Surveys of knowledge and awareness of antibiotic use and antimicrobial resistance in general population: A systematic review

Abstract Background Countries are currently seeking evidence-informed policy options to address antimicrobial resistance (AMR). While rigorous evaluations of AMR interventions are the ideal, they are far from the current reality. Additionally, poor reporting and documentation of AMR interventions impede efforts to use evidence to inform future evaluations and policy interventions. Objectives To critically evaluate reporting quality gaps in AMR intervention research. Methods To evaluate the reporting quality of studies, we conducted a descriptive synthesis and comparative analysis of studies that were included in a recent systematic review of government policy interventions aiming to reduce human antimicrobial use. Reporting quality was assessed using the SQUIRE 2.0 checklist of 18 items for reporting system-level interventions to improve healthcare. Two reviewers independently applied the checklist to 66 studies identified in the systematic review. Results None of the studies included complete information on all 18 SQUIRE items (median score = 10, IQR = 8–11). Reporting quality varied across SQUIRE items, with 3% to 100% of studies reporting the recommended information for each SQUIRE item. Only 20% of studies reported the elements of the intervention in sufficient detail for replication and only 24% reported the mechanism through which the intervention was expected to work. Conclusions Gaps in the reporting of impact evaluations pose challenges for interpreting and replicating study results. Failure to improve reporting practice of policy evaluations is likely to impede efforts to tackle the growing health, social and economic threats posed by AMR.

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The General Population’s Inappropriate Behaviors and Misunderstanding of Antibiotic Use in China: A Systematic Review and Meta-Analysis

Antibiotics ◽

10.3390/antibiotics10050497 ◽

2021 ◽

Vol 10 (5) ◽

pp. 497

Author(s):

Lixia Duan ◽

Chenxi Liu ◽

Dan Wang

Keyword(s):

Systematic Review ◽

General Population ◽

Meta Analysis ◽

Antibiotic Use ◽

Adverse Outcomes ◽

Easy Access ◽

Inappropriate Behaviors ◽

Inappropriate Use ◽

Western Area ◽

High Level

The general population has increasingly become the key contributor to irrational antibiotic use in China, which fuels the emergence of antibiotic resistance. This study aimed to estimate the prevalence of the general population’s irrational use behaviors of antibiotics and identify the potential reasons behind them. A systematic review and meta-analysis were performed concerning four main behaviors relevant to easy access and irrational use of antibiotics and common misunderstandings among the population about antibiotics. Four databases were searched, and studies published before 28 February 2021 were retrieved. Medium and high-level quality studies were included. Random effects meta-analysis was performed to calculate the prevalence of the general population’s irrational behaviors and misunderstandings relevant to antibiotic use. A total of 8468 studies were retrieved and 78 met the criteria and were included. The synthesis showed the public can easily obtain unnecessary antibiotics, with an estimated 37% (95% CI: 29–46) of the population demanding antibiotics from physicians and 47% (95% CI: 38–57) purchasing non-prescription antibiotics from pharmacies. This situation is severe in the western area of China. People also commonly inappropriately use antibiotics by not following antibiotic prescriptions (pooled estimate: 48%, 95% CI: 41–55) and preventatively use antibiotics for non-indicated diseases (pooled estimate: 35%, 95% CI: 29–42). Misunderstanding of antibiotic use was also popular among people, including incorrect antibiotic recognition, wrong antibiotic use indication, inappropriate usage, and ignorance of potential adverse outcomes. Over-and inappropriate use of antibiotics is evident in China and a multifaceted antibiotic strategy targeted at the general population is urgently required.

