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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 14  |  Issue : 2  |  Page : 72-78

Knowledge, attitude, and practices about antimicrobial usage and resistance among the second-year MBBS students: A questionnaire-based survey


Department of Pharmcology, Bharati vidyapeeth DTU Medical College, Pune, Maharashtra, India

Date of Submission12-Feb-2022
Date of Decision29-Apr-2022
Date of Acceptance05-May-2022
Date of Web Publication18-Jul-2022

Correspondence Address:
Jayshree Shriram Dawane
Department of Pharmacology, Bharati Vidyapeeth DTU Medical College, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajprhc.ajprhc_10_22

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  Abstract 


Antibiotic resistance is the burning issue and to curtail it is the need of the time, efforts are going on in all the direction. It is essential to assess the knowledge, attitude and practices of the medical undergraduate about the antimicrobial use and resistance for doing modifications in the current methods of teaching for encouraging the rational use. Objectives: To determine the prevalence of self medication practices of antibiotics among the second year medical students. To evaluate the knowledge of medical students about antibiotic resistance. To explore the solutions to curb the growing problem of antimicrobial resistance. Material and Methods: A Cross sectional, Unicentric, observational, questionnaire based survey study carried out from June 2021 to Sept 2021. Conventional sample method was used and phase II MBBS students willing to take part in the study were included. After obtaining the IEC clearance study was started. Questionnaire was prepared consisting of the various aspects like knowledge, attitude and perception of the antimicrobial use and resistance. The questionnaire was validated by subject experts for its content and relevance and the necessary changes were incorporated in the final one. The questionnaire was distributed as a Google form before they receive any teaching on antibiotics in their pharmacology classes as a Pre-test and after the exposure as post-test. Participation was voluntary and they were asked to complete the questionnaire anonymously. Returning of the completed Google form was accepted as consent by the participating students. Statistical analysis done with software SPSS. Results: Students had the knowledge about antibiotics and resistance. They had consumed it in last one year and completed the course of the antibiotics is the positive outcome. Small number shows confusion about use during viral infection, in pain, during cough& cold. Causes of antibiotic resistance needs special attention. In 20% it was not clear that skipping the doses can contribute to antimicrobial resistance. Conclusion: Repeated knowledge intervention are essential to increase the awareness of the problem arising due to the irrational use even to the undergraduate students.

Keywords: Antimicrobial resistance, attitude, practices, exposure, questionnaire


How to cite this article:
Suryawanshi SP, Dawane JS, Pandit VA, Khatavkar PS. Knowledge, attitude, and practices about antimicrobial usage and resistance among the second-year MBBS students: A questionnaire-based survey. Asian J Pharm Res Health Care 2022;14:72-8

How to cite this URL:
Suryawanshi SP, Dawane JS, Pandit VA, Khatavkar PS. Knowledge, attitude, and practices about antimicrobial usage and resistance among the second-year MBBS students: A questionnaire-based survey. Asian J Pharm Res Health Care [serial online] 2022 [cited 2022 Sep 27];14:72-8. Available from: http://www.ajprhc.com/text.asp?2022/14/2/72/351317




  Introduction Top


The development of antimicrobials is considered one of the key contributions of allopathy to health care. Availability of the antibiotic has changed the view of the physician about what power drugs have on diseases. Their importance is mainly considered in the developing countries, where infective diseases predominate.[1] However, problem of antibiotic resistance is threatening to the world, if it is growing with same speed, will be taking back to the pre-antimicrobial era. Antibiotic resistance is now one of the world's important and main health concerns. The problem of irrational and indiscriminate use of antimicrobials is one of the major problem resides in the developing countries including India.[2] The lack of knowledge with irrational prescription practices by physicians, availability of antibiotics over the counter without prescription, self-medication practices, and not having the proper knowledge about the rational use of antibiotics are the main contributing factors that add up to the current burning problem.[3] It has been studied from the different published articles that both doctors and medical students are well aware about antimicrobial resistance and consider it a global public health problem mainly due to inappropriate antimicrobial use. Adequate knowledge of antimicrobial resistance for prevention of it is the key component to be addressed.[4],[5]

