Knowledge and Expectations on Antibiotic Use Among the General Public in Malaysia: A Nationwide Cross-Sectional Survey

Figures & data

Table 1 Demographic Characteristics of Respondents (n = 1971)

Respondents’ Characteristics	Study, n (%)
Age, mean ± SD	36.88 ± 14.75
18–39 years old	1196 (60.68%)
40–59 years old	573 (29.07%)
≥60 years old	202 (10.25%)
Gender
Male	931 (47.2%)
Female	1040 (52.8%)
Ethnicity*
Bumiputra	1364 (69.2%)
Chinese	399 (20.2%)
Indian	170 (8.6%)
Others	38 (1.9%)
Educational level
No formal education	19 (1.0%)
Primary education	91 (4.6%)
Secondary education	728 (36.9%)
Pre-university education	322 (16.3%)
Tertiary education	811 (41.1%)
Main occupation
Unemployed	118 (6.0%)
Employed for wages	934 (47.4%)
Self-employed	280 (14.2%)
Housewife/Househusband	151 (7.7%)
Student	349 (17.7%)
Retiree	139 (7.1%)
Occupation related to healthcare
Yes	147 (7.5%)
No	1824 (92.5%)
Monthly income
None	654 (33.2%)
< RM 1000	217 (11.0%)
RM 1000 - RM 3999	756 (38.4%)
RM 4000 – RM 6999	241 (12.2%)
RM 7000 – RM 9999	64 (3.2%)
≥ RM 10,000	39 (2.0%)
Residence status (Geographic area)
Urban	1502 (76.2%)
Rural	469 (23.8%)
State of residency
Perlis	17 (0.9%)
Kedah	112 (5.7%)
Pulau Pinang	120 (6.1%)
Perak	138 (7.0%)
Selangor	495 (25.1%)
Negeri Sembilan	45 (2.3%)
Melaka	62 (3.1%)
Johor	217 (11.0%)
Pahang	113 (5.7%)
Terengganu	47 (2.4%)
Kelantan	86 (4.4%)
Sabah	151 (7.7%)
Sarawak	160 (8.1%)
The Federal Territories (Kuala Lumpur and Putrajaya)	208 (10.6%)

Notes: *The classifications of ethnicity were referring to the Department of Statistics Malaysia,²⁵ where the Bumiputra were Malays combined with other indigenous groups, and Others were Malaysian citizens of other nationalities.

Abbreviation: SD, standard deviation.

Table 2 Prior Experience in Antibiotic Use

	n (%)
Last take antibiotics (n= 1971)
In the last month	305 (15.5%)
In the last 6 months	423 (21.5%)
In the last year	218 (11.1%)
More than a year ago	326 (16.5%)
Never	35 (1.8%)
Cannot remember	648 (32.9%)
Not sure what antibiotic is	16 (0.8%)
Source of antibiotics^† (n= 1272)
Prescribed after consultation with doctor	1132 (89.0%)
Prescribed after consultation with dentist	68 (5.3%)
Retail pharmacy/community pharmacy	43 (3.4%)
Retail shop	5 (0.4%)
Friends/family/neighbors	15 (1.2%)
Leftover antibiotics (own/someone’s else)	9 (0.7%)
Reason(s) to take antibiotics^†‡ (n= 1272)
Fever	603 (35.5%)
Pain/inflammation	246 (14.5%)
Respiratory tract infection	381 (22.4%)
Urinary tract infection	57 (3.4%)
Skin problems/wounds/cuts	127 (7.5%)
Dental problem	84 (4.9%)
Diarrhea/vomiting	93 (5.5%)
Others	47 (2.8%)
Do not know	10 (0.6%)
Cannot remember	50 (2.9%)
Get advice on how to take antibiotics^† (n= 1272)
Yes	1143 (89.9%)
No	80 (6.3%)
Cannot remember	49 (3.9%)
Source(s) of advice^†‡ (n= 1143)
Doctor	960 (63.2%)
Pharmacist	256 (16.8%)
Nurse	121 (8.0%)
Dentist	79 (5.2%)
Friends/family/neighbors	46 (3.0%)
Patient information leaflet	29 (1.9%)
Mass media	18 (1.2%)
Social media	11 (0.7%)
Inappropriate practices
Obtained antibiotics without a prescription (n = 1971)
Yes	246 (12.5%)
No	1705 (86.5%)
Not answered	20 (1.0%)
Used own/others’ leftover antibiotics without advice from healthcare professionals (n = 1971)
Yes	250 (12.7%)
No	1700 (86.3%)
Not answered	21 (1.1%)
Not completed antibiotic course (n = 1971)
Yes	962 (48.8%)
No	988 (50.1%)
Not answered	21 (1.1%)
Shared own leftover antibiotics to friends or family or neighbors (n = 1971)
Yes	249 (12.6%)
No	1694 (85.9%)
Not answered	28 (1.4%)
Engaged in at least one inappropriate practice (n = 1971)
Yes	1116 (56.6%)
No	834 (42.3%)
Not applicable	21 (1.1%)

