A survey of reported behaviours, attitudes and knowledge related to antibiotic use of hospitalised patients in Thailand

Highlights

• Thai patients report frequent use of antibiotics in the community.

• During hospitalisation, patients were unsure whether they wanted antibiotics.

• Patients perceived intravenous antibiotics to be superior to oral antibiotics.

• Patients wanted to know more about safe use of antibiotics.

Abstract

Background

Inappropriate antibiotic use is a major driver of antimicrobial resistance especially in Thailand where people have access to antibiotics without prescription. Consumers may put pressure on clinicians to prescribe antibiotics when they are not necessary, however little is known about Thai patients' expectations. The aim of this study was to explore hospitalised patients' reported behaviours, attitudes and knowledge related to antibiotic use.

Methods

A cross-sectional survey was distributed to patients from selected medical and surgical wards at a 1000-bed university hospital in Bangkok between January and March 2016, Thailand. A total of 205 patients participated.

Results

The frequent use of antibiotics in the Thai community, misconceptions about the utility of antibiotics in viral illness, and over the counter acquisition of antibiotics were reported. During hospitalisation, patients were unsure whether they wanted antibiotics but if required, intravenous antibiotics were preferred with 84.0% believing that intravenous antibiotics were stronger. The majority wanted to know more about safe antibiotic use and feared acquiring antimicrobial resistant infections.

Conclusion

The results of this study add to our understanding of the patient influences on antibiotic use in the Thai setting and can inform strategies for more active patient participation and shared decision-making regarding antibiotic use.

Introduction

Antimicrobial resistance (AMR) is a major issue in healthcare [1]. The consequences of AMR are significant from both a human and economic perspective [2], [3]. A recent study predicted that 10 million people would die every year because of AMR by 2050 if there were no proactive global action to respond the AMR problem [4]. The economic implications of AMR are significant. When antibiotics become less effective, treatments are prolonged resulting in extended length of hospital stay and higher healthcare resource utilisation. In 2014, WHO estimated that antimicrobial resistance results in a loss of billions of dollars worldwide [5].

Antibiotic use is a major driver of AMR. The prevalence of AMR increases by approximately 1.5% when antibiotic use is increased by one defined-daily dose per one thousand people [6], [7]. AMR is a problem in both developing and developed countries [8]. The South-East Asia (SEA) region faces unique problems related to antibiotic usage [9]. In more than half of the SEA countries people have easy access to antibiotics without a doctor's prescription [10]. In Thailand, there are two classifications of modern drug stores: Type I drug stores are the places where at least a registered pharmacist is available to dispense all types of medicines, while Type II drug stores have no registered pharmacists and dispense medications classified as ‘non-dangerous’ [11]. Most antibiotics in Thailand are classified as dangerous medications which can only be dispensed by registered pharmacists. However, those antibiotics could be sold in Type II drug stores without a prescription [12].

In Thailand since the year 2000, antibiotics are the most produced and imported drug [13]. Over 5200 antibiotic formulations are registered with the Thai Food and Drug Administration, two thirds of which are for use in humans [14]. In 2010, the total value of antibiotics used in Thailand amounted to over US$ 430 million [15]. The availability of antibiotics and their inappropriate use in the Thai community affects the occurrence of AMR [16] as over 38,000 Thai people die every year because of AMR and it is estimated that AMR causes an additional 3.24 million extra days of hospital stay costing 0.6% of national GDP [17].

Unnecessary use of antibiotics, particularly in primary care, can be linked to patients' attitudes and perceptions about antibiotic therapy [18], [19], [20]. Patients often have misconceptions about the benefits of antibiotic treatment for viral illness [21], [22] and inappropriate behaviours related to antibiotic use such as skipping doses and sharing antibiotics [22], [23]. Further, patient expectations relating to antibiotic treatment puts pressure on clinicians to prescribe antibiotics when they are not necessary [22], [24].

In Thailand, inappropriate antibiotic use is a major problem. Saengcharoen et al. [22] conducted a survey of Thai high school and vocational training school students about their knowledge, attitudes, and behaviours regarding antibiotic use for upper respiratory tract infections. More than 75% of students had misconceptions about antibiotic use; 45% had taken an incomplete course of antibiotics, and half of the students surveyed had taken antibiotics for less than five days [22]. In a study of Thai clients in a community hospital, the only factor influencing appropriate antibiotic use was their level of knowledge of appropriate use of antibiotics [25]. Little is known about hospitalised patients' expectations regarding antibiotic use while in hospital and in the community. The aim of this study was to explore patients' reported behaviours, attitudes and knowledge related to antibiotic use.