Abstract
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.
Highlights
In the past several decades, antibiotic resistance (AR) has been increasingly recognized as one of the biggest threats to public health and economic development worldwide, as it makes common infectious diseases difficult to treat and results in increased mortality and treatment cost [1,2,3]
Based on the World Health Organization [15], four kinds of behaviors were highlighted which are prevalent among general populations, including demanding antibiotic prescriptions from physicians, non-prescription antibiotic purchasing from pharmacies, non-adherence to antibiotic prescriptions, and prophylactic use of antibiotics
A total of 8468 articles were retrieved through the literature search, of which 187 met the inclusion criteria, and a total of 78 studies were included in the final meta-analysis (Figure 2)
Summary
In the past several decades, antibiotic resistance (AR) has been increasingly recognized as one of the biggest threats to public health and economic development worldwide, as it makes common infectious diseases difficult to treat and results in increased mortality and treatment cost [1,2,3]. In addition to the huge loss to society, patients with AR require extra hospital stays, additional costs, and have an even greater risk of mortality compared to those without infections [5,6]. To address this issue, a call for whole society engagement from one health perspective is required, covering everyone from all sectors and disciplines who should be responsible for preserving the effectiveness of the antibiotic agents [1]. The public’s behaviors can sway physician’s rational use of antibiotics via expectation and pressure for antibiotics, which has been criticized as one key factor contributing to the unnecessary use of antibiotics by physicians [16,17,18,19,20]
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