Using social influencers for public health education on antibiotic use and antimicrobial resistance: protocol for a quasi-experimental study

Knowledge, attitudes, and practices of antibiotic use and antimicrobial resistance for pet cats and dogs in Singapore: A cross-sectional study.

Objective: This study aimed to compare pet owners' knowledge of antibiotic use, understanding of antimicrobial resistance (AMR) and antibiotic practices for themselves and their pets to guide behavioral interventions to reduce AMR. Methods: A cross-sectional study conducted between March 2023 and December 2023 involved 1080 pet owners recruited from 16 veterinary clinics in Singapore. An anonymous self-administered survey assessed the participants' knowledge of antibiotic use and AMR as well as their adherence to recommended antibiotic practices for themselves and their pets. McNemar's Chi-square test was used to identify significant differences in the outcome variables between self and pets. The differences between the type of pet owned (dog owner/non-dog owner) were assessed using Pearson's Chi-square test. Results: Among the 1080 pet owners surveyed, poorer knowledge of antibiotic use (46.3% vs. 33.2%; p < 0.001) and inappropriate antibiotic use (33.9% vs. 23.5%; p < 0.001) was more common for participants' pets than for themselves. Compared to dog owners, non-dog owners had poorer knowledge of antibiotic use for their pets (poor knowledge, 55.2%; 42.4%; p < 0.001), but the knowledge of AMR occurrence and antibiotic practices did not differ between the dog owners and the non-dog owners. Conclusions: Pet owners have significantly poorer antibiotic use knowledge and antibiotic practices for their pets than for themselves. Compared to dog owners, non-dog owners have poorer knowledge of antibiotic use. Educational initiatives addressing pet owners' knowledge deficits may improve their antibiotic practices for their pets and themselves, emphasizing the importance of cross-sectoral One Health planning.

Inappropriate use of antibiotics has been one of the main contributors to antimicrobial resistance, particularly in Southeast Asia. Different genders are prone to different antibiotic use practices. The objective of this scoping review is to understand the extent and type of evidence available on gender differences in antibiotic use across Southeast Asia. The search strategy for this scoping review involved PubMed, Semantic Scholar, BioMed Central and ProQuest. Two-level screening was applied to identify the final sample of relevant sources. Thematic content analysis was then conducted on the selected final sources to identify recurring themes related to gender differences in antibiotic use and a narrative account was developed based on the themes. Recommendations for next steps regarding reducing inappropriate antibiotic use and gender considerations that need to be made when developing future interventions were also identified. Research on gender and antibiotic use remains scarce. Studies that discuss gender within the context of antibiotic use often mention differences between males and females in knowledge, attitudes and/or behaviour, however, do not explore reasons for these differences. Gender differences in antibiotic use were generally examined in terms of: (i) knowledge of antibiotic use and antimicrobial resistance and (ii) practices related to antibiotic use. Evidence indicated that differences between males and females in knowledge and practices of antibiotic use varied greatly based on setting. This indicates that gender differences in antibiotic use are greatly contextual and intersect with other sociodemographic factors, particularly education and socioeconomic status. Educational interventions that are targeted to meet the specific needs of males and females and delivered through pharmacists and healthcare professionals were the most common recommendations for reducing inappropriate use of antibiotics in the community. Such targeted interventions require further qualitative research on factors influencing differences in knowledge and practices related to antibiotic use among males and females. In addition, there is also a need to strengthen monitoring and regulation practices to ensure accessibility to affordable, quality antibiotics through trusted sources.

Objectives: Understanding factors influencing inappropriate antibiotic use can guide the design of interventions to improve antibiotic practices and reduce antimicrobial resistance (AMR). Methods: A nationally representative cross-sectional survey (N = 2004) was conducted between November 2020 and January 2021. Knowledge of antibiotic use and AMR using the World Health Organization’s Multi-Country AMR Survey questionnaire, and antibiotic practices were examined. Multivariable logistic regression was performed to identify factors associated with inappropriate antibiotic use and examine effect measure modifications. Results: After adjusting for potential confounding, poor knowledge of antibiotic use was associated with a 3x increased odds of inappropriate antibiotic use in adults aged ≥50 years (aOR 3.11, 95% CI [2.24–4.32]), 5× increased odds in those aged 35–49 years (aOR 4.88, 95% CI [3.32–7.16]), and 7× increased odds in those aged 21–34 years (aOR 6.58, 95% CI [4.19–10.33]). While there was no statistically significant association in adults aged ≥50 years, poor knowledge of AMR increased the odds of inappropriate antibiotic use by 4 times in adults aged 35–49 years (aOR 3.73, 95% CI [1.53–9.11]) and 5 times in those aged 21–34 years (aOR 4.90, 95% CI [1.84–13.02]). Conclusions: Targeted educational interventions for specific age groups are needed in conjunction with empowering the public with knowledge of antibiotic use and AMR.

