الفهرس 
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Abstract
In recent decades, the emergence and spread of bacterial resistance to
antibiotics is a growing problem worldwide, which presents a significant threat to
public health globally in the 21st century. The increase of antibiotics resistance will
endanger their therapeutic effectiveness, increase treatment failures and, as a result
lead to longer and more severe illness episodes with higher costs and mortality rates.
The inappropriate and excessive use of antibiotics are among the key factors for the
increase and spread of resistance. The improper use of antibiotics may arise from a
complex interaction between numerous factors, such as prescribers’ knowledge and
experiences, diagnostic uncertainty, perceptions of patients in relation to the patientprescriber
interaction, and insufficient patient education by physicians. In addition,
other factors include patients’ knowledge, beliefs and attitudes towards antibiotic use,
self medication, patients expectations, and patients’ experience with antibiotics.
The current study aims to study self medication with antibiotics among adults
in Misurata city, Libya and to assess the impact of a health promotion program on
their knowledge and attitudes regarding self medication
with antibiotics. The study comprised the following objectives:
1. To estimate the extent of self medication with antibiotics
2. To determine the indication for self medication with antibiotics
3. To identify factors associated with antibiotic self medication
4. To assess knowledge and attitudes regarding antibiotics
5. To construct, implement and evaluate the impact of a health promotion
program on the adults’ knowledge and attitudes regarding self medication with
antibiotics
A cross sectional approach was used for the implementation of the 1st phase
of the study and an intervention approach (one group pre-test post-test design) was
used in the 2nd phase for subjects who had poor knowledge score in the pre-test . The
overall total sample was 277 accompanying the patients attending the hospital adults
(102 males and 175 females), selected from different out-patient clinics of Misurata
Central Hospital.
Data were collected using a pre-designed, structured interviewing
questionnaire composed of 4 sections (Socio-demographic data, pattern of self
medication with antibiotics, knowledge regarding self medication with antibiotics and
attitudes of participants towards self medication with antibiotics). The intervention
program was based on the questions posed in the questionnaire and used different
types of mass media included eight health education sessions or episodes broadcasted
through Misurata local radio station, two issues in Misurata University magazine, and
one episode in Misutata TV. The collected data were revised, coded and analyzed
using the appropriate statistical methods.
The present study revealed the following results:
I. The extent and indications of self medication with antibiotics
The age of the studied group ranged between 18 and 73 years.
Summary
74
Two thirds of participants were females.
More than half of participants were married.
About 3 quarters of the participants were clericals, teachers and students.
The proportion of antibiotics use among adults in Misurata during the previous
6 months was 58.5%.
Among those who used antibiotics, about 40% acquired/ used their antibiotics
without prescription as self medication.
Ailments like toothache (23.5%), common cold (18.4%), urinary tract
infection (17.3%), sore throat (14.3%) and tonsillitis (12.2%) were the most
common reported indications for prescribed antibiotics, while common cold
(49.4%), toothache (20.3%), sore throat (17.2%) and tonsillitis (10.9%) were
the most common reported indications for SMA.
About two thirds (68.8%) of participants with prescribed antibiotics completed
the antibiotic course compared to only one third (31.2%) of participants with
SMA.
The major reasons for non consulting a physician or self medication with
antibiotics included, minor illness and do not worth consultation of physician
(37.5%), previous or prior experience (17.2%), confidence in the pharmacist
(15.6 %), friends or relative advise (10.9%), unavailability of doctor (9.4%)
and avoiding crowding and waiting in visiting doctor (9.4%).
Less than half of adults who practiced self medication during the previous 6
months (46.9%) took antibiotics on the advice of pharmacists, 30.2% on self
decision, 14.1% on the advice of relatives or friends and 7.8% on the previous
prescription.
Participants who took prescribed antibiotics, knew about antibiotics through
physicians (62.2%) while self-medicated participants, leaflet was the main
source of knowledge (28.1%) followed by pharmacists (24%), previous
experiences (20.3%), relative or friend (14.1%) and physicians (12.5%).
