Knowledge and Awareness of Physicians About Rational Antibiotic Use and Antimicrobial Resistance Before and After Graduation: A Cross-Sectional Study Conducted in Malatya Province in Turkey

Figures & data

Table 1 The Behavior of the Groups About Personal Antibiotic Use and the Doctors’ Decisions in Starting the Antibiotics Treatment for Patients

			Group 1		Group 2		p* value
Question Number	Questions	Options	Number (n=225)	%	Number (n=230)	%
1	When did you last use antibiotics for yourself?	within the last 1 week	7	3.1	9	3.9	0.67
		within the last 1 month	19	8.4	26	11.3
		within the last 6 months	90	40.0	93	40.4
		I never used within the last 1 year	109	48.5	102	44.4
2	In which condition did you feel that it was necessary to start antibiotics the most?	High fever	63	28.0	81	35.2	<0.001
		Sore throat	74	34.9	35	15.2
		Prolonged cough and sputum excretion period	75	33.3	106	46.1
		Diarrhea	13	5.8	8	3.5
3	The way you took before you started antibiotics?	I saw the physician, I used that was prescribed in line with my diagnosis.	183	81.3	135	58.7	<0.001
		I started that I had at home and that I thought would be suitable	33	14.7	83	36.1
		I purchased from the pharmacy without a prescription saying I was a physician.	4	1.8	11	4.8
		I took from my friends/family members upon their recommendations.	5	2.2	1	0.4
4	Your behavior in the process when you started antibiotics treatment?	I use it in the first 1–2 days and then I stop using it when my symptoms recover.	27	12.0	18	7.8	0.32
		I try to use it; however, I quit using it when I see the slightest side effect.	38	16.9	32	13.9
		I try to complete the treatment process under any conditions.	152	67.6	170	73.9
		When prescribing, I never start them, I try to find alternative solutions.	8	3.6	10	4.3
5	The biggest concern before an antibiotic prescription for a patient?	Starting them even if it is not necessary.	83	36.9	131	57.0	<0.001
		Not starting them even if it is not necessary.	45	20.0	39	17.0
		Selecting a drug from the inappropriate antibiotic class.	40	17.8	14	6.1
		Overlooking important features of the drug and the patient.	57	25.3	46	19.9
6	The most important finding that drives physicians mostly to prescribe?	CRP elevation	66	29.3	57	24.8	<0.001
		Presence of pyuria	40	17.8	32	13.9
		Presence of fever	84	37.3	61	26.5
		Leukocytosis	34	15.1	80	34.8
7	The most important condition that drives physicians to prescribe?	Suspicion of unproven infection	39	17.3	96	41.7	<0.001
		Pressure of the patients or his/her relatives on the physician	63	28.0	65	28.3
		The desire of the physician to feel secure	78	34.7	50	21.7
		Inadequate knowledge level of the physician on the infection	45	20.0	19	8.3
8	The most significant feature of the antibiotics in the preferences of the physicians in prescribing?	Spectrum	106	47.1	109	47.4	0.59
		Effect mechanism	38	16.9	29	12.6
		Ease of use	9	4.0	11	4.8
		Penetration to infection tissue being good	72	32.0	81	35.2
9	The most vital criterion to start?	The patients’ fever	5	2.2	7	3.0	0.59
		Acute phase reactants being high	9	4.0	12	5.2
		Having a positive culture result	202	89.8	206	89.6
		The disrupted hemodynamics in the patient	9	4.0	5	2.2

Note: *Pearson’s chi-square test; the data are given as a number (percentage).

