resistance, among medical students.

Results

Of the 509 studies retrieved, 22 met the inclusion criteria. While medical students perceived resistance as posing a major public health problem, both worldwide and in their own countries, students in the last two course years were more aware of overprescription of antibiotics in general, and of broad-spectrum antibiotics, at their teaching hospital. There was a considerable lack of knowledge about the treatment of high-incidence infections, and upper respiratory tract infections in particular (41–69% of participants believed antibiotics to be useful for treating these), without any differences by course year. Students were conscious of their personal shortcomings and thus showed willing to improve their education.

Conclusions

Future physicians display important gaps in knowledge, particularly in terms of treatment of high-incidence infections. This finding may be of use when it comes to designing more effective training in antibiotic stewardship for undergraduates.

<p>Knowledge and Attitude Towards Antimicrobial Resistance of Graduating Health Science Students of Wollega University</p>

Background

Antimicrobial resistance is a worldwide concern due to the inappropriate and irrational use of antibiotics. Thus, this study was aimed at determining the knowledge and attitude of graduating health science students of Wollega University towards antimicrobial resistance.

Methods

An institution-based cross-sectional study design was employed from June to July 2019. Epi-data version 3.1 was used to receive data and exported to SPSS version 25 for further analysis. Both bivariable and multivariable logistic regression analysis were done to find factors associated with attitudes of students towards antibiotic consumption and resistance at a 95% confidence level. The strength of association was measured with the odds ratio. Variables with a p-value of <0.05 at multivariable analysis were considered to be a significant variable. Finally, texts and simple frequency tables were used to present the findings.

Results

Out of 249, 232 students were included in this survey yielding a response rate of 93.6%. Hundred fifty-eight (68.1%) of them had adequate knowledge about antibiotic identification, role, side effects, and resistance. Students with a family member who works in health and related professions had a lower probability of stopping antibiotics when they feel better (AOR = 0.50, 95% CI: 0.28–0.90) and using leftover antibiotics (AOR = 0.51, 95% CI: 0.28–0.92) compared to their counterparts.

Conclusion

Students' knowledge on antibiotic identification, role, side effects, and resistance was suboptimal, and the attitude of students towards antibiotic consumption was unfavorable. Respondents having a family member in a health-related field showed a good attitude. Respondents with three years of study also had a good attitude, female gender showed good attitude, and urban residence were independent predictors of attitude toward antibiotic consumption. Training on antimicrobial resistance should be arranged for graduating class nursing and medical students, as they are the future prescribers.

Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study

BACKGROUND

The objective of the present study was to describe the knowledge regarding the antibiotic therapy of students of three medical schools in Medellín, Colombia.

METHODS

The study population comprised medical students who were enrolled in three universities. The instrument contained questions regarding their current academic term, the university, the perceived quality of the education received on antibiotic therapy and bacterial resistance, and specific questions on upper respiratory tract infections, pneumonia, urinary tract infections, and skin and soft tissue infections. The information was analyzed by calculating frequencies and measures of dispersion and central tendency. Knowledge regarding the treatment for each type of infection was compared using the Mann-Whitney U test and the Kruskal-Wallis H test.

RESULTS

We included 536 medical students, of which 43.5% students consider that the university has not sufficiently trained them to interpret antibiograms and 29.6% students consider that the quality of information received on the subject at their university ranges from regular to poor. The mean score for knowledge regarding antibiotic therapy for upper respiratory tract infections was 44.2 (9.9) on a scale from 0 to 100. The median score with regard to the treatment of pneumonia was 52.9 (14.7), that of urinary tract infection was 58.7 (14.8), and that of skin and soft tissue infections was 63.1 (19.4). The knowledge regarding antibiotic therapy for upper respiratory tract infections, pneumonia, and urinary tract infection does not improve with the academic term, the university, or perceived quality of the education received.

CONCLUSION

A large proportion of medical students perceive that the training received from the university is insufficient with regard to antibiotic use and bacterial resistance, which is consistent with the limited knowledge reflected in the selection of antibiotic treatment for respiratory, urinary tract, and skin and soft tissue infections. Overall, the situation was identical among all universities, and it did not significantly increase with the completion of an academic term.

