Patient Attitudes and Patterns of Self-Medication with Antibiotics – A Cross-Sectional Study in Bulgaria

Abstract

BACKGROUND: Self-medication with antibiotics is a major concern worldwide because of the high risks of antimicrobial resistance which may result in complicated courses of treatment, increased risk of death and excess costs to the healthcare systems.AIM: The aim was to study the attitudes and self-medication patterns as related to the use of antibiotics among the general Bulgarian population and their determinants.MATERIALS AND METHODS: A questionnaire-based survey was performed among the patients in two randomly selected municipalities. The questionnaire was mailed to 50 randomly selected adult patients by each of the 33 responding GPs thus addressing a total of 1650 participants.RESULTS: A total of 1050 patients completed and returned the questionnaire. The observed self-medication rate was 43%. The women and the younger employees and students tended to have a higher self-medication rate. Fever (22%), sore throat and cough (12.7%) and discomfort when urinating (8.2%) were the most frequent patterns related to the practice of self-medication.CONCLUSION: This analysis reported an extensive use of self-medication with antibiotics in the study population before the changes in the Bulgarian legislation. Younger age and social status (students, employed) were the most important socio-demographic patterns that had probably led towards self-medication with antibiotics.

Evidence of the Practice of Self-Medication with Antibiotics among the Lay Public in Low- and Middle-Income Countries: A Scoping Review

“…A total of 24 studies were identified and included in this scoping review study; the characteristics of the included studies are presented in Table 1. These studies were executed using different methodologies such as cross-sectional [12][13][14][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39], quantitative, [40][41][42] and mixed-methods or observational designs [23]. The number of participants in these studies ranged from 100 to 2696 and publication dates ranged from 2009 to 2018.…”

“…The number of participants in these studies ranged from 100 to 2696 and publication dates ranged from 2009 to 2018. Data on attitude, prevalence, sociodemographic factors, predictors and causes of SMA were collected from self-completed questionnaires [13,14,[23][24][25][26][27][29][30][31]33,37], face-to-face interviews [32,36,38,40,41,43] and observer-rated compliance with recommendations [23]. Four of the studies were undertaken in Saudi Arabia [28][29][30]39], three in Pakistan [12,13,42], two studies in Jordan [40,41] and Turkey [38,41] and one each from Bangladesh, [24] Bulgaria [23], Beirut, [32] Cameroon [33] Columbia, [34] Greece, [25] Guatemala, [35] Haiti, [36] Indonesia [26] Cyprus, Egypt, Lebanon, Libya, Tunisia, [41] Nigeria, [14] Poland, [37] Portugal, [27] Romania, [43] and the United Arab Emirates …”

“…Together with these common reasons, most LMICs also have high rates of infectious diseases which makes the private sector a vital substitute for the community to gain access to primary healthcare facilities [51]. Yet, a number of studies pointed out that the possible benefits linked with SMA can only be achieved by utilizing antibiotics safely, effectively and responsibly [13,23,24,28]. The key determinants of SMA in LMICs are level of education, the intensity of illness, financial status and previous successful use of antibiotics.…”

Off-Label Use of Ceftazidime/Avibactam for the Treatment of Pan-Drug-Resistant Klebsiella pneumoniae in a Neonate: Case Report and Literature Review

“…The percentage of K. pneumoniae cases that were combined resistant to third generation cephalosporins, fluoroquinolones and aminoglycosides, in 2021, was 59.9% and 21.2% for Bulgaria and EU/EEA, respectively [ 26 ]. One of the main reasons for AMR is antibiotic consumption and Bulgaria is one of the European countries with a very high total consumption of antibiotics (24.4 DDD/1000 inhabitants/day for 2021) [ 27 , 28 , 29 ]. K. pneumoniae is also among the most common Gram-negative bacteria isolated to the NICU and one of the leading causes of morbidity and mortality [ 30 , 31 ].…”