Notes: ^†Only those who reported taking antibiotics were required to answer these questions. ^‡Respondents could choose more than one answer.

Table 3 Knowledge About Antibiotic Use and Resistance (n = 1971)

			Number of Respondents Answered, n (%)	Respondents’ Answer, n (%)
				Correct	Incorrect	Not Sure
Knowledge about antibiotic use
1.	Antibiotics are medicines that can kill bacteria.	True	1965 (99.7%)	1494 (75.8%)	142 (7.2%)	329 (16.7%)
2.	Antibiotics can be used to treat viral infections.	False	1965 (99.7%)	407 (20.6%)	1156 (58.7%)	402 (20.4%)
3.	Antibiotics work on most colds and coughs.	False	1958 (99.3%)	439 (22.3%)	1134 (57.5%)	385 (19.5%)
4.	Antibiotics can kill bacteria that normally live on the skin and gut (digestion tract).	True	1960 (99.4%)	824 (41.8%)	321 (16.3%)	815 (41.3%)
5.	Bacteria that normally live on the skin and in the gut are good for your health.	True	1959 (99.4%)	713 (36.2%)	442 (22.4%)	804 (40.8%)
6.	Antibiotics are the same as medications used to relieve pain and fever such as aspirin and paracetamol (Panadol).	False	1967 (99.8%)	1091 (55.4%)	515 (26.1%)	361 (18.3%)
7.	Penicillin is an antibiotic.	True	1959 (99.4%)	708 (35.9%)	369 (18.7%)	882 (44.7%)
8.	Antibiotics may cause allergy reactions.	True	1956 (99.2%)	1120 (56.8%)	306 (15.5%)	530 (26.9%)
9.	All antibiotics do not cause side effects.	False	1943 (98.6%)	997 (50.6%)	347 (17.6%)	599 (30.4%)
10.	It is okay to stop taking antibiotic when symptoms are improving.	False	1967 (99.8%)	1122 (56.9%)	539 (27.3%)	306 (15.5%)
11.	Taking less antibiotics than prescribed is healthier than taking the full course prescribed.	False	1951 (99.0%)	1197 (60.7%)	296 (15.0%)	458 (23.2%)
12.	Overuse of antibiotics can cause the antibiotics to lose effectiveness in long term.	True	1963 (99.6%)	1033 (52.4%)	277 (14.1%)	653 (33.1%)
Knowledge about antibiotic resistance
1.	Antibiotic resistance occurs when your body becomes resistant to antibiotics and they no longer work as well.	False	1965 (99.7%)	187 (9.5%)	1004 (50.9%)	774 (39.3%)
2.	Many infections are becoming increasingly resistant to treatment by antibiotics.	True	1964 (99.6%)	1009 (51.2%)	254 (12.9%)	701 (35.6%)
3.	If bacteria are resistant to antibiotics, it can be very difficult or impossible to treat the infections they cause.	True	1966 (99.7%)	1095 (55.6%)	218 (11.1%)	653 (33.1%)
4.	Antibiotic resistance is an issue that could affect me or my family.	True	1967 (99.8%)	850 (43.1%)	489 (24.8%)	628 (31.9%)
5.	Antibiotic resistance is an issue in other countries but not here.	False	1964 (99.6%)	724 (36.7%)	271 (13.7%)	969 (49.2%)
6.	Antibiotic resistance is only a problem for people who take antibiotics regularly.	False	1965 (99.7%)	451 (22.9%)	777 (39.4%)	737 (37.4%)
7.	Bacteria which are resistant to antibiotics can be spread from person to person.	True	1964 (99.6%)	628 (31.9%)	479 (24.3%)	857 (43.5%)
8.	Antibiotic-resistant infections could make medical procedures like surgery, organ transplants and cancer treatment much more dangerous.	True	1953 (99.1%)	808 (40.9%)	215 (10.9%)	930 (47.2%)

