Knowledge, Attitudes, and Beliefs Regarding Antimicrobial Therapy and Resistance Among Physicians in Alexandria University Teaching Hospitals and the Associated Prescription Habits

Abstract

Irresponsible prescription of antimicrobials (AMs) is the driving factor for the growing antimicrobial resistance (AMR) crisis. In this study, we assessed the knowledge, attitudes, perceptions, and beliefs regarding AMs and AMR together with the prescription habits of physicians in three University hospitals in Alexandria, Egypt. A 40-question survey was used. Physicians were stratified into residents and practicing staff members, and further into various departments. Clinical pharmacists at the University main hospital were included for comparative purposes. A total of 319 questionnaires were completed (response rate = 91.4%). Participants demonstrated fair average knowledge about AMs (4.71 ± 1.29 out of 7), with no significant difference between residents and staff members, whereas clinical pharmacists scored significantly higher on knowledge questions (p < 0.005). Participants showed poor awareness regarding local AMR patterns of Klebsiella pneumoniae and Pseudomonas aeruginosa (13% and 23%, respectively). AMR was perceived as a global (95%), national (97%), and local (85%) problem. High confidence regarding use of AMs was noticed with significantly higher levels among staff members (70.3% vs. 86.7%, p < 0.05). Most participants agreed that the patients' demands (78.5%) and socioeconomic statuses (76.3%) do influence their choices. The most significant knowledge deficit was regarding dosage adjustment in renal patients, and the survey highlighted poor engagement in educational activities, limited awareness of local resistance patterns, and neglect in explaining the side-effects to patients. Patients' demands and socioeconomic statuses were also shown to influence the physicians' decisions.

The knowledge, attitude and practice of health practitioners towards antibiotic prescribing and resistance in developing countries—A systematic review

“…The systematic search resulted in a total of 384 papers, with 345 papers left after removing duplicates, and 28 relevant papers upon reviewing titles and abstracts. Of these, 15 articles fulfilled our inclusion criteria upon full‐text review (Figure ), according to the United Nations, World Economic Situation and Prospects: four from Africa (two from East Africa: Ethiopia, the Democratic Republic of Congo, one from North Africa: Egypt and one from West Africa: The Gambia); nine from Asia (three from East Asia: Lao People's Democratic Republic, Malaysia, four from South Asia: Bangladesh, India and two from Western Asia: Saudi Arabia); and two from Latin America and the Caribbean (one from the Caribbean: West Indies and one from South America: Peru). All the studies were cross‐sectional, 13 were quantitative studies using questionnaires, and two were qualitative studies.…”

“…Nine studies reported on participants’ awareness and knowledge on antibiotics . Reported knowledge on antibiotics was either based on correct answers to questions that assessed participants’ knowledge or based on self‐assessment.…”

“…Based on correct answers, two of the studies reported level of knowledge based on the proportion of respondents with correct responses to questions that assessed their knowledge, with an overall proportion of 80.9% . Three of the studies reported mean score of knowledge as 5.9 of 10 (SD ± 1.3), 6.0 of 7.0 (SD ± 1.3) and 4.7 of 7 (SD ± 1.29) . Thriemer et al reported a proportion of 60.9% of the respondents had a score of more than 4.0 of 8.0, and Rajiah et al reported 59.5% of the respondents had a “good understanding” of antibiotic use, based on a score of 8.0 or more points of 15.0.…”

“…Five studies reported on the participants’ knowledge on local resistance patterns of pathogens in their health facilities . Overall, an average of 39.6% was aware of the local resistance patterns .…”

“…Five studies reported on the participants’ knowledge on local resistance patterns of pathogens in their health facilities . Overall, an average of 39.6% was aware of the local resistance patterns . Quet et al reported that participants had “no information about local antibiotic resistance patterns” for typhoid fever (54.0% of the respondents) and hospital‐acquired pneumonia (65.9% of the respondents).…”