Knowledge and Attitude Towards Antibiotic Usage: A Questionnaire-Based Survey Among Pre-Professional Students at King Saud bin Abdulaziz University for Health Sciences on Jeddah Campus, Saudi Arabia

Introduction: Knowledge and attitudes towards proper antibiotic usage among students in medical and other health allied fields play a vital role in limiting the pandemic of antibiotic resistance. This study aimed to assess knowledge and attitudes toward antibiotic usage among pre-professional students at King Saud bin Abdulaziz University for Health Sciences on Jeddah Campus, Saudi Arabia. Methods: A self-administered cross-sectional survey of 347 first year students was conducted at the College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences using a validated questionnaire. Results: Nearly 63% of the students had a moderate level of knowledge. Two third of the students (69.7%) correctly knew that antibiotics are indicated for the treatment of bacterial infections. However, about 36% of the students incorrectly thought that antibiotics are also used to treat viral infections, while 28.5% were not sure. Only 38.8% of the students were aware of antibiotic resistance phenomena in relation to the overuse of antibiotics. Furthermore, only 27.3% correctly knew that penicillin is an antibiotic, and 74.4% were not sure if Paracetamol is an antibiotic. With regard to attitudes, 25.7% believed that taking antibiotics when having cold symptoms could help them to recover faster, while 39.6% expected antibiotics to be prescribed for common cold symptoms. Conclusion: The students have misconception regarding antibiotic use indications. Therefore, awareness campaigns are needed to promote student's use of antibiotics in young generations particularly among the pre-professional health sciences students.

Managing knowledge for health care quality: An investigation of rational antibiotic use among Thai dentists

OBJECTIVES

Because of the irrational use of antibiotics, antimicrobial resistance is now a global concern that requires developing effective strategies against. The aim of this study was to assess the knowledge gap that causes the irrational use of antibiotics among Thai dentists.

METHODS

Thai dentists were asked to complete an online questionnaire regarding their knowledge, perception, and attitude towards rationale antibiotic use. The survey was conducted during November to December 2018.

RESULTS

Online questionnaires were completed by 588 dentists. Most respondents had a positive perception and were aware of the rational use of antibiotics. However, the use of antibiotics without proper indication and the lack of pharmacological knowledge were found. A mobile application was considered the most preferable approach to manage knowledge for rational drug use.

CONCLUSION

Irrational drug use among Thai dentists can be caused by lack of knowledge, attitude, and the perception of each dentist. Policy makers should promote self-learning through knowledge management strategies that can complement the pharmacology courses taught in dental school.

Parents' self-directed practices towards the use of antibiotics for upper respiratory tract infections in Makkah, Saudi Arabia

Background

Excessive and inappropriate antimicrobial use in the community is one risk factor that can result in the spread of antimicrobial resistance. Upper respiratory tract infections are most frequently reported among children and mainly of viral origin and do not require antibiotics.

We have conducted Knowledge, Attitude and Perception (KAP) survey of parents to explore the parent’s knowledge, attitude & perception of Saudi parents.

Methods

A knowledge attitude perception questioner was adopted from a previous study conducted in Greece by Panagakou et al. Raosoft online sample size calculator calculated the sample size by adding the total estimated Makkah population of 5,979,719 with a response rate of 30%, 5% margin of error and 99% confidence interval. Based on the described criteria five hundred & fifty-eight was the required sample size of the study. Incomplete questioners were excluded from the statistical analysis. SPSS version 21 was used to analyse data and to produce descriptive statistics.

Results

Most of the mothers (95%) responded among parents. 67% had no health insurance to cover medications costs. Most of them (74%) were related to medium income level. Seventy per cent of the parents believed physicians as a source of information for judicious antibiotics use. Interestingly, only 8% were agreed that most of the upper respiratory tract infections are caused by viral reasons.

Majority of Saudi parents (53%) expect pediatricians to prescribe antimicrobials for their children for symptoms like a cough, nose discharge, sore throat and fever.

Moreover, most the parents had the poor knowledge to differentiate commonly used OTC medications for URTI and antibiotics like Augmentin (Co-amoxiclav), Ceclor (cefaclor) and Erythrocin (Erythromycin). While comparing males and female’s knowledge level, few males have identified Amoxil (Amoxicillin). Similarly, parents of age 20–30 years have good knowledge about the antibiotics.

Conclusions

Majority of Saudi parents believe in pediatricians and use antibiotics on physician’s advice. Most of them expect antibiotics from their physicians as a primary treatment for upper respiratory tract infections. There is need for more educational activities to parents by the pharmacists to prevent antibiotics overuse among children.

