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What drives inappropriate use of antibiotics? A mixed methods study from Bahawalpur, Pakistan

Authors Atif M, Asghar S, Mushtaq I, Malik I, Amin A, Babar ZUD, Scahill S

Received 28 September 2018

Accepted for publication 18 January 2019

Published 26 March 2019 Volume 2019:12 Pages 687—699


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony

Muhammad Atif,1 Saima Asghar,1 Irem Mushtaq,2 Iram Malik,1 Anum Amin,1 Zaheer-Ud-Din Babar,3 Shane Scahill4

1Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan; 2Department of Education, The Islamia University of Bahawalpur, Bahawalpur, Pakistan; 3Department of Pharmacy, University of Huddersfield, Huddersfield, UK; 4School of Management, Massey Business School, Massey University, Auckland, New Zealand

Purpose: This study investigates the knowledge, attitudes and practices of the general public regarding the use of antibiotics in community pharmacy, in Pakistan.
Methods: This is a mixed method study where data were collected through a validated questionnaire and semi-structured interviews. Convenience sampling techniques were used to recruit participants from the general public of Bahawalpur, Pakistan who visited pharmacies to purchase antibiotics between 1 June 2018 and 31 July 2018. Descriptive statistics and regression analyses were used to tabulate the results of quantitative data while inductive thematic analysis was used to identify themes and draw conclusions from the qualitative data.
Results: Over 60% of the 400 survey participants (n=246; 61.5%) had a moderate level of antibiotic knowledge; however, attitudes regarding antibiotics use were poor in half the sample (n=201; 50.3%). More than half (n=226; 56.6%) of the respondents stated that antibiotics could cure all types of infections. Just under one third (n=129; 32.3%) of respondents obtained the appropriate dosage regimen while the majority did not complete the course (n=369; 92.3%); stopping when they felt better. Inductive thematic analysis yielded four themes, 10 subthemes and 27 categories. Two subthemes were related to knowledge, one to attitude, three to practices and four subthemes were related to suggestions to improve the healthcare system. Inappropriate antibiotic practices included: lack of consultation with healthcare professionals, purchase of antibiotics without prescription or refilling of previous prescription, use of home supply of antibiotics, sharing of antibiotics with others, improper dosage regimens and early cessation of antibiotic therapy.
Conclusion: Level of education, low health literacy, high consultation fees of private practitioners, inadequate health facilities in government hospitals and patient overload, busy schedules of people, poor healthcare infrastructure in rural areas and unrestricted supply of antibiotics were key factors associated with inappropriate use of antibiotics in Pakistan.

Keywords: antibiotic resistance, general public, knowledge, health literacy, self-medication

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