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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 3  |  Page : 203-208

Prevalence of self-medication of antibiotics among 2nd-year medical students and their knowledge about antibiotic resistance


1 Department of Pharmacology, SMS Medical College, Jaipur, Rajasthan, India
2 Department of Anatomy, SMS Medical College, Jaipur, Rajasthan, India

Date of Submission02-Mar-2020
Date of Acceptance25-Aug-2020
Date of Web Publication26-Sep-2020

Correspondence Address:
Dr. Uma Advani
Department of Pharmacology, SMS Medical College, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_13_20

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  Abstract 


Aims and Objectives: The objective of the study was to determine the prevalence of self-medication practices of antibiotics among medical students and to evaluate the knowledge of medical students about antibiotic resistance at SMS Medical College, Jaipur, India.
Methodology: In this descriptive type of cross-sectional study, a 31-item prevalidated questionnaire was prepared, which comprised both open-ended and closed-ended questions. The response was obtained, and the students were sensitized about the rational use of antimicrobials and antimicrobial resistance and about advantages and disadvantages of self-medication.
Results: The response rate in our study was 83.3%. The mean age of respondents was 20.09 ± 1.34 (mean ± standard deviation). While 63.2% of participants were found to be self-medicators, the most common source of knowledge about self-administration of antibiotic was information from parents as reported by 40.6% of respondents. The majority of students (35.8%) consumed amoxicillin. Gender-based significance of the difference of knowledge regarding self-medication was found nonsignificant as the value of P > 0.05. The majority of students (91.4%) knew about antibiotic resistance. There was no gender-based significant knowledge regarding antibiotic resistance. Overall knowledge of students was satisfactory. A postsession lecture on antibiotic resistance and its association with self-medication was arranged to reinforce the knowledge of students.
Conclusion: The awareness about the increasing incidence of antibiotic resistance is one of the needs of the moment.
The following Graduate Medical Education core competencies were addressed: Medical knowledge, Practice-based learning and improvement, Interpersonal and communication skills.

Keywords: Antibiotic resistance, competency-based medical education, medical students, self-medication


How to cite this article:
Sharma N, Jain M, Sharma P, Jain C, Bansal A, Sharma L, Advani U. Prevalence of self-medication of antibiotics among 2nd-year medical students and their knowledge about antibiotic resistance. Int J Acad Med 2020;6:203-8

How to cite this URL:
Sharma N, Jain M, Sharma P, Jain C, Bansal A, Sharma L, Advani U. Prevalence of self-medication of antibiotics among 2nd-year medical students and their knowledge about antibiotic resistance. Int J Acad Med [serial online] 2020 [cited 2020 Oct 21];6:203-8. Available from: https://www.ijam-web.org/text.asp?2020/6/3/203/296139




  Introduction Top


Self-medication, which is one element of self-care, is defined by the World Health Organization as “The selection and use of medicines which includes herbal and traditional products, by individuals to treat self-recognized illnesses or symptoms.”[1]

Due to the increased availability of over-the-counter (otc) drugs, the prevalence of self-medication practice is increased in developing countries.[2] Self-medication practice is said to be done when medicines are consumed by one's own initiative or on the consultation of others but without the guidance of a physician.[2],[3]

The prevalence of self-medication ranges from 26.2% to 92%.[4] In Ethiopia, it is 38.5% and 98% in palestine among university students.[5],[6] It is highly prevalent in India and Nepal as documented in a systematic review.[7]

Medical students and even doctors are more prone to self-medication because of their familiarity with medicines. It is expected that their practice of self-medication will also increase as their knowledge and familiarity with medicines increases.[7]

Knowledge of antibiotic resistance and its prevention is the need of the hour. We conducted this study because the first objective of the prevention of antibiotic resistance is to increase its awareness and understanding. One of the main drawbacks of self-medication is that, once the symptoms are resolved after taking self-medication, the users usually discontinue the drugs due to a lack of knowledge, which is responsible for antibiotic resistance.[8]

Moreover, self-medication is one of the major causes of antibiotic resistance. Hence, we first took the response of medical students regarding self-medication practices and their knowledge regarding antibiotic resistance, and then we sensitized the students.

Objectives

The objective of the study was to determine the prevalence of self-medication practices of antibiotics among medical students and to evaluate the knowledge of medical students about antibiotic resistance. The gender-based difference in the knowledge of medical students was also calculated. The study was based on the fact that the student would have some knowledge regarding self-medication and antibiotic resistance.

Assumptions

The study was based on the following assumptions:

  1. The student will have some knowledge regarding self-medication and antibiotic resistance
  2. The student will have some interest to know about antibiotic resistance
  3. Sensitization of students will improve their knowledge.



  Methodology Top


This descriptive type of cross-sectional study was carried out at the Department of Pharmacology at SMS Medical College, Jaipur, India. A 31-item questionnaire was prepared, which comprised both open-ended and closed-ended questions based on previous studies.[7],[9] The questionnaire was validated by four assessors of the department of pharmacology, preventive and social medicine, and medicine who are the experience holders with research and academic experience in their respective subjects, regarding its content and relevance. The questionnaire was modified as per instructions given by the assessors. Four questions were modified, and one question was added. After validation, the final questionnaire was approved for the study. Permission from the head of the pharmacology department was taken before conducting the study. Participation in the study was voluntary, and confidentiality of data was maintained. The students were informed about the study design and protocol, and the importance of participation in the study and their consent was taken. This prevalidated questionnaire was distributed among the 2-year MBBS students in the pharmacology lecture theater after their theory class. The duly filled questionnaire of the consented students was collected on the same day. Each question was mandatory. Incompletely filled questionnaires were not included in the study. After this, the students were sensitized about the rational use of antimicrobials and antimicrobial resistance and about advantages and disadvantages of self-medication.

The questionnaire consisted of three parts. Part A consisted of demographic profile of medical students, Part b assessed the knowledge of medical students regarding self-medication, and Part c included questions regarding the attitude of medical students regarding antibiotic resistance. The individual responses obtained from the study participants were then compiled, processed, and analyzed.

Sample size

Sample size was calculated as 210 students as per the previous study showing the prevalence of knowledge of antibiotic resistance as 66.4% for 80% power, 0.05 α error, and 10% relative error.[9]

Statistical evaluation

Statistical evaluation of the data obtained was done on SPSS (Statistical Package for the Social Sciences) software version 16.0 (SPSS inc., Chicago, IL, USA). Descriptive analysis (mean ± standard deviation) of the data was done. Chi-square test was applied to compare the gender-based significance of difference in the knowledge of students regarding self-medication and antibiotic resistance. The level of significance was set at P < 0.05 (Highly significant).


  Results Top


The descriptive cross-sectional questionnaire-based study was carried out among 234 2nd-year medical students regarding their knowledge and attitude about self-medication practices and antibiotic resistance. The response rate in our study was 83.3% as out of 234 included students, 195 students responded. Only completely filled questionnaire was considered for this study.

Nearly 65.64% were males and 34.35% were females. Male preponderance was seen. The majority of the students (60.7%) were in the age group of 18–20 years. The mean age of respondents was 20.09 ± 1.34 (mean ± standard deviation). Sociodemographic details of the respondents have been depicted in [Table 1].
Table 1: Sociodemographic details of the respondents

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Nearly 63.2% of participants were found to be self-medicators in our study. Around 36.8% of students used to consult doctor before taking medications. The most common source of knowledge about self-administration of antibiotic was information from parents as reported by 40.6% of respondents. This has been depicted in detail in [Figure 1].
Figure 1: Source of knowledge regarding self-medication

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The majority of students (35.8%) Consumed amoxicillin, followed by ciprofloxacin by 17.9% of students. Around 56.5% of students used to purchase these antibiotics from pharmacy, whereas 43.5% of students used to keep some common antibiotics at home. Other antibiotics used by medical students are shown in [Figure 2].
Figure 2: Common antibiotics used by medical students

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While most commonly used topical preparation of antibiotic used was antibacterial ointment by 24.5% of students, antifungal ointment by 20.8%, antifungal shampoo by 20.8%, antibacterial eye drops by 19.5%, antifungal powder by 11.3%, and as antibacterial ear drops in 3.1% of students.

