Understanding of Future Prescribers About Antimicrobial Resistance and Their Preparedness Towards Antimicrobial Stewardship Activities in Pakistan: Findings and Implications.

Khezar Hayat,Wenchen Liu,Faiz Ullah Khan,Zia Ul Rehman Najeeb,Muhammad Abuzar Ghaffari,Noor Fatima,Muhammad Farooq Umer,Yu Fang,Syed Qasim Raza,Farman Ullah Khan,Chen Chen

doi:10.3389/fphar.2022.771083

Abstract

Background: Insufficient antimicrobial-related training for physicians during their undergraduate education could have a negative impact on their prescribing. Unlike previous studies, this study not only explored the understanding and perception of Pakistani medical students about antibiotics and resistance, but also their preparedness towards antimicrobial stewardship programs. Methods: An online cross-sectional study was undertaken with final-year medical students using a validated questionnaire from January 2021 to May 2021. Descriptive and inference statistics were applied for data analysis. Results: Of 411 students, only 6.3% had undergone antimicrobial resistance (AMR) training. 16.1% of students believed that antibiotics are effective for viral ailments. More than half of the students agreed that AMR is a major healthcare problem in Pakistan (65.9%). Most students viewed poor infection control practices (66.9%), the use of too many broad-spectrum antibiotics (68.4%) for a longer duration (62.8%) with inadequate doses (67.9%) as the causes of AMR. The student’s preparation was insufficient in interpreting microbiological and pathological results (26.3%), selecting the correct antibiotics (22.1%), and awareness of the antibiotic spectrum (20.9%). The median preparedness score showed significant differences with sex (p = 0.049), age (p < 0.001), institute type (p = 0.014), and family income (p = 0.006). Conclusion: Pakistani medical students showed adequate understanding of antibiotics, but lacked preparedness for several components of ASPs, including interpretation of microbiological results and spectrum of antibiotics. More steps need to be taken to prepare medical students for AMR and stewardship initiatives adequately.

Highlights

Antimicrobial resistance (AMR) inherits a significant potential to affect people’s health globally (Ferri et al, 2017)
The students were well aware of the ineffectiveness of antibiotics against viral infections (n = 343, 83.5%) and destruction of the normal microbiota of the body, increasing the potential for secondary infections (n = 358, 87.1%)
Most students correctly said that the resistant bacteria could spread across healthcare facilities (n = 331, 80.5%); only a few students were familiar with the fact that skipping antibiotics could enhance the resistance potential (n = 116, 28.2%)

Summary

Introduction

Antimicrobial resistance (AMR) inherits a significant potential to affect people’s health globally (Ferri et al, 2017). Resistant infections are responsible for one in every three deaths globally, according to the World Health Organization (WHO, 2021), which attributes the increase to the inappropriate use of antimicrobials, including antibiotics. More than 700,000 people worldwide die each year from resistant infections (O’neill, 2016). In the U.S, which provides one-third of all antibiotic prescriptions globally, resistant infections affect at least two million people each year. Misuse and overuse of antimicrobials contribute to the spread of resistant strains of microbes (Markogiannakis et al, 2021). This study explored the understanding and perception of Pakistani medical students about antibiotics and resistance, and their preparedness towards antimicrobial stewardship programs

Objectives

Methods

Results

Discussion

Conclusion