The rational use of antibiotics is the only solution to curb this problem.[6] Awareness of this fact among medical students and budding future physicians who will have to act as patient educators, prescribers, and role models of correct antimicrobial use is considered extremely vital and has been incorporated as an important component of undergraduate curriculum.[7]

Toward this objective, the present study was initiated to judge medical students' current knowledge about antimicrobial agent use and resistance. Medical students learns the art of rational prescribing during the course, considering them as future prescribers, better understanding of their knowledge as well as practices regarding antibiotic usage is crucial. As a future doctor, their beliefs and practices regarding antibiotic usage and rational prescribing behavior will have an impact on antibiotic resistance.[8] Before planning any educational program, it is important to know the baseline knowledge, attitude, and practices (KAP) of the target population (with pretest), which will help in devising a suitable approach that can be tailored according to their earlier held KAP with various aspects covered in their pharmacology teaching (posttest). The present study results will help us to fine-tune the teaching to enable judicious use of antimicrobial agents (AMAs) and equip the students with rational antimicrobial prescribing skills. It will give insight to explore the solutions to overcome the growing problem of antimicrobial resistance.

Aim

The aim of this study is to evaluate the knowledge and attitudes of the medical students toward antibiotic use and antibiotic resistance.

Objectives:

  1. To evaluate the knowledge of medical students about antibiotic use and resistance
  2. To explore the solutions to curb the growing problem of antimicrobial resistance.



  Materials and Methods Top


Study site

The study was conducted in the Bharati Vidyapeeth (Deemed to be) University Medical College, Pune.

Study design

Cross-sectional, unicentric, observational, questionnaire-based survey.

Study period

From June 2021 to September 2021.

Study sample

Convenience sample of 133 students from second MBBS.

Inclusion criteria

All the 2nd-year MBBS students (Batch 2020) who were willing to take part in the study.

Study procedure

After obtaining the Institutional Ethics Committee (BVDUMC/IEC/23A – 30/6/2021) clearance, the study was started.

Detailed information of the study questionnaire was given to the students. Before the administration of questionnaires, the purpose of the survey was explained to the students, and they were encouraged to participate in the study.

The questionnaire was prepared consisting of the various aspects such as knowledge, attitude, and perception of the antimicrobial use and resistance. With the literature search, the questionnaire which we have used was prepared by modifying the earlier few similar studies by Padmanabha et al. and others.[9],[10] The questionnaire was discussed with the subject experts for its content and relevance, and the necessary changes were incorporated in the final one.

The questionnaire consists of the following parts:

  1. The first part (I) pertained to a collection of demographic information of the students: age, gender, and any family member working in health-care facility
  2. The questions in the second part (II) of the questionnaire assess the students' knowledge about antibiotic resistance and usage. The participants' knowledge was assessed with dichotomous questions
  3. The third part (III) of the questionnaire addressed questions related to their practices of antimicrobials. These questions were included to check the attitude of the participants regarding antibiotic usage and resistance
  4. Finally, in the last part (IV) of the questionnaire, participants were asked to give solutions to curb this growing problem of antimicrobial resistance.


The questionnaire was converted in the form of Google forms. These google forms were distributed and data was obtained from the students before receiving any teaching on antibiotics (pre-test). Post-test survey was done after students were given sufficient exposure to the antibiotics in the form of lecture and tutorial on antibiotics. Participation was voluntary and they were asked to complete the questionnaire without revealing their identity.

Specific note was mentioned in the Google form that if you are willing to participate in the study, complete the form and submit it and was considered as consent.

Statistical analysis

Data generated from the Google Forms were coded and imputed into the computer system and analyzed using statistical software (SPSS)-IBM SPSS statistics for window, Version 28.0, USA. Categorical variables were reported as frequencies and percentages. Questions related to attitude and practices from the pre and post-test were analysed with McNemar's test.