"Antibiotics kill things very quickly" - consumers' perspectives on non-prescribed antibiotic use in Saudi Arabia

Background

In recent decades, the Kingdom of Saudi Arabia has seen an exponentially growing antibiotic resistance, which is exacerbated by the use of antibiotics without a prescription and other various factors. However, no published data are available on factors influencing non-prescription use of antibiotics among the general public in Saudi Arabia using an in-depth interview technique.

Methods

Semi-structured interviews were carried out with 40 Saudi participants from the Eastern Province of Saudi Arabia, selected via snowball sampling technique. Participants were enrolled based on the following inclusion criteria: 18 years of age or older and had self-medicated themselves with antibiotics in the past two years. Data collection was continued until data saturation was attained. Interviews were audiotaped, transcribed verbatim and analysed using NVivo 10 software.

Results

Participants (80% female) had a mean (SD) age of 30 years (10.2). Self-medication with antibiotics was associated with various inappropriate antibiotic use behaviours and negative outcomes such as antibiotic resistance, treatment failures and adverse events. Interviews revealed that different reasons contribute to the rise of self-medication with antibiotics, ranging from difficulty accessing healthcare services, participant’s cultural beliefs and practices, lack of knowledge about antibiotics and antibiotic resistance, and weak regulatory enforcement.

Conclusions

The findings of the present study will aid in generating data that may provide an insight when designing future interventions to promote public health awareness regarding safe and effective use of antibiotics.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6088-z) contains supplementary material, which is available to authorized users.

Do final-year medical students have sufficient prescribing competencies? A systematic literature review

Aims

Prescribing errors are an important cause of patient safety incidents and are frequently caused by junior doctors. This might be because the prescribing competence of final‐year medical students is poor as a result of inadequate clinical pharmacology and therapeutic (CPT) education. We reviewed the literature to investigate which prescribing competencies medical students should have acquired in order to prescribe safely and effectively, and whether these have been attained by the time they graduate.

Methods

PubMed, EMBASE and ERIC databases were searched from the earliest dates up to and including January 2017, using the terms ‘prescribing’, ‘competence’ and ‘medical students’ in combination. Articles describing or evaluating essential prescribing competencies of final‐year medical students were included.

Results

Twenty‐five articles describing, and 47 articles evaluating, the prescribing competencies of final‐year students were included. Although there seems to be some agreement, we found no clear consensus among CPT teachers on which prescribing competencies medical students should have when they graduate. Studies showed that students had a general lack of preparedness, self‐confidence, knowledge and skills, specifically regarding general and antimicrobial prescribing and pharmacovigilance. However, the results should be interpreted with caution, given the heterogeneity and methodological weaknesses of the included studies.

Conclusions

There is considerable evidence that final‐year students have insufficient competencies to prescribe safely and effectively, although there is a need for a greater consensus among CPT teachers on the required competencies. Changes in undergraduate CPT education are urgently required in order to improve the prescribing of future doctors.

Antibiotic prescribing and resistance: knowledge level of medical students of clinical years of University Sultan Zainal Abidin, Malaysia

The innovation of penicillin by Dr Alexander Fleming in 1928 and its use in clinical practice saved many lives, especially during the Second World War. Tuberculosis still carries a significant public health threat and has re-emerged over the past two decades, even in modern countries where tuberculosis was thought to be eliminated. The World Health Organization defines antimicrobial resistance as the resistance of a microorganism to an antimicrobial drug that was initially effective for treatment of infections caused by the microbe. Therefore, the findings of the current study will provide data to enable the design of a new educational program to better equip our students in confronting antimicrobial resistance. This study was a cross-sectional, questionnaire-based survey, which was undertaken in the Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia. The study participants were students of the Bachelor of Medicine and Bachelor of Surgery program (MBBS) of Year III, IV, and V. A total of 142 out of 164 (86%) medical students returned the questionnaire. Specifically, the year-wise breakdown of responses was 29% (41), 39% (55), and 32% (45) for Year III, IV, and V, respectively. Among the study respondents, 28% (40) were male, and the remaining 72% (102) were female. In all, 67% of the participants felt more confident in "making an accurate diagnosis of infection/sepsis." The majority (88%) of the study participants stated that they would like more training on antibiotic selection. This research has found that there is a gap between theoretical input and clinical practice; the students are demanding more educational intervention to face the threat of antimicrobial resistance.