The most common reason for taking antibiotics found in 55.9% of students was upper respiratory tract infection. Gastrointestinal infection was the second cause of antibiotic usage.

Gender-based significance of the difference of knowledge regarding self-medication was determined by calculating Chi-square value and P value as shown in [Table 2]. It was found nonsignificant as P > 0.05.
Table 2: Depicting gender-based significance of difference of knowledge regarding self-medication

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The majority of students (91.4%) knew about antibiotic resistance. Nearly 55.9% of respondents correctly reported the causes of antibiotic resistance as reported in [Figure 3].
Figure 3: Cause of antibiotic resistance as reported by respondents

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Around 59.4% of respondents reported that they knew the measures to minimize antibiotic resistance. Nearly 42.9% of students did not take antibiotic in any type of fever. Around 21% of respondents used to take antibiotics in fever also, whereas 36.1% of students were in confusion whether to consume an antibiotic in fever or take antipyretic for that. Details about the perception of respondents regarding antibiotic resistance have been shown in detail in [Table 3].
Table 3: Perception of male and female respondents regarding antibiotic resistance

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There was no gender-based significant knowledge difference regarding antibiotic resistance. Overall knowledge of students was satisfactory. Knowledge of 79% of students was satisfactory, 13% of students was average, and for 8% students, it was below average.

A postsession lecture on antibiotic resistance and its association with self-medication was arranged to reinforce the knowledge of students.


  Discussion Top


The response rate in our study was 83.3%, which is less than a study done by Gillani et al.[10] who reported a response rate of 97%. Ghaieth et al.[11] have reported a response rate of 55%. In our study, we found male preponderance, which is in contradiction to other previously done studies.[2],[10],[11]

In our study, 63.2% of medical students were self-medicators which are higher than a study done by Ghaieth et al. who reported that medical students were more self-medicated (43%) as compared to their peer group from the nonmedical fields.[11]

Nearly 45% of self-medication was documented by Gillani et al.[10] Alshogran et al. reported a very high prevalence (96.8%) of self-medication in their cohort sample.[2] On the contrary to this, a very low prevalence of self-medication was seen in a study among Saudi medical students (26%).[12]

A lot of factors are playing a role in such a high prevalence of self-medication among medical students such as their knowledge of pharmacology subject, availability of OTC drugs, advice from parents and colleagues, and the most important is Internet.

As our study was restricted to self-medication of antibiotics only, the most common antibiotic consumed by students was amoxicillin (35.8%), which is in accordance with a study done previously in Karachi.[13] On the contrary, metronidazole and ciprofloxacin were the most common antibiotics used as documented by a study done among nonmedical students.[10] While it was metronidazole as the most common antibiotic used in another documented study.[14]

A satisfactory response was obtained regarding antibiotic resistance in our study, as most of the respondents knew about antibiotic resistance. An outstanding knowledge of antibiotic usage and awareness of antibiotic resistance among respondents was reported by a recently published study.[15]

A statistically significant difference in the Knowledge, attitude, and practice of antibiotic use among medical and nonmedical students is reported recently.[16]

There should be strict actions regarding the sale of OTC drugs. The Schedule H1 has come into force as an amendment to the Drugs and cosmetics Rules of 1945, to dampen the rampant use of antibiotics.[17]

Limitations of the study

Following limitations were found in our study:

  1. The study was limited to 2-year medical students of SMS Medical College only
  2. The study was limited to students who were willing to participate in this study
  3. The study was limited to students who were available on the day of data collection
  4. The study was limited to students who could understand Hindi and English.



  Conclusion Top


This study highlights the prevalence of self-medication among medical students and its woeful outcomes. The awareness about the increasing incidence of antibiotic resistance is the need of the hour. We suggest more studies in this field, especially in a larger sample of population to get more accurate results. Theoretical knowledge should be correlated clinically by the implementation of competency-based medical education. More of interdepartmental lectures should be arranged for medical students to enhance their clinical knowledge.

Acknowledgment

The authors acknowledge gratitude to all the medical students who sincerely participated in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical conduct of research

Institutional review board exemption was granted as this was an observational study, and no intervention was needed. Required permission from the Head of the Pharmacology Department and Medical Education Unit at SMS Medical College, Jaipur, Rajasthan, was sought before the commencement of the study. The authors utilized applicable EQUATOR (https://www. Equator-network. Org/) reporting guidelines.