  Results Top


A total of 133 students participated in the study. From the total participants, 75.2% had taken antibiotics for some or other reason. Out of these, 60.6% had taken it 1–2 times in a year and 35% consumed it 3–5 times. The number of students taking antibiotics more than 5 times, was less.

Question on completion of prescribed course of antibiotics for a particular condition shows the maximum response, 99.2% completed antibiotic course as prescribed and 1% stopped taking the remaining doses of the antibiotic.

Students obtain knowledge from different sources. About 60.9% said that they obtain it from parents, 55.6% from teachers, 25.6% talk with their friends, 79.7% confirm that it is obtained from doctor, 53.4% prefer to read the books, 43.6% obtain it from the Internet, and 25.6% come to know about it from old prescription [Figure 1].
Figure 1: Source of knowledge regarding antibiotics use

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Knowledge about the use of antibiotics related to viral, bacterial infections, pain, inflammation, cough & cold was reflected in this part. In the post-test, 3% decrease was seen in the use of antibiotics for viral infections. 16.8% improvement was seen for avoiding the irrational use antibiotics in the condition like inflammation, 12.2% in cough and cold and 3,7% [Figure 2].
Figure 2: Antibiotics are useful for which conditions?

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In the posttest, the results about outcome of indiscriminate use of antibiotics showed correct reasons with increase in percentage as ineffectiveness of treatment (7.54), increased adverse effect (11.3), exacerbation or prolongation of illness (29.32), emergence of bacterial resistance (12.03) (i.e., the antibiotic is less likely to work in future), and additional burden of medical cost to the patient (10.53) [Table 1]. The majority of students (88%) responded the cause of antibiotics resistance can be due to overuse, underuse and indiscriminate use of antibiotics in the absence of infection. But unable to pinpoint specific cause of resistance as underuse or usage without consideration [Figure 3]. Students obtain knowledge about antibiotic resistance from the general practitioner (72.9) and Internet (77.4) and some of them from television, newspaper and other sources [Figure 4].
Figure 3: Causes of antibiotic resistance

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Table 1 : Outcome of indiscriminate use of antibiotics

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Figure 4: Sources of information on antibiotic resistance

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  Discussion Top


A total of 133 students of Phase II MBBS participated in the study, with the majority of female students 63.2%. Information was collected pre- and postexposure to the learning of antimicrobial use and resistance through the didactic lectures. Most of them obtain information from doctors and parents [Figure 1]. Many times, antibiotics are prescribed for the viral infections, which is totally irrational, and the same is observed in 2% of students even after the postexposure[11] [Figure 2]. Antibiotics are drugs useful for bacterial infections; the percentage of correct answers increased from 95% to 98% postexposure. Basically, they had knowledge about it and little improvement was observed posttest in the students. Similar type of results is observed in the study done by Gupta et al. about the use of antibiotics.[12],[13]

There was a significant improvement in the responses obtained after the intervention in antimicrobial resistance-related concepts. Raupach-Rosin et al.'s study showed that policy campaigns about the correct use of antibiotics have increased knowledge and practice about antibiotic use and resistance among German public.[14] Kalyani et al. results are also in line with us.[15] The most significant factor, accurately identified by the majority of students, is the formation of bacterial resistance and ineffectiveness of the therapy as a result of indiscriminate use of antibiotics. Increase in negative effects and lengthening of the illness a hospital stay, or the increased financial burden of medical expenses are the secondary effects of indiscriminate use [Table 2]. These results are similar to the studies conducted by Afzal Khan et al. on the medical students of Southern Indian medical colleges.[16] Another study done on the medical students and interns by Asharani et al. mentions similar facts.[17] Increase in adverse effect, prolongation of illness or hospital stay, and additional burden of medical cost to the patient are the secondary effects of indiscriminate use and very few students had dilemma about this. However, postintervention, it remained in only 1%–2% who answered do not know, indicates that intervention was effective. Students were unable to specify the exact causes of antibiotic resistance, most of them answered all of the above, but underuse of antibiotic cannot be labeled as a reason for antibiotic resistance. This needs more training about judicious antibiotic use [Figure 3], which is already incorporated in the new curriculum of the medical schools.

