Antibiotics’ Self-medication and Its Knowledge among Healthcare Practitioners

Objective: The study aimed to evaluate the knowledge and usage pattern of antibiotics among HCPs. 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 knowledge and usage pattern of antibiotics among HCPs practicing antibiotics’ self-medication. Descriptive and inferential statistics were applied using the Statistical Package for Social Sciences (SPSS) version 24.0. A p-value < 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 antibiotics’ knowledge 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): 378-383, 2021; Article no.JPRI.82471 379


INTRODUCTION
The major issue with self-medication is the lack of clinical assessment of the disorders by an experienced medical professional, which could result in unnoticed diagnosis and hinder suitable treatments [1,2]. Self-medication is a serious global health issue. The term 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 [3].
In the US and Australia, healthcare practitioners (HCPs) reported that their knowledge regarding antibiotic use was not appropriate [4,5]. In another study, knowledge 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, knowledge regarding antibiotics seems to be inconsistent among HCPs. Studies from other countries also found that HCPs demonstrated good knowledge regarding antibiotic use, however, there was also a gap between knowledge and practice [8,9]. HCPs differ from the general population because of their knowledge 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 the knowledge, attitude, perceptions and practices of antibiotics' selfmedication among HCPs. Appropriate knowledge 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 knowledge and usage pattern of antibiotics among HCPs.

MATERIALS 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.

RESULTS AND DISCUSSION
From the obtained results, the females were 153 (52.9%) and males were 136 (47.1%) in the studied population. All of the studied HCPs were from different age groups, i.e. 20-35 years were 165 (57.1%), 36-45 years were 88 (30.4%) and >45 years were 36 (12.5%). Professional degrees of the HCPs included, medicine 53 (18.3%), pharmacy 103 (35.6%), dentistry 13 (4.5%), nursing 98 (33.9%), and others allied HCPs 22 (7.6%). They had different levels of experiences i.e. <10 years 169 (58.5), 11-20 years 96 (33.2%) and >20 years 24 (8.3%). A detailed description of the demographic characteristics is provided in Fig. 1. Table 1 shows Cronbach alpha value, which was obtained to ascertain the reliability of the research tool used among the study participants. The internal consistency was measured by Cronbach's alpha and the value was 0.895. Table 2 shows the knowledge questions and their obtained results, which were asked from the HCPs to know their viewpoint about antibiotics' self-medication. Data shows their responses about questions regarding awareness and knowledge of antibiotics' self-medication in different diseases.
A statistically significant association (p=0.032) was observed in the responses of the question regarding antibiotics self-medication practice in fever. Around 148 (51.2%) of the studied HCPs admitted of practicing self-medication of antibiotics in treatment of fever. For treatment of diarrhea, approx. 69 (23.9%) of the HCPs agreed at self-medication of antibiotics while around 220 (76.1%) of the HCPs opposed the idea of antibiotics self-medication practice while treating diarrhea but the association was not statistically significant.
Around 163 (56.4%) of the HCPs reported practice of self-medication of antibiotics while treating urinary tract infections and around 126 (43.6%) of them reported not practicing of selfmedication of antibiotics to treat urinary tract infections. There was a statistically significant difference (p=0.005) observed in the practice of antibiotics self-medication among HCPs to treat urinary tract infections.  According to the current study findings, statistically non-significant (p>0.05) differences were observed between the responses to the questions regarding the self-medication of antibiotics to treat eye infections, rhinitis and runny nose among the studied cohort of the HCPs. Table 3 shows the preferences or choices of antibiotics' self-medication among the studied HCPs. The current study findings also reported that statistically significant differences were observed in the usage or selection of cephalosporins and macrolides as selfmedication antibiotics over the rest of the antibiotics among the HCPs (p=0.026 & p=0.026; respectively). It is of greatest significance to know the exact level of knowledge and practice of HCPs about usage of antibiotics as selfmedication to treat their ailments. However, the obtained results showed that there is also a need to update the current knowledge of HCPs to better understand and precise practice of prescribing antibiotics or self-use of antibiotics. Antibiotics' improper usage pattern or their use without prescriptions from a registered HCP could lead to various side effects and a greater level of resistance among the population [12,13].

Fig. 1. Demographic characteristics of the participants
Advanced level of knowledge about antibiotics usage and awareness about their side effects and drug interactions could further improve their efficacy and efficiency. In total, appropriate knowledge and precise usage pattern of antibiotics are essential in order to combat numerous infectious diseases. This could further help in improving individuals' overall healthrelated quality of life [13][14][15].
Antibiotics are the most common and widespread class of drugs which are used to treat and prevent bacterial infections. They can be used in both outpatients and inpatients especially in intensive care & surgical units (ICSU). In achieving optimum health status, best care, unsurpassed infection, decreasing length of hospital stays and best therapy outcomes it is always recommended to use antibiotics in an appropriate way [14][15][16][17].

CONCLUSION
This study concluded that all of the studied HCPs had varied (low to good) level of antibiotics' knowledge 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
It is not applicable.

ETHICAL APPROVAL
It is not applicable.

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