 
  References Top

1.
Self-Medication - World Health Organization; 2019. Available from: http://apps.who.int/medicinedocs/en/d/Jwhozip32e/3.2.html. [Last assessed on 2019 Jul 19].  Back to cited text no. 1
    
2.
Alshogran OY, Alzoubi KH, Khabour OF, Farah S. Patterns of self-medication among medical and nonmedical university students in Jordan. Risk Manag Healthc Policy 2018;11:169-76.  Back to cited text no. 2
    
3.
Shehnaz SI, Agarwal AK, Khan N. A systematic review of self-medication practices among adolescents. J Adolesc Health 2014;55:467-83.  Back to cited text no. 3
    
4.
Karmacharya A, Uprety BN, Pathiyil RS. Knowledge and practice of self-medication among undergraduate medical students. J Lumbini Med Coll 2018;6:21-6.  Back to cited text no. 4
    
5.
Abay SM, Amelo W. Assessment of self-medication practices among medical, pharmacy, and health science students in Gondar University, Ethiopia. J Young Pharm 2010;2:306-10.  Back to cited text no. 5
    
6.
Sawalha AF. A descriptive study of self-medication practices among Palestinian medical and nonmedical university students. Res Social Adm Pharm 2008;4:164-72.  Back to cited text no. 6
    
7.
Nepal G, Bhatta S. Self-medication with antibiotics in WHO Southeast Asian region: A systematic review. Cureus 2018;10:e2428.  Back to cited text no. 7
    
8.
Ajibola O, Omisakin OA, Eze AA, Omoleke SA. Self-medication with antibiotics, attitude and knowledge of antibiotic resistance among community residents and undergraduate students in Northwest Nigeria. Diseases 2018;6:32.  Back to cited text no. 8
    
9.
Donmez S, Gungor K, Pinar G. Knowledge, attitude and practice of self medication with antibiotics among nursing students. Int J Pharmacol 2018;14:136-43.  Back to cited text no. 9
    
10.
Gillani AH, Ji W, Hussain W, Imran A, Chang J, Yang C, et al. Antibiotic self-medication among non-medical university students in Punjab, Pakistan: A cross-sectional survey. Int J Environ Res Public Health 2017;14:1152.  Back to cited text no. 10
    
11.
Ghaieth MF, Elhag SR, Hussien ME. Antibiotics self-medication among medical and nonmedical students at two prominent Universities in Benghazi City, Libya. J Pharm Bioallied Sci 2015;7:109-15.  Back to cited text no. 11
    
12.
Albusalih FA, Naqvi AA, Ahmad R, Ahmad N. Prevalence of self-medication among students of pharmacy and medicine colleges of a public sector university in Dammam City, Saudi Arabia. Pharmacy (Basel) 2017;5:E51.  Back to cited text no. 12
    
13.
Shah SJ, Ahmad H, Rehan RB, Najeeb S, Mumtaz M, Jilani MH, et al. Self-medication with antibiotics among non-medical university students of Karachi: A cross-sectional study. BMC Pharmacol Toxicol 2014;15:74.  Back to cited text no. 13
    
14.
Mumtaz Y, Jahangeer SA, Mujtaba T, Zafar S, Adnan S. Self-medication among university students of Karachi. JLUMHS 2011;10:102-5.  Back to cited text no. 14
    
15.
Kanneppady SS, Oo AM, Lwin OM, Ahmed Al-Abed AA, Kanneppady SK. Knowledge, attitude, and awareness of antibiotic resistance among medical students. Arch Med Health Sci 2019;7:57-60  Back to cited text no. 15
    
16.
Jairoun A, Hassan N, Ali A, Jairoun O, Shahwan M. Knowledge, attitude and practice of antibiotic use among university students: A cross sectional study in UAE. BMC Public Health 2019;19:518.  Back to cited text no. 16
    
17.
Hazra A. Schedule H1: Hope or hype? Indian J Pharmacol 2014;46:361-2.  Back to cited text no. 17
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