Attitude of the students toward the antibiotic use and development of resistance assessment shows casual approach. Understanding about the definition, concept of antibiotic resistance was known to them, but at the same time when the same question was asked in a little different way, there was a little confusion about it observed in approximately 30% of the students. Most of them know the result of bacterial resistance in the form of delay in the cure of the disease. In the post test many ideas were clarified in the mind-set of the students. Like the question about Long and frequent antibiotic use helps bacteria to develop resistance is answered correctly by 98% after the exposure to the educational session. Many organisms are becoming increasingly resistant to the antibiotics and these bacteria which are resistant to antibiotics can spread from person to person; a big misunderstanding was seen in this part.

Seventy-five percent have taken antibiotics in the past year and 99% have completed antibiotic course. Completing the course is a good practice and we need to inculcate and encourage these habbits in them. This can be partially attributed to 42.9% of students who have one or more family members working in the medical field which showed similar results in studies carried out by Sharma et al.[18] and Scaioli et al.,[19] and opposite results were seen in the many studies, such as skipping the antibiotics after 2–3 doses.[20] The well-known fact of not completing antibiotic course, skipping one or more doses of antibiotics contributes to the development of antibiotic resistance.[21],[22] This was known to 69.9% of students and answered correctly, which was significantly increased to 94.73% of students in post- test. It seems that 30% of the students' still needs better understanding of the problem. The findings of our study in this regard are consistent with a study carried out in Nepal, Palestinian, where it has been observed that respondents knew the meaning of antibiotic resistance, but nearly one third of them were unaware about missing the doses of antibiotics' will be a one of the reasons for antibiotics resistance.[23],[24]

Prescribers should only prescribe antibiotics whenever needed. To reduce inappropriate prescribing, it is important to understand the reasons and awareness with sensitization of physicians to promote adhering to the antibiotic prescription guidelines. Studies carried out by Zetts RM et al and Rassi N mentioned the same facts to avoid the misuse of antibiotics along with importance of communication skills.[25],[26] The present study the results are in line with the above studies. Students understood that active clinician participation in antibiotic audits in hospitals and other healthcare facilities should be promoted. Adoption of antimicrobial stewardship by healthcare professionals is crucial which students favored in modest numbers. There is an acute need of incorporating the Antimicrobial Stewardship Program in the curriculum with highlighting a goal of rational use of antibiotics in terms of their dose, duration of treatment, and route of administration.[27]
Table 2: Number and percentage of the questions on the attitude of antibiotic resistance questions related to practices

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The major strength of our study is that students' knowledge and beliefs regarding judicious use of antibiotics to curtail the problem of antibiotic resistance has changed a lot. An improvement in students' knowledge and perception was reflected in the post-test questionnaire survey which had been taken soon after finishing their pharmacology teachings [Table 3].
Table 3: Opinion on problem of antibiotic resistance?

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Although the response rate among students was higher and showed a positive impact of interventions in the form of pharmacological teaching aspects to promote awareness in the area of judicious use of AMAs, there are few limitations of our study.

The limitation of this study is that the data obtained are based on a convenience sampling method; study participants included were of only from Phase II MBBS medical students from single-teaching hospitals. Furthermore, a self-administered questionnaire was used during regular class sessions, so response was obtained from the present students only.


  Conclusion Top


The present KAP study was conducted on the Phase II MBBS students. They have very basic knowledge about the antimicrobial use and resistance, which is obtained from various sources such as books, Internet, parents, doctors, and friends. This knowledge needs to be enhanced with intervention at various steps. It is very essential to increase the awareness and understanding of the problem arising due to the irrational use even to the undergraduate students. Further, there is a need to explore this area with large sample size involving not only medical students but also interns and resident doctors who are future prescribers. Theoretical knowledge should be correlated clinically to improve the rational practices. This can be strengthened with additional teaching on rational antibiotic use and innovations in curriculum. This will be the crucial step to combat major public health issue of antibiotic resistance.

Acknowledgments

We thank all the student participants who contributed in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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