Abstract
Objectives
This study has been aimed at evaluating knowledge, attitudes and behaviour of university students regarding the usage of antibiotics focusing on differences between medical and nonmedical students.
Methods
This cross-sectional questionnaire-based study was performed on 800 students of the University of Novi Sad, Serbia.
Results
The identified predictors of adequate antibiotic knowledge were enrolled in medical program, higher grade average and appropriate use of antibiotics during last infection. Multivariate regression identified following predictors of self-medication: being medical student (B = 0.715; p < 0.001), more frequent (B = 0.628; p < 0.001) and irregular (B = 0.584; p = 0.001) antibiotic use, a family member engaged in medical profession (B = 0.789; p < 0.001), living in dormitory (B = 0.679; p = 0.007) or rented apartment (B = 0.621; p = 0.002), using antibiotics until symptoms resolved (B = 1.616; p < 0.001) or until the bottle was finished (B = 0.628; p < 0.001) during the last infection.
Conclusions
Although a high number of students showed adequate knowledge about antibiotics, numerous misconceptions were recorded, including self-medication. Further educational interventions are necessary to improve their understanding, perceptions as well as their behaviour towards antibiotic use.
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References
Azevedo MM, Pinheiro C, Yaphe J, Baltazar F (2009) Portuguese students’ knowledge of antibiotics: a cross-sectional study of secondary school and university students in Braga. BMC Public Health 9:359. https://doi.org/10.1186/1471-2458-9-359
Buke CA, Ermertcan S, Hosgor-Limoncu M, Ciceklioglu M, Eren S (2003) Rational antibiotic use and academic staff. Int J Antimicrob Agents 21:63–66. https://doi.org/10.1016/S0924-8579(02)00272-8
Buke C, Hosgor-Limoncu M, Ermertcan S, Ciceklioglu M, Tuncel M, Köse T, Eren S (2005) Irrational use of antibiotics among university students. J Infect 51(2):135–139. https://doi.org/10.1016/j.jinf.2004.12.001
Dutt HK, Sarkhil MZ, Hasseb AM, Singh G (2018) A comparative knowledge, attitude, and practice study of antimicrobial use, self-medication and antimicrobial resistance among final year students of MBBS, BDS, and BSc Nursing at a tertiary care hospital at Kannur. Natl J Physiol Pharm Pharmacol 8(9):1305–1311. https://doi.org/10.2147/IJGM.S200641
Dyar OJ, Howard P, Nathwani D, Pulcini C (2013) Knowledge, attitudes, and beliefs of French medical students about antibiotic prescribing and resistance. Méd Maladies Infect 43(10):423–430. https://doi.org/10.1016/j.medmal.2013.07.010
Eng JV, Marcus R, Hadler JL et al (2003) Consumer attitudes and use of antibiotics. Emerg Infect Dis 9:1128–1135. https://doi.org/10.3201/eid0909.020591
Ghadeer ARY, Suaifan Mayadah Shehadeh, Darwish Dana A, Al-Ijel Hebah, Yousef Al-Motassem M, Darwish Rula M (2012) A cross-sectional study on knowledge, attitude and behavior related to antibiotic use and resistance among medical and non-medical university students in Jordan. Afr J Pharm Pharmacol 6(10):763–770. https://doi.org/10.5897/AJPP12.080
Ghaieth MF, Elhag SR, Hussien ME, Konozy EH (2015) Antibiotics self-medication among medical and nonmedical students at two prominent Universities in Benghazi City, Libya. J Pharm Bioallied Sci 7(2):109–115. https://doi.org/10.4103/0975-7406.154432
Grigoryan L, Burgerhof JG, Degener JE, Deschepper R, Lundborg CS et al (2008) Determinants of self-medication with antibiotics in Europe: the impact of beliefs, country wealth and the healthcare system. J Antimicrob Chemother 61:1172–1179. https://doi.org/10.1093/jac/dkn054
