ANTIBIOTICS KNOWLEDGE AND THEIR USES AGAINST VARIOUS DISEASES AMONG THE DORMITORY STUDENTS OF A RESIDENTIAL UNIVERSITY IN BANGLADESH: A PILOT STUDY
Hasibul Islam, Mustafizur Rahman, M. Ibrahim Hossain*
Department of Biochemistry and Molecular Biology, Jahangirnagar University, Dhaka 1342, Bangladesh.
Aim and objective: The study attempts to investigate the knowledge and actual condition of antibiotic uses among university students to get rid from different infectious diseases.
Methods: The study was conducted in a residential dormitory of a public university of Bangladesh. About 145 (n=145) students took part in the study which was conducted in January, 2020. Data were collected on the basis of a questionnaire made of basic questions about antibiotics and its resistance.
Results: Among 145 students, 94.5% previously known about antibiotic which is impressive but a vast majority (46.4%) had no idea about antibiotic resistance and 51% did not know anything what will happen if bacteria become resistant to antibiotics which is alarming. It was found that the most used antibiotic was Azithromycin (46.4%), whereas amoxicillin (40%) was second highest. Those antibiotics were used to treat mostly fever (63.4%), various infections (31%), cold cough (25.4%), diarrhea(15.5%) irritable bowel syndrome (9.9%) etc. Most students (83.7%) used antibiotics as per doctor’s prescription. About 50% students had knowledge about antibiotic course and resistance which was evaluated by simple yes/no question.
Conclusion: This work highlights the basic statistics of the knowledge about antibiotics use and abuse among the students of a residential dormitory of a public University of Bangladesh.
Keywords: Antibiotic, antibiotic resistance, fever, self-medication.
INTRODUCTION
The discovery of antibiotic is undoubtedly one of the most important discoveries in the 20th century1. Alexander Fleming discovered modern day penicillin which leads the way to discover antibiotics which are the most important type of antibacterial agents for fighting against bacterial infections and are widely used in the treatment and prevention of various infections. Though antibiotics were very effective in the starting periods but later it was found that some antibiotics lost their effectiveness due to microbial resistance1. This antimicrobial resistance is a serious threat for the public health and it is increasing day by day. To fight against the antimicrobial resistance, WHO (World Health Organization) has taken several steps2 which steps should be followed to minimize antibiotic resistance.
Bangladesh, a developing country in South Asia, has high degree of antibacterial resistance which is both local and global threat3. Antibacterial resistance (ABR) is a term which defines when antibiotic doesn't work against bacteria. There are some factors which can be the vital cause of ABR like misconceptions regarding antibiotic use, self-medication of antibiotics, in-completion of the recommended doses, unwanted uses of antibiotics by the physicians etc4. The less developed and low income countries have been reported with high incidents of infectious diseases and high usage of antibiotics and/or unwanted usage of antibiotics can increase the possibility of increased bacterial resistance. Due to some specific factors like overcrowding, poor sanitation, and warm humid climate, the resistant bacteria spread rapidly in Bangladesh as like others middle income countries. University students are the most educated person in the society as well as country. In this study, we aimed to find out the knowledge of antibiotics together with antibacterial resistance and their uses among the students of a residential dormitory of a public university of Bangladesh. It was also tried to gather information of which type of antibiotics are commonly used among these students. Another aim of this survey study was to make awareness among students about the usage of antibiotics and give them some knowledge about bacterial resistance and what might happened if antibacterial resistance increases day by day.
SUBJECTS AND METHODS
A cross sectional survey was conducted in period of one month (January 2020) in one of the residential hall of a public University of Bangladesh, where inclusion criteria include the willingness of students to participate in the study. Written consent was taken from each of the participants during data collection. Required data were collected through a questionnaire (see appendix). Data collected through questionnaire which composed of three sections. The first section was basic demographic information such as name, age, etc. In the second part, questions were set about their knowledge of antibiotics. They had to answer the questions with yes or no mostly. If the answer of a specific question was yes, participants were asked more questions on that specific answer. Third part was about the attitudes of the participants toward the usage of antibiotics.
Data analysis
All the collected data were analyzed by using Microsoft Excel (2010) software and results are represented either as percentages in tables or Pie chart.
RESULTS
The results of the second part of this current study were given in the Table 1. The study demonstrated that 94.5% of the participants had previous knowledge about antibiotics which is satisfactory and the same percentage of participants had previously used antibiotics for different purposes (Table 1). But the most alarming findings of the present study are that almost half of the participants (42.1%) had no idea about the completion of the antibiotic courses. It is very much possible that participants of this group may also do not have knowledge about antibacterial resistance. And yes, we found about 46.4% of the participants do not know about the occurrence of antibiotic resistance (Table 1). Again, about 51.0% students do not have any knowledge what will happen if bacteria become resistant to most of the antibiotics. All of this information gives us a common scenario why antibiotic resistance is increasing day by day in developing and/or low income countries. But almost everyone (97.9%) agrees that antibiotics should not be taken without doctor’s advice (Table 1).
