This part of the study was to assess public knowledge, attitudes and behaviour regarding antibiotics to provide information for local health education policy makers.
The results of this study showed that 57% had experienced antibiotic use. Only 21% of the study subjects followed their physician’s instructions. Several studies have shown that patients often do not have accurate knowledge of antibiotics. Hong et al. for example, found that patients often could not identify whether a medication was an antibiotic or not and that many patients considered “antibiotics” to be any prescription medication. Overuse of antibiotics may relate to misinformation or misunderstanding about which infections benefit from the use of an antibiotic.
Not surprisingly, 41% indicated they would ask a laboratory technician for advice about antibiotic use. 61% indicated they would ask a pharmacist for advice about antibiotic use. This result indicates that a serious problem with the health system wherein patients don’t consult physicians and consult laboratory technicians and pharmacists instead. 44% of the study group self- stopped without consultation, 36 % decreased the dosage without consultation. Only 16 % visited physician for follow- up after taking antibiotics, 46 % of subjects considered that physician’s advice about the need for compliance was poor; 54 % took antibiotic according to advice from persons other than their physician (friends, relatives) consultation. 81% of subjects lacked knowledge about antibiotic resistance whereas; 19% were concerned about antibiotic resistance. These misguided behaviors were associated with a lack of awareness of the dangers of antibiotic use. National educational efforts are needed to address these issues if patient demand for antibiotics is to be reduced.
Flu-like symptoms seems to be one of the most common conditions in which antibiotics are used. 65% of subjects always asked their physician for antibiotics prescription when they suffered from flu-like symptomes. Several previous studies found that patient pressure was the most frequently cited reason for the prescribing of antibiotics. Pressure from patients to prescribe antibiotics, particularly for flu-like symptoms, has been identified the most common reasons for doctors discomfort with prescribing decisions. Additionally, subjects may have misunderstood the statements about colds and antibiotics. For example, if they had previous experience with what they thought was a cold, and a physician diagnosed a bacterial ear infection, they may have responded that antibiotics help them get better more quickly when they have a cold .
Physician questionnaire
The aim of this questionnaire is to evaluate the tendency and practices of physicians regarding the proper use of antibiotics, using a self-administered questionnaire for physicians.
Only 31% of the interviewed physicians depend totally on culture results for antibiotic prescription (Table 4.20), while 6% of them stated that they do not request culture and sensitivity as a basis for antimicrobial treatment. The majority of physicians (63%) stated that they sometimes depend on culture and sensitivity. This result is confusing but could be explained by the lack of trust on the laboratory results as shown in table 4.21, wherein, only 40% of physicians have admitted that they trust microbiology results. This raises a basic question, is there a justification from the physician point of view for being skeptical about the competence of the local laboratories? In order to have some answers, further investigation may be required.
High percentage of physician used vancomycin for patient treatment (Figure 4.12) and this may explain why high percentage of resistance was observed in hospitalized patients.
About 10% of the interviewed physicians used antimicrobials in treating uncomplicated viral infections (figure 4.11). This result suggests that there are physicians who over prescribe or abuse antimicrobials and these could be considered important factors for inappropriate antibiotic prescription, therefore, contributing to the growing problem of antimicrobial resistance.
Eighty two out of 100 of the interviewed physicians used vancomycin in treating their patients, 73 of them used it for various gram positive infections and 9 of them used it to treat gram negative infections (table 4.23). Few physicians stated that they use vancomycin to treat gram negative bacteria which could be an indication of miss use of the antibiotic in local hospitals indicating the need to review hospital antimicrobials therapy protocols and initiate continuous educational programs for physicians.
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