Self-medication with antibiotics at the time of Covid-19 pandemic: public perception and behaviours

Antibiotic resistance (ABR) is a major global health threat and would claim an estimated loss of 10 million lives by 2050 (O’Neill, 2016). As many antibiotics have become less effective, the treatment and control for a number of infectious diseases e.g. pneumonia, tuberculosis are now much harder (WHO 2020). In developing countries, ABR mainly originate from poor surveillance of drug-resistant infections, poor quality of available antibiotics and convenience of access to antibiotics whilst in developed nations, poor hospital-based antibiotic use regulation and excessive use of antibiotics in food-producing animals are the main contributors (Chokshi, et al., 2019). Overall, the influential factors associated with ABR are overuse and misuse of antibiotics, lack of knowledge on hygiene and sanitation, low prevention of infection in medical care settings, antibiotic overuse in livestock and aquaculture and failure to discover new antibiotics (Richardson 2017, Duong 2019).

SARS-CoV-2 (Covid-19) is accompanied with severe acute respiratory syndrome and there is therefore a surge in ICU admission, mechanical ventilation and prescription of antibiotics (Phua et al., 2020). Therefore, there is potentially a risk that the outbreak of Covid-19 virus could lead to higher rates of ABR. A rapid review of Covid-19 cases, mostly on studies conducted in Asia reported an overuse of antibiotics in 70% of Covid-19 patients despite having the mild bacterial or fungal infection in 10% of cases (Rawson et al., 2020). Consequently acceleration of ABR as a result of Covid-19 pandemic is expected and it is a big challenge especially in under-resourced countries.

In a short survey, we aimed to assess knowledge about ABR and behaviours on self-medication using antibiotics for prevention of Covid-19 in a convenient sample from two developing and developed countries i.e. Bangladesh and the United Kingdom (UK).

The ethical approval was obtained from the UK University that this survey was conducted. An information sheet about the project was also shared through the survey link and participation in the study was considered as the basis of respondent’s consent. A short questionnaire captured data on demographic characteristics, general knowledge on ABR and perceptions on antibiotic use in relation to Covid-19 Pandemic. The survey link was shared via different social media i.e. multiple Facebook and Whatsapp groups together with Messenger, inviting the followers, friends and members in these groups from the UK and Bangladesh separately to participate into the survey. People were also asked to invite their family members, relatives and friends to take part in the survey.

Overall, 468 participants responded to the online survey and of these, 245 (52.3%) and 223 (47.7%) were from Bangladesh and the UK respectively. Most respondents were between 25–34 years old (34%) followed by 19.4% and 17.1% in 35–44 and 55–64 age groups, correspondingly. Majority were female (63.6%) and had Bachelor (22%) or Master degrees (27.8). Illiterate and primary school education was reported in 9.6% of respondents, mainly from the Bangladeshi sample. The most reported occupations were homemaker (13.7%), health-profession (16.9%), self-employed (18.4%) and others including administrative, office jobs and accounting (24.1%).

Overall, 28% of participants stated either have not heard or could not remember the term ABR, and also, less percentage of Bangladeshi participants had heard of the term (56.3%), which was significantly different from the UK sample. Also, 12.4% of respondents believed that “antibiotics can prevent/treat Covid-19” while a greater proportion stated did not know about this (24.6%). Additionally, 17.1% of respondents had either taken or did not remember taking antibiotics for prevention of Corona virus and 51.9% specified that they did not know whether the pandemic is increasing ABR. Overall, there were major differences between the UK and Bangladeshi respondents to the survey questions where the general knowledge was lower in the Bangladeshi participants. An exception to this was both sample from the UK and Bangladesh similarly replied to whether “hydroxychloroquine can treat Corona virus” and a large percentage either replied yes (19.9%) or don’t know (41%).

This survey, providing an insight to the knowledge of public about ABR showed that understanding about ABR and self-medication behaviours is very limited. The finding that a large proportion of respondents were not aware whether antibiotics can prevent Corona virus, especially in the Bangladeshi sample highlights the importance of improving knowledge and awareness about the appropriate modes and approaches that people can protect themselves against the disease and thus, minimise the risk of overuse and misuse of antibiotics. Likewise, knowledge of the sample about the antimalarial drug i.e. hydroxychloroquine was inadequate and warrants educating the public to avoid hazards of self-medication in individuals. A recent study in the US (Keuhn 2020) has warned that over prescription of hydroxychloroquine during the Covid-19 pandemic has raised an alarm when there is limited evidence for pre or post-exposure prophylaxis to hydroxychloroquine for Covid-19 and any probable benefits do not outweigh the risks.

To conclude, ABR occurs naturally however, overuse and misuse of antibiotics can significantly accelerate the process and thus, transmission of ABR between humans or humans to animals and environment in both hospital and community settings. The pandemic of SARS-CoV-2 is a potential factor for increasing ABR globally, either in relation to misunderstandings among the public or over-prescription of antibiotics and other drugs by health professionals. Findings from this survey have important implications for further research and communicating appropriate knowledge on ABR to the public.

Co-authors: Dr Martin Hind, Raktim Das

This survey has not received any fund from an organisation and it is conducted as part of an MSc course of study.

References

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Duong A. 2019. 6 Factors that have caused Antibiotic Resistance [online]. InfectionControl.tips. https://infectioncontrol.tips/2015/11/18/6-factors-that-have-caused-antibiotic-resistance

Kuehn B. Shifting hydroxychloroquine patterns raise concern. JAMA 2020;324(16):1600. doi:10.1001/jama.2020.20311

O’Neill J. Tackling drug-resistance infections globally: final report and recommendations, 2016. https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf

Phua J, Weng L, Ling L, Egi M, Lim Ch.M, Divatia J.V. et al. Intensive care management of coronavirus disease (COVID-19): challenges and recommendations. The Lancet Respiratory Medicine 2020;8:50617.

Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, et al. Bacterial and fungal coinfection in individuals with Coronavirus: a rapid review to support Covid-19 antimicrobial prescribing. Clinic Infect Dis 2020;ciaa530.

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WHO, 2020. Antibiotic resistance. Available at: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance