Awareness, knowledge and practice of community residents on antimicrobials and the development of antimicrobial resistance

AWARENESS, KNOWLEDGE, AND PRACTICE OF COMMUNITY RESIDENTS ON ANTIMICROBIALS AND THE DEVELOPMENT OF ANTIMICROBIAL RESISTANCE

Teresa May B. Bandiola¹,²,³ ; Rosaline B Amoin¹,²,³ ; Jon Paulo F. Bautista¹,²,³ ; Janine Aliza B. Birog¹,²,³ ; Jasper

D. Cayanga¹,²,³ ; and Juneve F. Tejada¹,²,³

¹ College of Pharmacy,² Research Development and Innovation Center,³ Our Lady of Fatima University

*Present address: Our lady of Fatima university-College of Pharmacy, Lagro, Quezon City

ABSTRACT

Objectives: This study aimed to assess the awareness, knowledge, and practice of the residents in Greater Lagro, Quezon City, on antimicrobials and the development of antimicrobial resistance.

Methodology: A questionnaire-based survey was conducted on 340 residents in Greater Lagro, Quezon City, Philippines, whereby their awareness, knowledge, and practices regarding antimicrobial use and the development of antimicrobial resistance was assessed by using a five point Likert scale, whose responses ranged from “strongly agree” to “strongly disagree”, ”no knowledge” to “very knowledgeable” and “always” to “never”. A self-made validated survey instrument was used. (Awareness: α=0.84; Knowledge: α=1.02; Practices-self-medication: α =0.83; Practices- Doctor’s prescription: α =0.682). Simple descriptive statistics was then applied which include percentage, mean, and standard deviation.

Findings: The study showed that the respondents had little awareness regarding antimicrobials and antimicrobial resistance. They were partly knowledgeable that the inappropriate use of antibiotics could lead to ineffective treatment as well as antimicrobial resistance. Furthermore, the respondents were uncertain that they could get trustworthy information about antimicrobials from doctors and pharmacists, and were also uncertain if expensive antimicrobials are more effective than the cheaper ones. Alarmingly, poor practices on the use of antimicrobials were also observed. Malpractices such as non-compliance to complete antibiotic therapy for seven days, not discarding the leftover antibiotics, and giving away leftover antibiotic drugs were noted. These practices could contribute to antimicrobial resistance.

Conclusion: The misuse of antimicrobials and the development of antimicrobial resistance are fundamental public health problems, and necessary plans and actions to combat these should be taken into action immediately.

Keywords: Antimicrobials, Antimicrobial Resistance, Antibiotics

INTRODUCTION

Long before antimicrobials were discovered, infection had been linked to many causes of death such as the epidemics of smallpox, leprosy, tuberculosis, and diphtheria in ancient Greece and Egypt, the pandemic of black plague that swept through Asia, Europe, and Africa in the 14th century, and the epidemic of syphilis in 1490s as a highly contagious venereal disease in Spain, Italy, and France. This was until the accidental discovery of Penicillin on 1929 by Alexander Fleming and its introduction to therapy on 1938 by Florey and Chain, which opened doors to the development of new antibiotics for various forms of infection.

Antimicrobial resistance (AMR) is the resistance of a microorganism to an antimicrobial drug that was originally effective for the treatment of infections caused by it. Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs, antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others (WHO, 2015). It is a broader term, encompassing resistance to drugs to treat infections caused by other microbes as well, such as parasites (e.g. malaria), viruses (e.g. HIV), and fungi (e.g. Candida) while antibiotic resistance refers specifically to the resistance to antibiotics that occurs in common bacteria that cause infections. Mechanisms underlying microbial resistance to cell wall synthesis inhibitors involve the production of antibiotic-inactivating enzymes, changes in the structure of target receptors, increased efflux via drug transporters, and decreases in the permeability of microbes’ cellular membranes to antibiotics.

WHO’s 2014 report on global surveillance of antimicrobial resistance revealed that antibiotic resistance is no longer a prediction for the future; it is happening right now, across the world, and is putting at risk the ability to treat common infections in the community and hospitals. Without urgent and coordinated action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill (WHO, 2015).

When infections become resistant to first-line drugs, more expensive therapies must be used. A longer duration of illness and treatment, often in hospitals, increases health care costs as well as the economic burden on families and societies. The inappropriate use of antimicrobial drugs, including in animal husbandry, favors the emergence and selection of resistant strains, and poor infection prevention and control practices contribute to further emergence and spread of antimicrobial resistance.

Owing to this, the greater challenge that the humankind has to face is to continue designing strategies to combat microbial resistance. This includes the use of antibiotic combinations, the introduction of new (and often expensive) chemical derivatives of established antibiotics, and efforts to avoid the indiscriminate use or misuse of antibiotics.

Therefore, with this research, the researchers aimed to go to the basic, which is to assess the consumers’ awareness, knowledge, and practice that lead to anti-microbial resistance, in the area of Greater Lagro, Quezon City, Philippines.

MATERIALS AND METHODS

-Respondents

The study involved adult residents of Greater Lagro, Quezon City, Philippines. A sample of 340 respondents was used in the research.

-Sampling Technique

Systematic sampling technique was employed. The researchers conducted the survey on December 15 and 16, 2015.

-Instruments Used

A self-made questionnaire survey instrument was employed to assess the respondents’ awareness, knowledge and practices to antibiotics leading to antimicrobial resistance. The series of questions were analysed by using a 5-point Likert scale, whose responses ranged from “strongly agree” to “strongly disagree”, “no knowledge” to “very knowledgeable” and “always” to “never”. A Filipino translation was also included on the questionnaire in order for the respondents to understand each question easily.