Table 2 The Distribution of the Questions and Answers Related to the Rational Use of Antibiotics

			Group 1		Group 2		p* value
Question Number	Questions	Options	Number (n=225)	%	Number (n=230)	%
10	The most important principle in rational antibiotic using?	Presence of infection that requires antibiotics use	206	91.6	215	93.5	0.03
		General condition of the patient	9	4.0	10	4.3
		Presence of immunosuppression	9	4.0	1	0.4
		Recent infection history	1	0.4	4	1.8
11	Not having a rational antibiotics use purpose?	Common cold treatment	207	92.0	198	86.1	0.006
		Simple cystitis treatment	8	3.6	4	1.7
		Treatment of opportunistic infections	8	3.6	22	9.6
		Treatment of invasive diarrhea	2	0.8	6	2.6
12	The most important purpose of empirical using?	Having a wide spectrum	54	24.0	57	24.8	0.44
		Having a narrow spectrum	2	0.9	7	3.0
		Covering the most probable infection factors	165	73.3	162	70.4
		Including combined treatment as much as possible	4	1.8	4	1.7
13	The most important purpose of combined using?	The desire for keeping the infection under control as soon as possible	91	40.4	104	45.2	0.59
		Reducing toxicity	8	3.6	11	4.8
		Expanding the targeted active microorganism group	100	44.4	93	40.4
		Bringing the active plasma concentration to the highest level	26	11.6	22	9.6
14	The most accurate definition of chemoprophylaxis purpose?	An optional process to prevent an infection with a high risk of progression	153	68.3	120	52.2	0.003
		A routine process in an endemic area	23	10.3	40	17.4
		A compulsory process in an endemic area	29	12.9	35	15.2
		A protective process for diseases with high mortality risk	20	8.5	35	15.2
15	Not among the surgical prophylaxis purposes?	Preventing surgical site infections	13	5.8	21	9.1	0.04
		Reducing postoperative infectious morbidity and mortality	33	14.7	33	14.3
		Absolutely starting for all patients that undergo surgery	96	42.7	85	37.0
		Avoiding negative changes in the patient/hospital microorganism flora	83	36.8	91	39.6
16	The thing you want to hear most from the representative of a drug company?	Emphasizing the efficacy and indications	92	40.9	93	40.4	0.93
		Supporting the introduction with previously conducted scientific clinical studies	90	40.0	88	38.3
		Emphasizing the ease of use, and the side effects and drug interactions	40	17.8	45	19.6
		Supporting the presentation with medical and paramedical ingredients/promises	3	1.3	4	1.7

Note: *Pearson’s chi-square test; the data are given as a number (percentage).

Table 3 The Distribution of the Antimicrobial Resistance and Awareness, Developing Recommendations and Slogans for Decreasing Antibiotic Resistance and Increasing Awareness

			Group 1		Group 2		p* value
Question Number	Questions	Options	Number (n=225)	%	Number (n=230)	%
17	The most important condition that may occur as a result of irrational using?	High costs and economic losses	9	4.0	10	4.3	0.99
		Severe side effects and toxicity	18	8.0	18	7.8
		Possible drug interactions with other drugs	5	2.2	5	2.2
		Antimicrobial resistance	193	85.8	197	85.7
18	What is the antimicrobial resistance?	Suppression and elimination of microbial flora	9	4.0	10	4.3	0.06
		Narrow-spectrum antibiotics being of no use	44	19.6	28	12.2
		The necessity of using wide-spectrum antibiotics under any conditions	13	5.8	7	3.0
		The inactivation of antibiotics with irrational antibiotics use	159	70.7	185	804
19	The most frequent reason for penicillin resistance in staphylococci?	The secretion of B-lactamase enzyme	95	42.2	117	50.9	0.02
		Modifying enzymes	9	4.0	11	4.8
		Decrease in membrane permeability	7	3.1	4	1.7
		Acquisition of a new PBP (Penicillin Binding Protein)	114	50.7	98	42.6
20	How can the national awareness of antibiotics resistance be increased?	By bringing it to the written and visual media frequently	64	28.4	83	36.1	0.007
		By preparing public spots, brochures and posters on antibiotics resistance	46	20.4	64	27.8
		By providing periodical training to physicians before/after graduation	44	19.6	39	17.0
		By developing strict use policies and applying a penal sanction	71	31.6	44	19.1
21	The adequacy of the education provided to you on antibiotics during medical education?	Yes	43	19.1	66	28.7	0.048
		No	83	36.9	75	32.6
		Partly	89	39.6	85	37.0
		No idea/I do not want to explain	10	4.4	4	1.7
22	Method of the habit of prescribing the most accurate by a physician who is about to graduate?	By actively examining patients especially in senior students in clinics	145	64.4	135	58.7	0.54
		By writing prescriptions over virtual patient scenarios	54	24.0	63	27.4
		By memorizing the prescriptions on the Internet/written sources	3	1.3	6	2.6
		By adopting the prescription habits of the assistants/lecturers	23	10.3	26	11.3
23	What is your slogan about lowering the rate of antibiotics resistance?	Either awareness or resistance develops for antibiotics	156	69.3	163	70.9	0.034
		Unawareness antibiotic use kills	48	21.3	39	17.0
		Do not touch my antibiotics	9	4.0	3	1.3
		Other	12	5.4	25	10.8