Amoxicillin was the antibiotic most commonly used by the participants who
consulted a physician (41.5%), followed by Amoxicillin-Clavulanate (26.4%),
then Azithromycin (9.4%), Ciprofloxacin (7.5%) and the least percentages
were Ceftriaxone injection, Procaine penicillin injection and Furadantin tablets
(3.7% each). The antibiotics most frequently used in self medication were
Amoxicillin-Clavulanate (54.8%) followed by Amoxicillin (25.8%),
Azithromycin (9.7%), Ciprofloxacin (6.4%) and the least percentage was Cotrimoxazole
tablets (3.2%).
II. Factors associated with self medication with antibiotics:
Male participants using antibiotics as self medication (51.5%) were higher
than females (31.2%), while the percentage of females participants using
antibiotics on medical prescription (68.8%) were higher than males (48.5%).
(p<0.05).
III. Adults’ knowledge and attitudes regarding self medication with antibiotics.
1. The knowledge of adults regarding role and identification of antibiotics:
Less than two thirds of the participants knew that bacterial infections can be
treated by antibiotics (64.3%).
The majority of participants did not know that antibiotics would not work
against viral infections (81.1%).
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Less than half of participants (46.1%) did not know that antibiotics do not
work on most coughs and cold.
Almost one fifth of the participants (20.2%) knew that antibiotics would not
always be effective in treatment of the same infection in the future.
More than one third of participants (36.5%) knew that antibiotics could not
cure all infections.
More than half of participants (52.6%) did not know that antibiotics were not
indicated to relive pain.
Only one fifth of participants (20.9%) knew that antibiotics were not used to
stop fever.
Two thirds (63.9%) of participants did not know that antibiotics could kill
bacteria that normally live on the skin and in the gut.
As regards identification of antibiotics, 39% of the participants were able to
correctly identify paracetamol as not being an antibiotic.
More than half of participants (54.9%) could not correctly identify penicillin
as an antibiotic.
2. The knowledge of adults regarding antibiotics use and resistance.
More than half of participants (53.8%) knew that antibiotics should be given
with prescription.
About three quarters of the respondents (75.1%) had correct knowledge of the
need to complete the full course of antibiotics when symptoms of infection
were improving.
The majority of participants (85.1%) knew that taking incomplete antibiotics
course than prescribed was not healthy than taking the full complete course
prescribed.
As regards the antibiotics resistance, almost one third of participants (32.5%)
knew the meaning of antibiotic resistance.
Less than half of participants (41.9%) knew that infection by antibiotic
resistant bacteria cannot be easily cured.
More than half of participants (55.6%) knew that if antibiotics are taken for
long time, bacteria become more resistance to antibiotics.
More than half of participants (52%) knew that using of antibiotics without
medical consultation may cause bacterial resistant to antibiotics.
3. The knowledge of adults regarding antibiotics side effects
Almost one third (33.2%) of the participants did not know that antibiotics
caused side-effects.
The proportion of those who did not know ranged from 31.8% for ”antibiotics
can cause allergic reaction ”to 80.5% for ”antibiotics can impair bone growth”.
About two thirds (65%) of participants knew that antibiotics were not safe to
be used with other medication and 75.5% knew that overuse of antibiotics
could lead to losing the effectiveness on the long term.
Regarding the level of knowledge of adults regarding antibiotics, about two
thirds of participants (62.5%) had poor knowledge level while 23.1% and
14.4% of participants had fair and good knowledge levels respectively.
4. The attitude towards physician visit for diagnosis and treatment:
About 15% of participants agreed that they expected antibiotics to be
prescribed if they suffered from common cold symptoms.
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The majority of participants (84.8%) demonstrated negative attitudes in taking
antibiotics according to the instructions of physician and pharmacist.
More than half of participants (56.7%) greed that they were less satisfied if
the doctor did not prescribe antibiotics for treatment of common cold.