-Validation of Instrument

Prior to the study, the questionnaire was validated by subject experts for its content and relevance. To attain a high degree of validity, a dry-run was conducted. Pre-testing was done on 20 respondents who were not included in the study. Internal consistency was evaluated using Cronbach’s alpha. [Awareness Question: α=0.84 (Good); Knowledge Question: α=1.02 (Excellent); Practices-self medication: α =0.83(Good); Practices- Doctor’s prescription: α =0.682 (Acceptable)]

-Data Gathering Procedure

On the day of the survey, the researchers gave the respondents a survey questionnaire with the assurance that all answers would be treated with confidentiality. No time limit was given for the respondents to ensure careful response to each question. The researchers attended to respondents in answering the questions that seemed unclear to them. To attain high percentage of returns, the researchers personally distributed the questionnaire. Questionnaires were then retrieved from the respondents as soon as they finished answering.

-Statistical Tool

Simple descriptive statistics was applied which include percentage, mean, and standard deviation.

RESULTS

The response rate was 100% among the 340 respondents who participated in the survey. The results are tabulated in Table 1, Table 2, Table 3, and Table 4.

Table 1. Assessment of Awareness on Antimicrobials and Antimicrobial Resistance

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As presented in Table 1, the respondents somewhat agreed that antimicrobials are used to treat a lot of illnesses (x =2.01), that they have used antimicrobials at some point of their lives (x=1.67), and that antimicrobials must be purchased with a prescription (x=1.57). Though following doctor’s prescription, they were undecided that they should stop antimicrobials when they feel better (x=2.71), that their friends recommend antimicrobials to them (x=3.00), and that they recommend antimicrobials to their friends (x=3.06). But they strongly agreed that they should follow the doctor’s instruction when taking antimicrobials (x=1.48) and that everyone has a role to play to ensure that antibiotics remain effective (x=1.50).

Table 2. Assessment of Knowledge on Antimicrobials and Antimicrobial Resistance

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Table 2 showed that the respondents had little knowledge or familiarity regarding the classification of antimicrobials (x=2.40) and little knowledge or familiarity that they can get antimicrobial resistance from poultry products that they eat (x=2.43). They also had some knowledge that the inappropriate use of antimicrobials can lead to ineffective treatment (x=3.07), some knowledge on how to properly store antibiotic suspensions (x=2.82), some knowledge that if taken too often, antibiotics are less likely to work in the future (x=2.77), some knowledge that an antibiotic will always be effective in the treatment of the same infection in the future (x=2.70), some knowledge that bacteria are germs that cause common cold and flu (x=2.95), some knowledge or familiarity regarding antimicrobial resistance (x=2.65), some knowledge or familiarity that they can get antimicrobial resistance when they make contact with contaminated water (x=2.61), and lastly, they also had some knowledge or familiarity that a lot of people die due to antimicrobial resistance (x=2.78).

Table 3. Assessment of Self-Medication Practices on Antimicrobials and Antimicrobial Resistance

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Results in Table 3 showed that the respondents were undecided that when they have colds, they should take antibiotics to prevent from getting a more serious illness (x=2.68), undecided that when they get a fever, antibiotics help them to get better more quickly (x=2.76), undecided that when they forget to take their antibiotics, they skip doses (x=2.98), undecided if branded antimicrobials are better than generic ones (x=2.69), undecided if expensive antimicrobials are more effective than cheaper ones (x=2.58), and lastly, they were undecided if antibiotics are safe drugs and that they can be commonly used (x=2.83). Furthermore, they also somewhat agreed that they could get trustworthy information about antimicrobials from doctors (x=1.74) and pharmacists (x=1.89) and they somewhat agreed that whenever they take an antibiotic, they contribute to the development of antibiotic resistance (x=2.42).

Table 4. Assessment of Doctor’s Prescription Practices on Antimicrobials and Antimicrobial Resistance

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Table 4 revealed that the respondents usually stop taking the antibiotics before the 7-day treatment (x=2.29). Sometimes, they keep the remaining antibiotics for the next time they get sick (x=2.56), discard the remaining leftover medication (x=2.98), and give the leftover medication to their family members/friends/relatives (x=3.02).

DISCUSSION

The study provides useful information about the awareness, knowledge, and practices of respondents with respect to antimicrobial resistance and usage, which may be utilized to plan suitable educational interventions that aim at improving the antimicrobial prescribing and use.

The study showed that the respondents had little awareness regarding antibiotics and antimicrobial resistance. They were partly knowledgeable that the inappropriate use of antibiotics could lead to ineffective treatment as well as antimicrobial resistance.

Furthermore, the respondents were uncertain that they could get trustworthy information on antimicrobials from doctors and pharmacists and also uncertain if expensive antimicrobials are more effective than the cheaper ones.

Alarmingly, poor practices on the use of antimicrobials were also observed. Malpractices such as noncompliance to complete antibiotic therapy for seven days, not discarding of leftover antibiotics, and giving away leftover antibiotic drugs were noted. These practices could contribute to antimicrobial resistance.

CONCLUSION

Misuse of antimicrobials and the development of antimicrobial resistance are public health problems, and necessary plans and actions to combat these should be taken into action immediately. Improvement on the promotion and evaluation of medical practice guidelines, restriction of antibiotic use, and development of new antibiotics are some of the steps required.

Above all, the public, health care providers, and leaders are encouraged to change the dynamics on antibiotic usage, and the need to educate the consumers must be a top priority before all antimicrobials become ineffective because of antimicrobial resistance.

ACKNOWLEDGEMENT

The researchers would like to thank the entire OLFU-College of Pharmacy and the residents of Greater Lagro, Quezon City who whole-heartedly devoted their time to the study, and above all, to the Almighty Father for bestowing the researchers enthusiasm and wisdom throughout the research.

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