Gualano MR, Gili R, Scaioli G, Bert F, Siliquini R (2015) General population’s knowledge and attitudes about antibiotics: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf 24(1):2–10. https://doi.org/10.1002/pds.3716
Hawkings NJ, Butler CC, Wood F (2008) Antibiotics in the community: a typology of user behaviours. Patient Educ Couns 73(1):146–152. https://doi.org/10.1016/j.pec.2008.05.025
Horvat OJ, Tomas AD, Paut Kusturica MM, Savkov AV, Bukumirić DU, Tomić ZS, Sabo AJ (2017) Is the level of knowledge a predictor of rational antibiotic use in Serbia? PLoS ONE 7:e0180799. https://doi.org/10.1371/journal.pone.0180799
Huangn Y, Gu J, Zhang M, Ren Z, Yang W, Chen Y et al (2013) Knowledge, attitude and practice of antibiotics: a questionnaire study among 2500 Chinese students. BMC Med Educ 13:163. https://doi.org/10.1186/1472-6920-13-163
Jairoun A, Hassan N, Ali A, Jairoun O, Shahwan M (2019) Knowledge, attitude and practice of antibiotic use among university students: a cross sectional study in UAE. BMC Public Health 19(1):518. https://doi.org/10.1186/s12889-019-6878-y
Jamshed SQ, Elkalmi R, Rajiah K, Al-Shami AK, Shamsudin SH, Siddiqui MJ et al (2014) Understanding of antibiotic use and resistance among final-year pharmacy and medical students: a pilot study. J Infect Dev Ctries 8:780–785. https://doi.org/10.3855/jidc.3833
Kalaba M, Kosutic J, Godman B, Radonjic V, Vujic A, Jankovic S et al (2018) Experience with developing antibiotic stewardship programs in Serbia: potential model for other Balkan countries? J Comp Eff Res 7:247–258. https://doi.org/10.2217/cer-2017-0055
Khan AKA, Banu GKKR (2013) Antibiotic resistance and usage-a survey on the knowledge, attitude, perceptions and practices among the medical students of a Southern Indian Teaching Hospital. J Clin Diagn Res 8:1613–1616. https://doi.org/10.7860/JCDR/2013/6290.3230
Kim SS, Moon S, Kim EJ (2011) Public knowledge and attitudes regarding antibiotic use in South Korea. J Korean Acad Nurs 41(6):742–749. https://doi.org/10.4040/jkan.2011.41.6.742
Klemenc-Ketis Z, Hladnik Z, Kersnik J (2010) Self-medication among healthcare and non-healthcare students at university of Ljubljana, Slovenia. Med Princ Pract 19(5):395–401
Kusturica MP, Tomic Z, Bukumiric Z, Horvat O, Pavlovic N, Mikov M, Sabo A (2015) Antibiotics in Serbian households: a source of potential health and environmental threats? Cent Eur J Public Health 23(2):114–118. https://doi.org/10.21101/cejph.a4093
Limaye D, Naware S, Bare P, Dalvi S, Dhurve K, Sydymanov A, Limaye V, Pitani RS, Kanso Z, Fortwengel G (2018) Knowledge, attitude and practices of antibiotic usage among students from Mumbai University. Int J Res Med Sci 6(6):1908. https://doi.org/10.18203/2320-6012.ijrms20182270
Lv B, Zhou Z, Xu G et al (2014) Knowledge, attitudes and practices concerning self-medication with antibiotics among university students in western China. Trop Med Int Health 19:769–779. https://doi.org/10.1111/tmi.12322
Mc Nulty CAM, Boyle P, Nichols Clappison P, Davey P (2007) Don’t wear me out-The public’s knowledge of and attitudes to antibiotic use. J Antimicrob Chemother 59(4):727–738. https://doi.org/10.1093/jac/dkl558
Minen MT, Duquaine D, Marx MA, Weiss D (2010) A survey of knowledge, attitudes, and beliefs of medical students regarding antimicrobial use and resistance. Microb Drug Resist 16(4):285–289. https://doi.org/10.1089/mdr.2010.0009
Pan H, Cui B, Zhang D, Farrar J, Law F et al (2012) Prior knowledge, older age, and higher allowance are risk factors for self-medication with antibiotics among university students in southern China. PLoS ONE 7:e41314. https://doi.org/10.1371/journal.pone.0041314
Sanya TE, Titilayo OF, Adisa R, Segun JS (2013) Use of antibiotics among non-medical students in a Nigerian University. Afri Health Sci 13(4):1149–1155. https://doi.org/10.4314/ahs.v13i4.41