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Antibiotic Use and Misuse in Dentistry in India—A Systematic Review

Antibiotics ◽

10.3390/antibiotics10121459 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1459

Author(s):

Aarthi Bhuvaraghan ◽

Rebecca King ◽

Harriet Larvin ◽

Vishal R. Aggarwal

Keyword(s):

Systematic Review ◽

General Population ◽

Antibiotic Use ◽

Fixed Dose ◽

Secondary Outcome ◽

Publication Date ◽

Self Medication ◽

Cross Sectional ◽

Low Middle Income Countries ◽

Dental Practitioners

Infections caused by antibiotic resistance pose a serious global health threat, undermining our ability to treat common infections and deliver complex medical procedures. Antibiotic misuse, particularly in low-–middle-income countries, is accelerating this problem. Aim: The aim of this systematic review was to investigate the use and misuse of antibiotics in dentistry in India. Method: We included studies carried out on Indian populations evaluating the prescription of prophylactic or therapeutic antibiotics by dental practitioners or other healthcare providers, along with antibiotic self-medication by the general population. The primary outcome measure was prescription rate/use of antibiotics for dental/oral problems. The secondary outcome measures included indications for antibiotic use in dentistry, their types and regimens, factors influencing practitioners’ prescription patterns and any differences based on prescriber and patient characteristics. Multiple databases were searched with no restrictions on language or publication date. The quality assessment of all included studies was carried out using the AXIS tool for cross-sectional studies and the Joanna Briggs Institute checklist for qualitative studies. Results: Of the 1377 studies identified, 50 were eligible for review, comprising 35 questionnaire surveys, 14 prescription audits and one qualitative study (semi-structured interviews). The overall quality of the included studies was found to be low to moderate. The proportion of antibiotic prescriptions amongst all prescriptions made was found to range from 27% to 88%, with most studies reporting antibiotics in over half of all prescriptions; studies also reported a high proportion of prescriptions with a fixed dose drug combination. Worryingly, combination doses not recommended by the WHO AWaRe classification were being used. The rate of antibiotic self-medication reported for dental problems varied from 5% to 35%. Conclusions: Our review identified the significant misuse of antibiotics for dental diseases, with inappropriate use therapeutically and prophylactically, the use of broad spectrum and combination antibiotics not recommended by WHO, and self-medication by the general population. There is an urgent need for targeted stewardship programmes in this arena.

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Systematic review of public-targeted communication interventions to improve antibiotic use

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkw520 ◽

2016 ◽

Vol 72 (4) ◽

pp. 975-987 ◽

Cited By ~ 26

Author(s):

Elizabeth Louise Anne Cross ◽

Robert Tolfree ◽

Ruth Kipping

Keyword(s):

Systematic Review ◽

Antimicrobial Resistance ◽

General Public ◽

Community Intervention ◽

Antibiotic Use ◽

The United States ◽

Cochrane Library ◽

Control Group ◽

Antibiotic Prescribing ◽

Communication Interventions

Background: Excessive use of antibiotics accelerates the acquisition/spread of antimicrobial resistance. A systematic review was conducted to identify the components of successful communication interventions targeted at the general public to improve antibiotic use. Methods: The databases MEDLINE, EMBASE, CINAHL, Web of Science and Cochrane Library were searched. Search terms were related to the population (public, community), intervention (campaign, mass media) and outcomes (antibiotic, antimicrobial resistance). References were screened for inclusion by one author with a random subset of 10% screened by a second author. No date restrictions were applied and only articles in the English language were considered. Studies had to have a control group or be an interrupted time-series. Outcomes had to measure change in antibiotic-related prescribing/consumption and/or the public’s knowledge, attitudes or behaviour. Two reviewers assessed the quality of studies. Narrative synthesis was performed. Results: Fourteen studies were included with an estimated 74–75 million participants. Most studies were conducted in the United States or Europe and targeted both the general public and clinicians. Twelve of the studies measured changes in antibiotic prescribing. There was quite strong (P < 0·05 to ≥ 0·01) to very strong (P < 0·001) evidence that interventions that targeted prescribing for RTIs were associated with decreases in antibiotic prescribing; the majority of these studies reported reductions of greater than −14% with the largest effect size reaching −30%. Conclusion: Multi-faceted communication interventions that target both the general public and clinicians can reduce antibiotic prescribing in high-income countries but the sustainability of reductions in antibiotic prescribing is unclear.

