Comparison of the knowledge, attitudes and practice with antibiotic use between traditional Chinese medicine and western medicine usual attenders in Hong Kong

Abstract

Background

Patients who usually attend Traditional Chinese Medicine (TCM) need to go to western medicine (WM) doctors for antibiotics in Hong Kong. They might have different knowledge, attitude and practice (KAP) with antibiotics from the WM-attenders.

Objective

This study compares TCM attenders with the WM-attenders in Hong Kong about their KAP with antibiotics. The comparison could help future campaigns/education on appropriate antibiotic use.

Design and setting

A questionnaire on KAP with antibiotics was designed after eight focus groups of purposively selected participants. A territory-wide telephone survey then interviewed randomly selected residents who were aged 18 years or above and spoke the local dialect.

Result

Of 2471 respondents, 270 and 2092 usually attended TCM and WM, respectively. Majority of both the TCM- and WM-attenders preferred doctors who were judicious in prescribing antibiotics and seldom asked for them. The TCM-attenders were significantly more likely to be female and with lower household income. They were also more likely to agree that antibiotics were not useful for upper respiratory tract infections and that antibiotic resistance was a serious local problem. They were less likely to accept or be treated with antibiotics. The TCM-attenders were also more concerned about the side-effects of antibiotics. However, they were also less likely than the WM-attenders to always finish a full course of antibiotic.

Conclusion

Apart from non-compliance, the TCM-attenders’ KAP with antibiotics favour the appropriate use of antibiotics.

Introduction

Misuse of antibiotics is widespread in the community;¹ alternative medicine was suggested as a mean of reducing antibiotic use and hence resistance.2, 3 Harbarth et al. attributed the much lower prevalence of penicillin-resistant pneumococci in Germany (than in France) to her much higher prevalence of using alternative medicine.⁴ However a study of children in UK showed that the use of homeopathic products was not associated with decreased antibiotic consumption.⁵ There are too few studies on the use of antibiotics by people opting for alternative medicine to examine if alternative medicine could diminish antibiotic resistance.

A systematic review shows that the prevalence of the use of alternative medicine ranges from 9% to 65% in different parts of the world.⁶ People choose alternative medicine based on the perceived nature of their illness or their expectations from the alternative therapies.7, 8 One of their common concerns is the potency and associated side-effects of western drugs.8, 9, 10, 11 Antibiotics are among them.¹² While their attitudes about antibiotics are known, their knowledge and use of antibiotics are largely understudied.

This study aims to compare the knowledge, attitude, and practice (KAP) with antibiotics between people using alternative medicine and people using the western-medicine (WM). In Hong Kong, traditional Chinese medicine (TCM) is part of the healthcare system with a similar statutory status as WM and is by far the most major alternative medicine used. The Government's Thematic Household Survey in 2010 showed that 13.2% of the residents who had sought medical care in the previous 30 days attended TCM.¹³ As TCM practitioners do not have the legal right to prescribe antibiotics, patients who need antibiotics must attend WM. The use of antibiotics can thus be compared between the public who usually attend TCM and those usually attend WM (defined in this study as TCM-attenders and WM-attenders).

We hypothesized that there were significant differences in KAP between these two groups. The results would reveal whether TCM was a significant factor for reducing antibiotic use. Besides, the knowledge and other behaviour (e.g. finishing a full course of antibiotics or not) of the TCM-attenders could be better understood. The findings will be useful for the individual patient education and public campaigns for the appropriate use of antibiotics in the community.