Behavior and Attitude of Healthcare Practitioners about Antibiotics’ Self-medication

Objective: The study aimed to evaluate the attitude and behavior of HCPs about self-medication of antibiotics. Methods: A cross-sectional study was done using a validated research tool to obtain the required data. Data was obtained using different questions regarding the behavior and attitude towards antibiotics usage among HCPs about antibiotics’ self-medication. Descriptive and inferential statistics were applied using the Statistical Package for Social Sciences (SPSS) version 24.0. A pvalue < 0.05 was considered statistically significant. Results: Different demographic characteristics were studied from the selected cohort of the HCPs. Around 153 (52.9%) of the studied HCPs were the females and 136 (47.1%) were males. The studied HCPs were of different professions, whereby 53 (18.3%) from medicine, 103 (35.6%) from pharmacy, 13 (4.45%) from dentistry, 98 (33.9%) from nursing, and 22 (7.6%) from others allied professions. Conclusion: From the obtained results, it was concluded that all of the studied HCPs had varied level of attitude and behavior towards antibiotics’ usage pattern but still there is a greater need to strictly adhere with and follow the recommended and concerned guidelines regarding antibiotics usage to avoid any unwanted side effects, adverse drug reactions and antibiotics resistance. Original Research Article Khan and Iqbal; JPRI, 33(61A): 372-377, 2021; Article no.JPRI.82470 373


INTRODUCTION
Self-medication is defined as the use of medical products by a user to self-treat well-known illnesses or symptoms, or the recurrent or sustained use of a medication normally prescribed by a physician for chronic or returning diseases without a physician prescription [1]. The problem with self-medication is the lack of clinical assessment of the disorders by a qualified medical professional, which could result in misdiagnosis and hinder suitable treatments [2,3]. Self-medication is a serious global health issue.
In literature, healthcare practitioners (HCPs) reported that their awareness regarding antibiotic use was not up to date appropriate and the health care practitioners could be deficient in knowledge regarding antibiotic use [4,5]. In another study, awareness of the pharmacological aspects of antibiotics and prophylactic antibiotic use among dentists was low [6]. Another study from Russia found that more than 73% of pharmacists self-medicate using antibiotics [7]. However, awareness regarding antibiotics seems to be inconsistent among HCPs. Two other studies reported that HCPs demonstrated good knowledge regarding antibiotic use, however, there was also a gap between attitude and practice [8,9]. HCPs differ from the general population because of their awareness regarding disease and drugs. In countries such as Ethiopia and Nigeria, 68% and 52% of HCPs reportedly practice self-medication, respectively [10,11].
Limited studies are evident regarding the evaluation of knowledge, attitude, perceptions and practices of antibiotics' self-medication among HCPs. Appropriate positive attitude about antibiotics and awareness about their appropriate usage among HCPs is crucial as they prescribe antibiotics to treat their patients. However, many times it happens where HCPs do use antibiotics for themselves to treat various infections which may not be an appropriate approach. Identifying factors that influence the self-usage practice of antibiotics among HCPs could help to overcome and control the misuse of antibiotics. This study evaluated the attitude and behavior of HCPs about self-medication of antibiotics.

MATERIAL AND METHODS
The study was conducted among HCPs, and data was collected from those who met the inclusion criteria. A data collection form was specially designed to collect the required information. There were different demographic characteristics observed among the study participant. A pilot study was also conducted to test the relevancy and appropriateness of the data collection form.
All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) statistical software version 24. Descriptive statistics were used to describe demographic characteristics of the studied HCPs. Percentages and frequencies were used for categorical variables, while means and standard deviation were calculated for the continuous variables. Normality distribution was ascertained prior to each analysis and appropriate parametric or nonparametric tests were chosen accordingly.

Fig. 2. Antibiotics' classes/groups with adverse drug reactions
A statistically significant association (p=0.006) was observed in the response of the question regarding the belief that antibiotics should not be started without a culture susceptibility test. Around 187 (64.7%) of the studied HCPs agreed that antibiotics should not be started without a culture susceptibility test whereas around 102 (35.3%) of the HCPs believed that antibiotics could be started without a culture susceptibility test. In another question, regarding the attitude that HCPs read the side effects of antibiotics beforehand prior their self-use and round 269 (93.1%) of the interviewed HCPs agreed that they always read the side effects of antibiotics before their self-use. In opposition, around 20 (6.9%) of the participant HCPs didn't read the side effects of antibiotics beforehand of self-use of antibiotics but the association among both of the groups was not statistically significant (p=0.289). Fig. 2 presents attitude of the HCPs towards adverse drug reactions of the various classes/groups of the antibiotics. According to the obtained results, around 126 (53%) of HCPs believed that penicillins have higher ADRs as compared to the cephalosporins, which 54 (23%) of the HCPs believed having ADRs. In addition, around 12 (5%) of the studied HCPs also believed that aminoglycosides have ADRs.
In Table 3, around 214 (74%) of the HCPs reported that antibiotics should not be used until necessary while 75 (26%) of the HCPs agreed that antibiotics could be used even when they are not needed and the association was not statistically significant. Around 246 (85.1%) of the HCPs believed that antibiotics can't be discontinued without completing their full course while 43 (14.9%) of the HCPs agreed that antibiotics could be discontinued without completing their full course and the association was not statistically significant (p>0.05).
The current study findings also reported that statistically non-significant difference (p=0.376) was observed in the viewpoint of taking antibiotics with other drugs as 30 (10.4%) of the HCPs agreed that antibiotics could be taken with other drugs while 259 (89.6%) of the HCPs agreed that antibiotics could not be taken with other drugs. It is of greatest significance to know the exact level of attitude and behaviors of HCPs about self-medication of antibiotics to treat their ailments. However, the obtained results showed that there is also a need to improve the current knowledge of HCPs to better understand and use up to date information when prescribing antibiotics or engaging in self-use of antibiotics. Antibiotics' improper usage pattern or their use without prescriptions from a registered HCP

CONCLUSION
This study concluded that all of the studied HCPs had positive attitude towards antibiotics' usage pattern but still there is a greater need to strictly adhere with and follow the recommended and concerned guidelines regarding antibiotics usage to avoid any unwanted side effects, adverse drug reactions and antibiotics resistance.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
It's not applicable.

ACKNOWLEDGEMENT
This publication was supported by the Deanship of Scientific Research at Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia.