Behaviour and perception of parents on irrational use of antibiotics in children at primary care level: A cross-sectional study from Turkey

Abstract

Objective: To investigate the perception of antibiotics, the frequency of inappropriate antibiotic use, and the factors that lead to inappropriate antibiotic use by parents who apply to primary healthcare organizations. Methods: This cross-sectional study included 973 parents who applied to primary healthcare centers. We analyzed basic concepts related to antibiotics prescribed for their children, antibiotic administration, and antibiotic resistance, as well as parents' knowledge and attitudes towards antibiotic use, and their experiences, practices, and perceptions related to purchasing antibiotics without prescription. Results: In the past one year, 78.9% of the parents gave antibiotics to their children at least once, and 39.1% gave antibiotics three or more times. Some of the participants (7.1%) reported having forced the physician to prescribe antibiotics and purchased antibiotics without a prescription (13.2%). The knowledge about antibiotics and awareness about antibiotic resistance were found to be more frequent; among parents who had university degrees, higher income levels, two or fewer children, social insurance and negative behaviours were lower in those who received information about antibiotics from healthcare professionals. The probability of taking antibiotics without prescription was lower in that of with higher income level (OR 0.460; 95% CI 0.219-0.965), and the probability of forcing antibiotic prescription was higher in those with 3 or more children (OR 6.94; 95% CI 2.37-20.26). The score obtained from the awareness of antibiotic resistance sub-dimension was found to negatively affect the behavior of forcing antibiotic prescription (OR 0.852; 95% CI 0.732-0.993) but the score obtained from the behaviour sub-dimension was positively affect this behaviour (OR 1.136; 95% CI 1.011-1.276). Conclusions: Inappropriate antibiotic use appears to be a problem with negative perception, lack of knowledge and socioeconomic dimension. Studies should be conducted to increase antibiotic knowledge in parents and to expand the scope of social insurance.

Keywords

Antibiotics / Attitudes / Social insurance / Educational activities

References

[1] Abobotain AH, Sheerah HA, Alotaibi FN, Joury AU, Mishiddi RM, Siddiqui AR, et al. Socio-demographic determinants of antibiotic misuse in children. Saudi Med J 2013; 34(8):832-840.

[2] Alili-Idrizi E, Dauti M, Malaj L. Validation of the parental knowledge and attitude towards antibiotic usage and resistance among children in Tetovo, the Republic of Macedonia. Pharm Pract (Granada) 2014; 12(4):467.

[3] Scaioli G, Gualano MR, Gili R, Masucci S, Bert F, Siliquini R. Antibiotic use: A cross-sectional survey assessing the knowledge, attitudes and practices amongst students of a school of medicine in Italy. PLoS One 2015; 10(4):e0122476.

[4] Deschepper R, Grigoryan L, Lundborg CS, Hofstede G, Cohen J, Van Der Kelen G, et al. Are cultural dimensions relevant for explaining cross-national differences in antibiotic use in Europe? BMC Health Serv Res 2008; 8:123.

[5] Vanden Eng J, Marcus R, Hadler JL, Imhoff B, Vugia DJ, Cieslak PR, et al. Consumer attitudes and use of antibiotics. Emerg Infect Dis 2003; 9(9):1128-1135.

[6] Kardas P, Devine S, Golembesky A, Roberts C. A systematic review and meta-analysis of misuse of antibiotic therapies in the community. Int J Antimicrob Agents 2005; 26(2):106-113.

[7] Wang J, Sheng Y, Ni J, Zhu J, Zhou Z, Liu T, et al. Shanghai parents perception and attitude towards the use of antibiotics on children: A cross-sectional study. Infect Drug Resist 2019; 12:3259-3267.

[8] Alumran A, Hou XY, Sun J, Yousef AA, Hurst C. Assessing the construct validity and reliability of the Parental Perception on Antibiotics (PAPA) scales. BMC Public Health 2014; 14:73.

[9] Ozdemir C. Validation of Turkish parental perception on antibiotics scale [thesis]. Denizli:Pamukkale University; 2018. [Online]. Available from:http://acikerisim.pau.edu.tr:8080/xmlui/bitstream/handle/11499/3479/Caner%20O%cc%88zdemir%20Tez.pdf?sequence=1&isAllowed=y. [Accessed on 26 January 2023].

[10] Teng C, Leong K, Aljunid S, Cheah M. Antibiotic prescription in upper respiratory tract infections. Asia Pac Fam Med 2004; 3:38-45.

[11] Cebotarenco N, Bush P. Reducing antibiotics for colds and flu: A student-taught program. Health Educ Res 2008; 23:146-157.

[12] Ahmed K, Al-Saadi A. A survey of multiple prescriptions dispensed in Saudi Arabia. Pak J Pharm Sci 2005; 18:1-2.

[13] Irshaid Y, Al-Homrany M, Hamdi A, Adjepon-Yamoah K, Mahfouz A. A pharmacoepidemiological study of prescription pattern in outpatient clinics in Southwestern Saudi Arabia. Saudi Med J 2004; 25:1864-1870.

[14] Mainous A, Hueston W, Davis M, Pearson W. Trends in antimicrobial prescribing for bronchitis and upper respiratory infections among adults and children. Am J Public Health 2003; 93:1910-1914.

[15] Huang S, Rifas-Shiman S, Kleinman K, Kotch J, Schiff N, Stille C, et al. Parental knowledge about antibiotic use: Results of a cluster-randomized, multicommunity intervention. Pediatrics 2007; 119:698-706.

[16] Yu M, Zhao G, Lundborg SC, Yipin Zhu, Zhao Q, Xu B. Knowledge, attitudes, and practices of parents in rural China on the use of antibiotics in children: A cross-sectional study. BMC Infect Dis 2014; 14:112.

[17] Chang J, Lv B, Zhu S, Yu J, Zhang Y, Ye D, et al. Non-prescription use of antibiotics among children in urban China: A cross-sectional survey of knowledge, attitudes, and practices. Expert Rev Anti Infect Ther 2018; 16(2):163-172.

[18] Ding L, Sun Q, Sun W, Du Y, Li Y, Bian X, et al. Antibiotic use in rural China: A cross-sectional survey of knowledge, attitudes and self-reported practices among caregivers in Shandong province. BMC Infect Dis 2015; 15:576.

[19] Pavydė E, Veikutis V, Mačiulienė A, Mačiulis V, Petrikonis K, Stankevičius E. Public knowledge, beliefs and behavior on antibiotic use and self-medication in Lithuania. Int J Environ Res Public Health 2015; 12(6):7002-7016.

[20] Paredes JL, Navarro R, Watanabe T, Morán F, Balmaceda MP, Reateguí A, et al. Knowledge, attitudes and practices of parents towards antibiotic use in rural communities in Peru: A cross-sectional multicentre study. BMC Public Health 2022; 22(1):459.

[21] Albayrak A, Karakaş NM, Karahalil B. Evaluation of parental knowledge, attitudes and practices regarding antibiotic use in acute upper respiratory tract infections in children under 18 years of age: A cross-sectional study in Turkey. BMC Pediatr 2021; 21(1):554.

[22] Rousounidis A, Papaevangelou V, Hadjipanayis A, Panagakou S, Theodoridou M, Syrogiannopoulos G, et al. Descriptive study on parents' knowledge, attitudes and practices on antibiotic use and misuse in children with upper respiratory tract infections in Cyprus. Int J Environ Res Public Health 2011; 8(8):3246-3262.

[23] Zyoud SH, Abu Taha A, Araj KF, Abahri IA, Sawalha AF, Sweileh WM, et al. Parental knowledge, attitudes and practices regarding antibiotic use for acute upper respiratory tract infections in children: A cross-sectional study in Palestine. BMC Pediatr 2015; 15:176.

[24] Panagakou SG, Spyridis N, Papaevangelou V, Theodoridou KM, Goutziana GP, Theodoridou MN, et al. Antibiotic use for upper respiratory tract infections in children: A cross-sectional survey of knowledge, attitudes, and practices (KAP) of parents in Greece. BMC Pediatr 2011; 11:60.

[25] Cantarero-Arévalo L, Hallas MP, Kaae S. Parental knowledge of antibiotic use in children with respiratory infections: A systematic review. Int J Pharm Pract 2017; 25(1):31-49.