Background/Objectives: Antibiotic resistance (AR) is a major public health concern, mainly driven by the misuse of antibiotics. Dental settings are one area where unnecessary antibiotic prescriptions and misconceptions among dental patients contribute significantly to antibiotic misuse. This study aimed to evaluate the knowledge and understanding of antibiotic use and AR among dental clinic visitors in Saudi Arabia. Methods: A cross-sectional survey was conducted between March and June 2024, targeting males and females aged 18 years and older residing in Saudi Arabia who visited a dental clinic within the past five years. A self-administered questionnaire was used to assess participants' knowledge of antibiotic use and their awareness of AR. Results: A total of 1455 respondents from different regions of Saudi Arabia completed the survey. The majority of participants (70.1%) correctly identified that antibiotics kill bacteria, but around 30% incorrectly believed antibiotics treat viral infections. Additionally, 19.58% thought it was acceptable to stop taking antibiotics once they feel better. More than half of the participants thought that antibiotics reduce inflammation (69.10%) or relieve pain (52.40%). Nearly half of the participants (48.45%) were unaware of the term "antibiotic resistance (AR)," and only 27.2% identified antibiotic overuse as a cause of AR. A significant association was found between undergoing dental procedures and perceiving antibiotics as necessary (p < 0.0001). Educational level was the only significant predictor of AR awareness (AOR = 2.942; p < 0.0001). Conclusions: Although many participants correctly answered a knowledge question about antibiotics killing bacteria, several misconceptions about antibiotic use and a lack of awareness regarding AR were identified. These findings highlight the need for targeted educational interventions and enhanced antibiotic stewardship in dental practice to control AR.

Background: Poor knowledge of antibiotic use drives poor antibiotic practices, but little is known about the influence of health information orientation (HIO) on knowledge of antibiotic use in the general public. Methods: We conducted a nationally-representative population-wide cross-sectional study (November 2020–January 2021), on a proportionately stratified random sample of 2004 Singapore residents aged ≥21 years. Multivariable logistic regression analysis was performed to assess the association between HIO and knowledge of antibiotic use. Results: Forty percent of respondents had low-levels of HIO (LL-HIO); they tended to be younger, not currently married, and did not have family/friends working in the healthcare sector. Respondents with LL-HIO (aOR 1.82, 95% CI 1.32–2.51, p < 0.001) were 82% more likely to have poor knowledge of antibiotic use. In particular, older adults aged ≥50 years with LL-HIO (aOR 1.81, 95% CI [1.32–2.51], p < 0.001) were much more likely to have poor knowledge than their HL-HIO counterparts. They were also less likely to use the Internet to seek health information and had poor eHealth efficacy. Conclusion: LL-HIO is independently associated with poor knowledge of antibiotic use. Educational strategies on antibiotic use should disseminate a consistent message through both online and offline platforms, involving traditional and non-traditional healthcare and non-healthcare influencers.

BackgroundResistance to antibiotics is an increasing and major threat to global health. While the large majority of antimicrobial use occurs in the community where antibiotics are available without prescription, we did not find any studies investigating community-level factors influencing the inappropriate use of antibiotics in the Democratic Republic of Congo (DRC), where non-prescription antibiotic use is prevalent.MethodsThis qualitative study was conducted from April 1st 2019 to May 5th 2019 and consisting of in-depth semi-structured interviews, utilizing purposive and snowball sampling schemes to recruit adult heads of households in the Pakadjuma slum, in Kinshasa, DRC. Participants with differing medical and educational backgrounds were selected. We employed a thematic analysis approach to explore community knowledge and use of antibiotics in the sampled population.ResultsA total of 18 participants with a median age of 35 years were interviewed. The majority was female (77.7%), had at least a secondary education (83.4%), and unemployed (61.1%). We found that participants were familiar with the term “antibiotics”, but had limited knowledge of the indications and risks of antibiotics, including the risk of antibiotic resistance. Inappropriate use of antibiotics was common and there was frequent self-medication of non-prescribed medicines for a range of non-indicated conditions such as menstruation. Having limited income was the most commonly reported reason for not visiting a health facility for appropriate health care.ConclusionInappropriate use of antibiotics is a widespread practice and is influenced by lack of adequate knowledge of antibiotic use, indications and risks, prevalent self-medication, and financial barriers to accessing appropriate health care. There is need for both community education as well as structural interventions addressing poverty in order to reduce the inappropriate use of antibiotics in the Pakadjuma slum in Kinshasa.

