Knowledge, attitudes and practices towards antibiotic use in upper respiratory tract infections among patients seeking primary health care in Singapore

Abstract

BackgroundPatients’ expectations can influence antibiotic prescription by primary healthcare physicians. We assessed knowledge, attitude and practices towards antibiotic use for upper respiratory tract infections (URTIs), and whether knowledge is associated with increased expectations for antibiotics among patients visiting primary healthcare services in Singapore.MethodsData was collected through a cross-sectional interviewer-assisted survey of patients aged ≥21 years waiting to see primary healthcare practitioners for one or more symptoms suggestive of URTI (cough, sore throat, runny nose or blocked nose) for 7 days or less, covering the demographics, presenting symptoms, knowledge, attitudes, beliefs and practices of URTI and associated antibiotic use. Univariate and multivariate logistic regression was used to assess independent factors associated with patients’ expectations for antibiotics.ResultsNine hundred fourteen out of 987 eligible patients consulting 35 doctors were recruited from 24 private sector primary care clinics in Singapore. A third (307/907) expected antibiotics, of which a substantial proportion would ask the doctor for antibiotics (121/304, 40 %) and/or see another doctor (31/304, 10 %) if antibiotics were not prescribed. The majority agreed “antibiotics are effective against viruses” (715/914, 78 %) and that “antibiotics cure URTI faster” (594/912, 65 %). Inappropriate antibiotic practices include “keeping antibiotics stock at home” (125/913, 12 %), “taking leftover antibiotics” (114/913, 14 %) and giving antibiotics to family members (62/913, 7 %). On multivariate regression, the following factors were independently associated with wanting antibiotics (odds ratio; 95 % confidence interval): Malay ethnicity (1.67; 1.00–2.79), living in private housing (1.69; 1.13–2.51), presence of sore throat (1.50; 1.07–2.10) or fever (1.46; 1.01–2.12), perception that illness is serious (1.70; 1.27–2.27), belief that antibiotics cure URTI faster (5.35; 3.76–7.62) and not knowing URTI resolves on its own (2.18; 1.08–2.06), while post-secondary education (0.67; 0.48–0.94) was inversely associated. Those with lower educational levels were significantly more likely to have multiple misconceptions about antibiotics.ConclusionMajority of patients seeking primary health care in Singapore are misinformed about the role of antibiotics in URTI. Agreeing with the statement that antibiotics cure URTI faster was most strongly associated with wanting antibiotics. Those with higher educational levels were less likely to want antibiotics, while those with lower educational levels more likely to have incorrect knowledge.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0547-3) contains supplementary material, which is available to authorized users.

Combating Antimicrobial Resistance in Singapore: A Qualitative Study Exploring the Policy Context, Challenges, Facilitators, and Proposed Strategies

“…There were also reports suggesting a lack of awareness of AMR from the public and as a result, patients continued demanding antibiotics even when they were not clinically indicated. This was also reported in a Singaporean study that surveyed patients and found that most patients seeking primary health care in Singapore were misinformed about the role of antibiotics, with poor knowledge being associated with wanting antibiotics [32].…”

Ten-year narrative review on antimicrobial resistance in Singapore

“…There remains a gap in knowledge about the amount and appropriateness of antibiotic prescribing in the primary healthcare setting in Singapore, although it is likely that improvements can be made. (53) A similar gap exists for antibiotics prescribed in local veterinary and agricultural practices. In these settings, in addition to attempts to improve data capture, strategies to improve prescribing practices in the community -such as guidelines for antibiotic prescription and incentives to encourage proper antibiotic usage -should be developed to tackle the issue of inappropriate prescribing.…”

“…As misconceptions about appropriate antibiotic use and the consequences of misusing antibiotics are common, (53) education is needed to guide people towards a correct, unified understanding and perception of AMR, including its impact on society. Education serves two main purposes: (a) to let the target audience recognise that AMR is an urgent issue that needs to be acted upon; and (b) to equip them with the right knowledge to effectively participate in activities against AMR.…”

“…These could potentially be addressed through improved communication with the various hospital departments via educational roadshows, regular reports on their antibiotic prescription trends, and published evidence that ASP recommendations specific to their department are advantageous to their patients. (56)(57)(58)(59)(60) Patients' attitudes and expectations often influence physicians' antibiotic prescribing practices, (53) reinforcing the need for public education to increase awareness about the issue of AMR and appropriate antibiotic use. Since 2016, Singapore has been actively participating in the annual World Antibiotic Awareness Week, supported by the WHO every November, by reaching out to the public at various public forums, hospitals and national libraries.…”

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…Despite URTIs generally being minor illnesses, they result in an appreciable number of medical consultations globally 87,[199][200][201][202][203] . The number of healthcare consultations combined with parental and patient pressure increases antibiotic use for URTIs including LMICs thereby increasing AMR rates 88,153,200,[204][205][206][207][208][209] . Patients or parents who are concerned about their or their child's respiratory illness are likely to seek treatment, and want an antibiotic, especially if they perceive the illness as severe 21,209,210 .…”