Note: *Pearson’s chi-square test; the data are given as number (percentage).

Table 4 Data of the Groups on Answering the Questions on Antibiotic Information (Fill in the Blanks)*

			Group 1		Group 2			Group		Group 2
Question Number	Questions	Answering Questions	Number (n=225)	Rate (%)	Number (n=230)	Rate (%)	Correct Answers	Number (n=225)	Rate (%)	Number (n=230)	Rate (%)
24	Three antibiotics groups that are contraindicated during pregnancy.	Zero answer	3a	1.3	32b	13.9	Zero correct	6a	2.7	35b	15.2
		One group	10a	4.4	9a	3.9	One correct	29a	12.9	26a	11.3
		Two groups	49a	21.7	24b	10.4	Two correct	88a	39.1	74a	32.2
		All groups	163a	72.6	165a	71.8	All correct	102a	45.3	95a	41.3
25	Three antibiotics group that require dose adjustment in renal failure.	Zero answer	19a	8.4	52b	22.6	Zero correct	19a	8.4	68b	29.6
		One group	36a	16.0	15b	6.5	One correct	53a	23.6	83b	36.1
		Two groups	51a	22.7	35b	15.2	Two correct	64a	28.4	62a	26.9
		All groups	119a	52.9	128a	55.7	All correct	89a	39.6	17b	7.4
26	Three antibiotics group that cause cell wall synthesis inhibition.	Zero answer	14a	6.2	56b	24.4	Zero correct	15a	6.7	61b	26.5
		One group	18a	8.0	7b	3.0	One correct	29a	12.9	20a	8.7
		Two groups	53a	23.6	27b	11.7	Two correct	71a	31.5	55a	23.9
		All groups	140a	62.2	140a	60.9	All correct	110a	48.9	94a	40.9
27	Two antibiotics that may be used in surgical prophylaxis.	Zero antibiotics	31a	13.8	42a	18.2	Zero correct	83a	36.9	93a	40.4
		One antibiotics	54a	24.0	26b	11.3	One correct	90a	40.0	67b	29.1
		Two antibiotics	140a	62.2	162a	70.5	Two correct	52a	23.1	70a	30.5
28	The most frequent factors of acute cryptic tonsillitis, simple acute cystitis, and community-acquired pneumonia.	Zero factor	14a	6.2	59b	25.7	Zero correct	9a	4.0	43b	18.7
		One factor	3a	1.3	4a	1.7	One correct	8a	3.6	15a	6.5
		Two factors	8a	3.6	8a	3.4	Two correct	57a	25.3	45a	19.6
		All factors	200a	88.8	159b	69.2	All correct	142a	63.1	103b	44.8
							Mistakenly	9a	4.0	24b	10.4

Notes: *Different letters (a, b) in each row show a statistically significant difference (p<0.05; Bonferroni-corrected Pearson’s chi-square test); the data are given as a number (percentage).

Table 5 Three-Year Antibiotic Consumption Rates by Years in Primary Health Care Services in Malatya Province in Turkey

Years	Total Prescription Numbers	Number of Prescriptions Written Antibiotics	Rates (%)
2016	1.150.674	349.607	30.04
2017	1.274.435	342.313	26.85
2018	1.357.365	361.737	26.64

Note: The data are given as a number (percentage)