The General Population’s Inappropriate Behaviors and Misunderstanding of Antibiotic Use in China: A Systematic Review and Meta-Analysis

Abstract

The general population has increasingly become the key contributor to irrational antibiotic use in China, which fuels the emergence of antibiotic resistance. This study aimed to estimate the prevalence of the general population’s irrational use behaviors of antibiotics and identify the potential reasons behind them. A systematic review and meta-analysis were performed concerning four main behaviors relevant to easy access and irrational use of antibiotics and common misunderstandings among the population about antibiotics. Four databases were searched, and studies published before 28 February 2021 were retrieved. Medium and high-level quality studies were included. Random effects meta-analysis was performed to calculate the prevalence of the general population’s irrational behaviors and misunderstandings relevant to antibiotic use. A total of 8468 studies were retrieved and 78 met the criteria and were included. The synthesis showed the public can easily obtain unnecessary antibiotics, with an estimated 37% (95% CI: 29–46) of the population demanding antibiotics from physicians and 47% (95% CI: 38–57) purchasing non-prescription antibiotics from pharmacies. This situation is severe in the western area of China. People also commonly inappropriately use antibiotics by not following antibiotic prescriptions (pooled estimate: 48%, 95% CI: 41–55) and preventatively use antibiotics for non-indicated diseases (pooled estimate: 35%, 95% CI: 29–42). Misunderstanding of antibiotic use was also popular among people, including incorrect antibiotic recognition, wrong antibiotic use indication, inappropriate usage, and ignorance of potential adverse outcomes. Over-and inappropriate use of antibiotics is evident in China and a multifaceted antibiotic strategy targeted at the general population is urgently required.

The vicious cycle of the public's irrational use of antibiotics for upper respiratory tract infections: A mixed methods systematic review

“…This review shows that the public overuse of antibiotics for URTIs is prevalent worldwide. This result is consistent with the findings of the public's antibiotic use in general ( 12 , 122 ). However, URTIs are a self-limiting condition usually caused by virus, for which antibiotic treatment is not recommended ( 123 ).…”

“…The high level of antibiotic usage also induces unnecessary expectations from the public (9), which puts healthcare providers under great pressure (10), driving the over-prescription of antibiotics (10,11). Meanwhile, non-adherence to prescribed antibiotic therapy is prevalent worldwide (12)(13)(14), further accelerating the emergence of AR. A recent study from China shows that self-actions of the public driven by irrational expectations have surpassed irrational antibiotic prescribing, becoming the leading cause of the misuse of antibiotics for URTIs (15).…”

“…Extensive studies have been conducted to explore the knowledge, attitudes and behaviors of the public in relation to antibiotic consumption under various socioeconomic circumstances (12,(16)(17)(18)(19). Many interventions, both individualbased and population-based, have been designed to improve the antibiotic knowledge of the public using traditional (e.g., printed leaflets) and modern (e.g., social media) communication channels (20,21).…”

Bacterial profile and antibiotic susceptibility pattern of uropathogens causing urinary tract infection in the eastern part of Northern India

“…The main factor fueling AMR is improper usage of antibiotics that needs to be checked ( Duan et al, 2021 ). According to the Infectious Diseases Society of America’s proposed regulations, empirical antibiotic treatment for UTI should be based on regional susceptibility data, drug accessibility, and patient history ( Tamma et al, 2022 ).…”

Assessment of Knowledge, Attitude, and Practice of Antibiotic Use among the Population of Boyolali, Indonesia: A Cross-Sectional Study

“…Respiratory and gastrointestinal diseases are common but are also commonly incorrectly managed by using antibiotics, and physicians needlessly write antibiotic prescriptions, increasing the chances of ABR prevalence [2,7,11,16]. A recent systematic review and meta-analysis has reported that antibiotics are used inappropriately by the general population, as seen in behaviours such as purchasing antibiotics from pharmacies without a prescription, demanding antibiotics from physicians, not following prescribed antibiotics, and using antibiotics as prophylaxis for non-indicated diseases [17]. An incomplete course of antibiotics-not completing the entire course of antibiotics prescribed by the physician-educates microbes to become resistant, probably leading to a higher rate of ABR development [18,19].…”