This study on antibiotics knowledge and usage found that almost 59.1% students acquired information of antibiotics from doctors, besides 6.8% from newspaper and 12.1% from media. Most of the students (83.7%) had taken antibiotics as doctor’s prescription where from registered pharmacy was 9.2%, from someone’s advice 5%, self-medication 2.1% (Figure 1).
This study found azithromycin (46.4%) is the most frequently used antibiotics among the dormitory students whereas the least used antibiotic is the kanamycin (1.6%) (Table 2). It was also found fever (63.4%) is the disease where most of the participants use antibiotics (Table 3). Fever is considered as one of the common sign and symptoms of many diseases but here very often fever is treated with antibiotics without knowing the exact cause of the fever which also explains the occurrence of antibiotic resistance.
Finally according to the questionnaire, students were asked the very simple question to evaluate their general knowledge about antibiotics, which was antibiotics works against which type of microorganisms.
Though 64.1% of the participants gave the correct answer, a large number of the participants (29.7%) gave the answer that antibiotics work against viruses as well as against fungus (6.2%) (Figure 2).
DISCUSSION
There are some factors like geographical regions, social circumstances and existing health care systems influence antibiotic use and misuse in all over the world5. Since antibiotic resistance is increasing day by day in the world, especially in the developing/low income countries, the aim of the current study was to known the knowledge of antibiotics and antibiotic resistance among a group of people together with collecting the data which type of antibiotics are being used by the group to treat which type of diseases. We choose University students to carry out this survey study because University is the organization of a country where students receive higher studies and it is expected that they will know better than other community of the country. Results showed that 94.5% of the participants are familiar with antibiotics and have used antibiotics at least once in life. But a large percentage of participants have a poor knowledge about antibiotics and antibiotic resistance. Such as 61 out of 145 (42.1%) participants have no idea about completion of antibiotic courses, 48 (33.6%) participants do not know the outcome of the incompletion of antibiotic courses, 65 (46.4%) participants do not know about antibiotic resistance and even half of the participants (51%) do not know if bacteria become resistant to antibiotics what will happen if bacterial infections spread all over the World. Taken together, this scenario speaks the occurrence of antibiotic resistance in developing/low income countries like Bangladesh. The current study found azithromycin was the most frequently used antibiotics among the dormitory students where they use antibiotics to treat mainly fever (63.4%), cold and cough (25.4%), infections, etc. In a survey study of 900 participants in the three major cities of Bangladesh, it was found that people of those cities used antibiotics especially for cold and fever, infections, diarrhea etc6. Results of current study also found cough and fever is the major illness for taking antibiotics. This is very much expected results because our physical practitioners often prescribe antibiotics without proper identifying the cause of the illness mostly for the fever bearing in mind a secondary infection by bacteria. On the other hand, a group of people also seek others suggestion to treat cold and fever and most of the people give advice to take antibiotics because he/she might take that antibiotic and get cured from cold and fever. Again, some people go directly to the pharmacy store and buy antibiotics just consulting with the pharmacist without proper doctor’s prescription. Even some people do not consult with pharmacist. They just buy and use antibiotics by themselves6,7. Biswas et al., found about 347 (26.69%) out of 1300 participants experienced self-medication with antibiotics and the research group claims this self-medication of antibiotics is a serious problem of health sector in Bangladesh8 which might also be a big problem for the World. It is very common for developing or low income countries that people can buy any medicine without doctor’s prescriptions. Therefore, both the reasons (prescribing antibiotics by physicians without proper identifying the cause of the disease and people can buy antibiotics without doctor’s concern) might play a role in increasing antibiotic resistance. Though, now-a-days, according to the Government rules some pharmacy stores do not sell antibiotics without proper evidence of doctor’s prescription but this practice is only limited to certain areas of some cities.
In survey study of antibiotic abuse in Ghana, researchers showed that 71.5% people bought antibiotics without doctor’s prescription and 69.9% did not seek even pharmacist’s advice. They found that people bought mostly amoxicillin 71.5%, ampicillin 13.1%, Flucloxacillin, Metronidazole, Cloxacilin was 10.8%. They used those antibiotics for the treatment of mostly cold 50.8%, cough/chest pain 33.1%, stomach ache 16.9% and skin infection 9.2%5. In current study most of the students (64.1%) knew that antibiotic works against bacteria but other answers weren’t satisfactory9. But the positive sign was that self-medication of antibiotic was markedly less (2.1%). Most of them admired that they shouldn’t take antibiotic without doctor’s concern (97.9%).
CONCLUSIONS
Seminars on the importance of antibiotics use and antibiotic resistance should be arranged in the Universities of Bangladesh to aware the students about the misuse or abuse of antibiotics. Giving them the knowledge about how antibiotics misuse or abuse can make bacteria resistant against different antibiotics. Hopefully students will be more conscious about antibiotics and their uses by this process and can teach their family members about all these things. Subsequently, the students need to be aware on the fact that, the effectiveness of an antibiotic can be preserved only when they are used with a valid prescription and also when the full course is completed9.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
AUTHOR’S CONTRIBUTION
HI and MIH planned the research work, HI and MR made the questionnaire, communicate with students and collected data, HI and MIH wrote the manuscript.
REFERENCES