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Complex Determinants Influencing Inappropriate Antibiotic Use - A Systematic Review

International Journal of Health Sciences and Pharmacy ◽

10.47992/ijhsp.2581.6411.0068 ◽

2020 ◽

pp. 34-53

Author(s):

Architha Aithal ◽

Abhishek Pradhan ◽

Shubhrajyotsna Aithal ◽

A. R. Shabaraya

Keyword(s):

Systematic Review ◽

Antimicrobial Resistance ◽

Bacterial Infections ◽

Antibiotic Use ◽

Current Status ◽

Human Beings ◽

Determinant Factors ◽

Inappropriate Use ◽

Research Gap ◽

Agricultural Plants

Antibiotic medicine is a kind of antimicrobial substance used to fight against the bacteria entered to the human body and hence is considered as a most important category of antibacterial agents to fight against bacterial infections either by killing them or inhibiting their growth. Antibiotic medications are widely used both for preventing and curing infections in human beings, animals, and agricultural plants but are not effective against viral infections, such as the common cold, flu, coughs, sore throats, etc. Even though antibiotics found their importance in fighting against bacterial infections, inappropriate use of them in humans, animals, and agricultural plants has considered as one of the reasons for developing antimicrobial resistance in them and which has several negative effects from different stakeholders’ points of view. In this paper, through a systematic review, we made an attempt to study the determinant issues and complex affecting factors which influence the inappropriate antibiotic use and its consequences in controlling bacterial infections. The study focus on identifying and analyzing misuse of antibiotics including challenges involved in the inappropriate use of Antibiotics, the determinant factors influencing the inappropriate use of antibiotics through a systematic review, predict the determinant factors affecting the process of inappropriate use of antibiotics in an ideal situation which is the final goal of antibiotics research, developing a model by identifying the determinant factors which affects the decision of inappropriate use of antibiotics in society by various stakeholders. It also includes identifying the research gap which is the difference between current status and future anticipated optimistic ideal state and to develop research agendas based on identified research gap on inappropriate use of antibiotics and its effect on human health. Keywords: Antibiotics, Inappropriate use, Humans and agriculture, Research agenda, Research gap, Antimicrobial resistance.

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Antibiotics Use and Its Knowledge in the Community: A Mobile Phone Survey during the COVID-19 Pandemic in Bangladesh

Antibiotics ◽

10.3390/antibiotics10091052 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1052

Author(s):

Zubair Akhtar ◽

Syeda Mah-E-Muneer ◽

Md. Mahbubur Rashid ◽

Md. Shakil Ahmed ◽

Md. Ariful Islam ◽

...

Keyword(s):

Antimicrobial Resistance ◽

General Population ◽

Mobile Phone ◽

Antibiotic Use ◽

Community Level ◽

Illness Episode ◽

Phone Survey ◽

Antibiotics Use ◽

Harmful Effects ◽

Recent Illness

The general population has been excessively using antibiotics during the COVID-19 pandemic. Therefore, the use of antibiotics for any reported illnesses in the preceding four weeks and knowledge of antibiotics among the general population in the community were assessed for possible interventions. A mobile phone survey among a general population across eight administrative divisions of Bangladesh was conducted during January–March 2021. Reported illness episodes irrespective of COVID-19 in the preceding four weeks of the interview, use of antibiotics for the illnesses, and knowledge on antibiotics among the general population were recorded. Descriptive analyses were performed. We randomly interviewed 1854 participants, with a mean age of 28.5 years (range: 18–75 years); 60.6% were male. Among all participants, 86.3% (95% CI: 84.7–87.8) heard names of antibiotics, but only 12.1% reported unspecified harmful effects, and 3.5% reported antimicrobial resistance when antibiotics were taken without a physician’s prescription. Among 257 (13.9%) participants, who consumed medicines for their recent illness episode, 32.7% (95% CI: 27.2–38.6) reported using antibiotics. Of those who could recall the names of antibiotics prescribed (n = 36), the most frequently used was azithromycin (22.2%) followed by cefixime (11.1%) and ciprofloxacin (5.6%). Our findings show an increased antibiotic use for illnesses reported in the preceding four weeks and an elevated knowledge at the community level during the COVID-19 pandemic compared with the pre-pandemic period.

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