Sarahroodi S, Arzi A, Sawalha AF, Ashtarinezhad A (2010) Antibiotic self-medication among south Iranian University students. Int J Pharmacol 6(1):48–52. https://doi.org/10.3923/ijp.2010.48.52
Sawalha AF (2008) A descriptive study of self-medication practices among Palestinian medical and nonmedical university students. Res Social Adm Pharm 4:164–172. https://doi.org/10.1016/j.sapharm.2007.04.004
Scaioli G, Gualano MR, Gili R, Masucci S, Bert F, Siliquini R (2015) Antibiotic use: a cross-sectional survey assessing the knowledge, attitudes and practices amongst students of a school of medicine in Italy. PLoS ONE 10:e0122476. https://doi.org/10.1371/journal.pone.0122476
Special Eurobarometer 478, Antimicrobial Resistance (in the EU) European commission (2018) Available: http://data.europa.eu/euodp/data/dataset/S2190_90_1_478_ENG
Suaifan GA, Shehadeh M, Darwish DA, Al-Ije H, Yousef AM, Darwish RM (2012) A cross-sectional study on knowledge, attitude and behavior related to antibiotic use and resistance among medical and non-medical university students in Jordan. Afr J Pharm Pharmacol 6(10):763–770. https://doi.org/10.5897/AJPP12.080
Tomas A, Kusturica MP, Tomic Z, Horvat O, Koprivica DD, Bukumiric D, Sabo A (2017) Self-medication with antibiotics in Serbian households: a case for action? Int J Clin Pharm 39(3):507–513. https://doi.org/10.1007/s11096-017-0461-3
Trninic B, Vlajic N, Tomas A, Pavlovic N (2018) Self-medication attitudes and behaviour among medicine and pharmacy students. In: Abstract book of the 59th Congress of students of biomedical sciences, Kopaonik, Serbia, p 399
Wang X, Peng D, Wang W, Xu Y, Zhou X, Hesketh T (2017) Massive misuse of antibiotics by university students in all regions of China: implications for national policy. Int J Antimicrob Agents 50(3):441–446. https://doi.org/10.1016/j.ijantimicag.2017.04.009
World Health Organization (2015) Antibiotic resistance: multi-country public awareness survey. WHO Available: https://apps.who.int/iris/handle/10665/194460
World Health Organization (2018a) Central Asian and Eastern European surveillance of antimicrobial resistance. Annual report WHO Available: http://www.euro.who.int/__data/assets/pdf_file/0007/386161/52238-WHO-CAESAR-AR2018_low_V11_web.pdf?ua=1
World Health Organization (2018b) WHO report on surveillance of antibiotic consumption: 2016–2018 Early Implementation. Available: https://www.who.int/medicines/areas/rational_use/who-amr-amc-report-20181109.pdf
You JHS, Yau B, Choi KC, Chau CTS, Huang OR, Lee SS (2008) Public knowledge, attitudes and on antibiotic use: a telephone survey in Hong Kong. Infection 36:153–157. https://doi.org/10.1007/s15010-007-7214-5
Acknowledgements
We would like to thank all the students involved in this research for giving up their time to take part in the study.
Funding
This work was supported by the Ministry of Science and Technological Development, Republic of Serbia [Grant Number 451-03-68/2020-14/200117]; and the Provincial Secretariat for Science and Technological Development, Autonomous Province of Vojvodina [Grant Number 142-451-2565/2019-02].
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The study was approved by the Ethical Committee of the Faculty of Medicine in Novi Sad (Approval Number 01-39/240/1).
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Horvat, O., Tomas, A., Paut Kusturica, M. et al. Serbian students’ knowledge, attitudes and behaviour towards antibiotic use: is there room for improvement?. Int J Public Health 65, 1257–1267 (2020). https://doi.org/10.1007/s00038-020-01448-6
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DOI: https://doi.org/10.1007/s00038-020-01448-6