Complementary and alternative medicine (CAM) use and its association with antibiotic usage practices: A nationally representative population study

Abstract

Inappropriate antibiotic use drives antimicrobial resistance (AMR). Alongside Western medicine, complementary and alternative medicine (CAM) is also often used in multicultural Singapore. This study aims to assess the influence of CAM use on antibiotic use practices. A nationally-representative cross-sectional population survey was conducted in Singapore (November 2020January 2021). CAM use was defined as having used traditional Chinese medicine, acupuncture, Jamu, Ayurvedic medicine or herbal remedies. Multivariable logistic regression analysis was conducted to assess the association between CAM use and good antibiotic use practices, as defined by six proxy statements adapted from the US Centers for Disease Control and Prevention advisory. Sociodemographic characteristics, motivations for CAM use, and knowledge of antibiotic use and AMR were analyzed alongside. Of 2004 respondents, 34% used CAM; they tended to be female (CAM users: 57% vs non-CAM users: 50%, p=0.004), Chinese (82% vs 66%, p<0.001), higher educated (68% vs 64%, p=0.036), living in highest tiered public housing apartments or private housing (45% vs 36%, p<0.001) and have good knowledge of antibiotic use (63% vs 58%, p=0.036). After adjusting for potential confounding, CAM use (aOR 1.23, 95% Cl [1.00-1.52], p=0.048) was associated with 23% increased odds of good antibiotic use practices. Top reasons for CAM use included influence from family and friends (65%) and concern over Western medications' side effects (44%). CAM use is positively associated with good antibiotic use practices. Further studies assessing educational interventions utilizing social networks and highlighting side effects of antibiotics may be useful in improving antibiotic use practices in communities.