Only 18.1% of participants agreed that they would prefer to visit the doctor if
they get the disease.
5. The attitude towards administration and reuse of antibiotics.
Less than half of participants (44.1%) agreed that antibiotics should be
stopped when they feel better.
Only 4% of participants agreed that they normally look at the expiry dates of
antibiotics before using it.
Only 6.1% of participants agreed that they read the leaflet that came with
antibiotic packet.
About three quarters (74.4%) agreed that there was no difference if not
committed with one or two doses of prescribed antibiotic.
Almost 16% of participants agreed that the long term use of antibiotics would
affect their effectiveness in future.
The statement that ” antibiotic resistance could not affect me and my family”
was agreed upon by 44% of participants.
Only 2.5% of participants would like to get more information about
antibiotics.
Regarding reuse of antibiotics, more than three quarters of participants
(78.7%) agreed that they would give their medicines to a sick family member.
Nearly one third (32.5%) agreed that they would keep antibiotics stocks at
home in case of emergency.
The statement that ”frequent use of antibiotics would not decrease their
effectiveness” was agreed upon by 53.4% of participants.
6. The parental attitude toward antibiotics use in children.
One quarter of participants (25.9%) agreed that they would give antibiotics to
children to treat cough and or common cold.
About one tenth of participants (10.8%) agreed that they would give their
children antibiotic without medical prescription.
Almost one fifth of participants (20.2%) agreed that they would give their
children antibiotics for treatment of fever.
When their children were feeling better, about more than quarter of
participants (26.6%) agreed that they would reduce the dose of antibiotic.
The statement that ”if my child start feeling better, I would stop giving him
antibiotic ” was agreed upon by 20.9% of participants.
Almost one tenth of participants (10.8%) agreed that they would visit another
doctor if the doctor does not prescribe antibiotic for their children.
Only 11.5% of participants agreed that they would ask the doctor to prescribe
antibiotics to their children.
Less than on quarter (23%) agreed that they would not wake up their children
to take antibiotic if they were sleep.
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More than half of participants (57.5%) agreed that they would store antibiotic
syrup in the refrigerator.
The level of attitude of adults regarding antibiotics use showed that half of
participants (50.5%) had neutral attitude toward antibiotics use, 35.8% had a
positive attitude while only 13.7% had a negative attitude
Logistic regression analysis of the results of the current study showed that the
factors affecting knowledge score were age, level of education and occupation.
knowledge.
Logistic regression analysis of the results of the current study showed that the
factors affecting attitude score were Gender and knowledge score.
IV. Evaluation of the health promotion intervention program:
The current study showed that 62.5%, 23.1% and 14.4% of participants in the
pre intervention program had poor, fair and good level of knowledge respectively,
compared to 15.5%, 34.8% and 49.7% respectively post intervention. The difference
between two groups was statistically significant (p<0.05). Comparison of the pre and
post intervention scores for the total study showed a significant increase in the post
intervention mean cumulative knowledge scores.
The current study revealed that 13.7% , 50.5% and 37.8% of the participants in
the pre intervention program had negative, neutral and positive level of attitude
respectively, compared to 11.5% , 12.9% and 75.6% respectively, post intervention.
The difference between the pre and post intervention program regarding the level of
attitude was statistically significant (p<0.05).
The following are the main recommendations of the study:
Policies of auditing antibiotic prescriptions in the healthcare facilities.
Improve communication about antibiotic appropriateness between healthcare
professionals and patients.
Public education programs using all media means that should be targeted more
efficiently at those who have low knowledge, negative attitude and
inappropriate practice to wards antibiotic use.
Highlighting pharmacists’ role in health education and promotion, and
responsibility in prohibiting antibiotic dispensing without prescription.
Reliable information in school curricula regarding health education.
Further research on SMA behavior should involve people in all cities of Libya
to capture its determinants geographical characteristics. This will be useful to
develop strategies in improving the safe use of antibiotics among community
members.