Table 4 Expectation on Antibiotics to Be Prescribed for the Listed Common Symptoms (n = 1971)

		Number of Respondents Answered, n (%)	Respondents’ Answer, n (%)
			Yes	No	Not Sure
1.	Fever	1951 (99.0%)	1239 (62.9%)	588 (29.8%)	124 (6.3%)
2.	Colds or flu	1938 (98.3%)	1003 (50.9%)	767 (38.9%)	168 (8.5%)
3.	Cough	1932 (98.0%)	945 (47.9%)	785 (39.8%)	202 (10.2%)
4.	Runny nose with clear mucus	1930 (97.9%)	576 (29.2%)	996 (50.5%)	358 (18.2%)
5.	Runny nose with green mucus	1932 (98.0%)	976 (49.5%)	555 (28.2%)	401 (20.3%)
6.	Sore throat	1941 (98.5%)	1128 (57.2%)	471 (23.9%)	342 (17.4%)
7.	Ear infection	1941 (98.5%)	1028 (52.2%)	620 (31.5%)	293 (14.9%)

Table 5 Respondents’ Mean Total Knowledge Score and Expectation to Discuss with Doctor on Antibiotic Use

			n (%)	Mean total Knowledge Score, ± SD	p value
1.	If I expect an antibiotic, I am less satisfied with the doctor visit if I do not receive one. (n=1962)	Agree/Strongly Agree	448 (22.83%)	8.47 ± 3.75	p<0.001*
		Neutral	558 (28.44%)	7.35 ± 4.03
		Disagree/Strongly Disagree	956 (48.73%)	9.35 ± 4.40
2.	I would rather take an antibiotic that may not be needed than wait to see if I will get better without it. (n=1967)	Agree/Strongly Agree	336 (17.08%)	8.21 ± 3.99	p<0.001*
		Neutral	396 (20.13%)	6.94 ± 3.88
		Disagree/Strongly Disagree	1235 (62.78%)	9.20 ± 4.26
3.	If a doctor does not prescribe an antibiotic when I think one is needed, I will visit another doctor. (n=1967)	Agree/Strongly Agree	431 (21.91%)	8.45 ± 4.17	p<0.001*
		Neutral	365 (18.52%)	7.26 ± 4.01
		Disagree/Strongly Disagree	1171 (59.53%)	9.03 ± 4.25
4.	I expect the doctor to discuss with me regarding the need of an antibiotic for my symptoms, rather than just giving me a prescription. (n=1967)	Agree/Strongly Agree	1474 (74.94%)	9.03 ± 4.21	p<0.001*
		Neutral	320 (16.27%)	6.62 ± 3.91
		Disagree/Strongly Disagree	173 (8.80%)	8.29 ± 4.00

Notes: Test used = One-way ANOVA test. *Significant with p<0.05.

Abbreviation: SD, standard deviation.

World Health Organization. Antibiotic Resistance: Multi-Country Public Awareness Survey. WHO Press; 2015:1–51. Available from: http://apps.who.int/iris/bitstream/10665/194460/1/9789241509817_eng.pdf?ua=1. Accessed October 13, 2021.

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