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

The present study aimed to assess the factors associated with pet owners' expectations for receiving antibiotics for their pet dogs and/or cats and the factors associated with pets (dogs and/or cats) receiving antibiotics during non-routine veterinary clinic consultations in Singapore. A cross-sectional study was conducted on consenting pet owners who attended 16 veterinary clinics in Singapore, between March and December 2023. An online survey measured participants' knowledge of antibiotic use, prior antibiotic use experience, expectation for antibiotics and receipt of antibiotics during the last non-routine clinic consultation for their pets. Multivariable logistic regression models were used to determine the factors associated with expectation of antibiotics and receipt of antibiotics. Among the 821 pet owners, over one-in-four (27.5%) expected antibiotics. Owners with prior antibiotic use (adjusted OR 5.18, 95%CI 2.85-9.42) and poor knowledge of antibiotic use (adjusted OR 1.69, 95% CI 1.21-2.35) were 5 times and nearly 2 times as likely as owners without prior antibiotic use and those with good knowledge of antibiotic use respectively, to expect antibiotics for their pets. After adjusting for potential confounders, owners who expected antibiotics (adjusted OR 12.09, 95% CI 7.83-18.68) and had prior antibiotic use for their pets (adjusted OR 8.57, 95% CI 4.75-15.47) were more likely to receive antibiotics for their pets. Factors which significantly influenced expectation of antibiotics in pet owners included poor knowledge of antibiotic use and prior usage of antibiotics. This highlights the importance of effective communication by veterinarians to mitigate pet owners' expectations to address inappropriate antibiotic prescribing.

BackgroundAntimicrobial resistance (AMR) is a major challenge for global health care. Pharmacists play a key role in the health care setting to help support the quality use of medicines. The education, training, and experiences of pharmacy students have the potential to impact on patterns of antibiotic use in community and hospital settings. The aim of this study was to investigate antibiotic use, knowledge of antibiotics and AMR among undergraduate pharmacy students at Sri Lankan universities and to compare this between junior and senior pharmacy student groups.MethodsA cross-sectional study was conducted at the six universities in Sri Lanka that offer pharmacy undergraduate programmes. All pharmacy students in each university were invited to participate in this study using a self-administered questionnaire with ethics approval. The study instrument comprised five major sections: demographic information, self-reported antibiotic use, knowledge of antibiotic uses in human health, knowledge of AMR and antibiotic use in agriculture. Descriptive data analyses were conducted and Chi-squared analysis was used to explore associations between different variables and level of pharmacy education.ResultsFour hundred sixty-six pharmacy students completed the questionnaire. A majority of participants (76%) reported antibiotic use in the past year. More than half (57%) of the junior pharmacy students incorrectly indicated that antibiotic use is appropriate for the management of cold and flu conditions. Senior pharmacy students (n = 206) reported significantly better antibiotic knowledge than junior students (n = 260), p < 0.05. Overall pharmacy students showed good understanding of AMR and their knowledge level increased as the year of pharmacy study increased.ConclusionsThis study found that pharmacy students commonly report using antibiotics. Junior students report some misconceptions about antimicrobials. A comparison between junior and senior pharmacy students suggests that pharmacy education is associated with improved understanding of appropriate antibiotic use and AMR among undergraduate pharmacy students in Sri Lanka.

Utilización adecuada de antibióticos en atención primaria: ¿sabemos qué piensan los padres?

Background/Objectives: Antibiotic resistance (ABR) is a global crisis leading to increased mortality and economic burden. Antimicrobial stewardship (AMS) promotes responsible antibiotic use and prescribing practices to combat ABR. This study assessed the knowledge, awareness, and perceptions of final-year medical and pharmacy students in Saudi Arabia regarding antibiotic use, ABR, and AMS. Methods: A national cross-sectional survey was conducted from January to April 2024 using a 49-item questionnaire. The survey assessed knowledge of antibiotic use, ABR, and AMS using predefined scoring, while perceptions were evaluated with a 5-point Likert scale. Data were analyzed using descriptive statistics and Chi-square tests to explore associations between independent variables and outcomes. A logistic regression analysis identified factors associated with good knowledge, and results were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Among 197 participants from 26 Saudi universities, pharmacy students comprised 73.1% of the sample. Good knowledge was observed in 44.7% for antibiotic use, 47.7% for ABR, and 52.8% for AMS. However, 28.4% lacked awareness of AMS, and 5.6% were unaware of ABR. Pharmacy students demonstrated significantly higher knowledge and confidence in AMS and antibiotic handling compared to medical students (p < 0.001). Higher knowledge was also associated with the university's region and prior education on resistance or AMS during college. Conclusions: This study highlights significant gaps in knowledge and awareness of antibiotic use, ABR, and AMS among final-year medical and pharmacy students in Saudi Arabia. The findings emphasize the need for targeted educational strategies, standardized curricula, and enhanced AMS training to better prepare future healthcare professionals to combat ABR effectively.

BackgroundInappropriate antibiotic use is a major contributor to antimicrobial resistance (AMR) globally. Pharmacists with appropriate skills and training can help address the challenge of AMR.AimTo investigate antibiotic use, knowledge of antibiotics and AMR among pharmacy students in Australian universities and to compare these outcomes between junior and senior pharmacy student groups.MethodA survey regarding global knowledge on AMR was conducted at 14 Australian universities offering pharmacy programmes. All pharmacy students were invited to participate in a self‐administered online questionnaire with five major sections: demographic information, self‐reported antibiotic use, knowledge of antibiotic use in human health, knowledge of AMR and antibiotic use in agriculture. Descriptive data analysis and Chi‐square tests were used in the analysis.ResultsFive hundred and twenty‐five pharmacy students completed the questionnaire. The majority of participants (88%) reported antibiotic use in the past year. Senior pharmacy students (n = 274) reported significantly improved knowledge of appropriate antibiotic indications when compared to junior students (n = 251), p &lt; 0.05. Junior pharmacy students were more likely to incorrectly recommend antibiotics for the management of cold and flu (p &lt; 0.05). Overall,pharmacy students demonstrated a sound understanding of AMR and this knowledge increased among senior pharmacy students.ConclusionThis study found that pharmacy students in Australian universities commonly report using antibiotics. Senior pharmacy students demonstrate an improved understanding of the appropriate use of antibiotics and AMR when compared to junior pharmacy students in Australia.

Introduction. Antimicrobial resistance (AMR) is a complicated public health challenge. This study aimed to obtain a baseline assessment of undergraduate health and science students’ knowledge and attitudes of antibiotic use, resistance and stewardship across European countries and to evaluate education methods.Methods. A 43-item cross-sectional multilingual survey of healthcare practitioners and undergraduates studying dentistry, medicine, nursing, pharmacy and science subjects was conducted by Public Health England (now UK Health Security Agency) in 2018 across 30 EU/EEA countries. Of the 43 questions developed for healthcare workers, a subset of 33 questions directly relevant to students was available for student completion.Results. A total of 1,222 students from 27 EU/EEA countries participated in the survey, with 50% studying medicine (379/760). The mean score across seven knowledge questions was 6.04 out of 7 (sd, 1.14). Knowledge scores differed by the degree being studied and were higher among students in the later years of their degree programme. Knowledge was significantly higher (P<0.001) in those who had received training on prudent antibiotic use and infection management. Most students had not heard about AMR awareness campaigns, including European Antibiotic Awareness Day, and felt they did not have a key role in addressing AMR.Conclusion. Although students demonstrated good overall knowledge of antibiotic use and AMR, many lacked awareness of their role in tackling AMR. Designing more effective targeted educational interventions for these students, such as curriculum development and interprofessional education and training, could be beneficial to support appropriate antibiotic use and efforts to tackle AMR.

BackgroundAntimicrobial resistance (AMR) is a serious public health problem and a global concern. The inappropriate use of antibiotics has been identified by the World Health Organization as a major risk factor for AMR.MethodsThe purpose of this research study is to assess the prevalence of inappropriate antibiotic use among Qatar University students and their family members, detect sociodemographic factors associated with inappropriate use, evaluate the knowledge and attitude towards antibiotic use, and assess respondents’ opinions on healthcare providers’ antibiotic prescription practices. Participants (N = 596) completed a self-administered questionnaire. Descriptive analysis, the Pearson chi-squared test, and multivariate logistic regression analyses were performed.ResultsThe major inappropriate antibiotic use practices followed by the respondents were using antibiotics without prescription (82%), not completing the antibiotic course (45%), and obtaining antibiotics from the pharmacy without prescription (23%). The chi-square test results showed that age (p = 0.031) and nationality (p = 0.041) were associated with using antibiotics without prescription. In addition, respondents less than 21 years of age (p<0.001), who had only a secondary education (p = 0.007), and who lived in one of the large and crowded cities in Qatar (p = 0.011) had higher odds of stopping the antibiotic before completing the course. Our study also revealed that almost 60% of the respondents had inadequate knowledge and a negative attitude towards antibiotic use. Nationality and municipality were the independent factors associated with having appropriate knowledge of antibiotic use. Univariate logistic regression analyses in our study demonstrated that older (>26 years), married and university-graduated participants were more likely to have a positive attitude towards antibiotic use than others. Respondents also reported that neither doctors nor pharmacists were providing adequate patient education about appropriate antibiotic use. The Socio-Ecological Model was applied to interpret the findings and frame implications.ConclusionThe findings shed light on various factors shaping antibiotic use practices and provide evidence to design multilevel behavioral interventions to improve public practices of antibiotic use.