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Original Research (Original Article) 


Eyad Khalil Alsulaimani et al, 2020;4(3):605–611.

International Journal of Medicine in Developing Countries

Evaluation of the knowledge of bacterial resistance and antibiotics among population and healthcare providers in the western region in Saudi Arabia

Eyad Khalil Alsulaimani1, Adel Mahmoud Hajjay2, Lujein Fareed Idris3, Duoaa Mohammed Sakabomi4, Mashaal Amer Husni5

Correspondence to: Eyad Khalil Alsulaimani

*King Abdulazziz University, Jeddah, Saudi Arabia.

Email: eyad.10.15 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 09 December 2019 | Accepted: 17 January 2020


ABSTRACT

Background:

Bacterial resistance is a worldwide issue; many studies suggest the reasons that cause this critical problem. Recent studies proved that Saudi Arabia is facing a problem regarding bacterial resistance against antibiotics. This study aimed to focus on the lack of awareness in antibiotics use among the general population and the healthcare providers in Saudi Arabia.


Methodology:

A quantitative, descriptive survey study, based on two questionnaires, was done to estimate the level of awareness of bacterial resistance in the general population and healthcare providers.


Results:

The participants were 104 Healthcare providers (HCP) and 282 non-healthcare providers (NHCP). In a period of a year, only 34 (32.7%) HCP had received training regarding antibiotics. In the last 6 months, 43 (41.3%) either prescribed or suggested to others to use an antibiotic. Only 6 (5.8%) HCP believed that the bacterial resistance is not a national problem. Forty-six (44.2%) considered the increasing number of prescribing an antibiotic as one of the most important causes of bacterial resistance. Moreover, 42 (40.4%) claimed that the excessive use of broad-spectrum antibiotics is a very important reason, and 39 (37.5%) agreed that not removing causative tools of spreading infections, such as medical devices has a negative impact toward antibiotic efficacy. Seventy-eight percent of NHCP agreed that the main reason for the excessive use of antibiotics is that antibiotic accelerates the healing process.


Conclusions:

Establishing well-constructed stewardship is critical in Saudi Arabia with the involvement of the whole community, including healthcare providers.


Keywords:

Antibiotics, bacterial resistance, antibiotic stewardship.


Introduction

In 1945, during a Nobel Prize lecture, Mr. Alex Fleming gave a fair warning of bacterial resistance due to misuse and overuse of antibiotics [1]. Bacterial resistance is a defensive mechanism against the antibiotic. Those changes have different strategies: 1) by producing enzymes that destroy the drug, 2) structural changes in the bacterial wall, thus inhibiting the influx of the drug into the bacteria, and 3) changing to drug binding site [2]. It is a highly progressive evolutionary change. For instance, from the first discovery of Penicillin in 1928, the first resistance appeared in 1940 as reported by Abraham and Chain [3]. Nowadays, bacterial resistance has become a global health issue. Furthermore, it is not only restricted to penicillin, but it also involves more potent antibiotics like carbapenems [4]. Many studies suggest the reasons that lead to the outbreaks of this critical problem, these reasons include overprescribing, unawareness of population, over the counter, and low determination of the drug companies on investing in that field [58].

Based on the researchers' review of the literature, it is concluded that Saudi Arabia is facing a challenging problem regarding bacterial resistance against antibiotics [9]. This problem has a negative impact on the economic status of the country [9]. Although many authors have suggested reasons for this worldwide issue, there is no single analytic study in a period of 10 years discussed the problem from these two points of view: the lack of awareness toward antibiotics among the general population and the healthcare providers. In this study, we will focus mainly on these two reasons.


Subjects and Methods

A quantitative, descriptive survey study aimed to estimate the level of awareness of bacterial resistance in the general population and healthcare providers. It is based mainly on two questionnaires; the first, an electronic survey, targeted the healthcare providers in the western region of Saudi Arabia, including physicians, dentists, pharmacists, medical students, and dental students. It is a modified version of a questionnaire designed by Pulcini [10]. The second, an electronic survey, designed by the researchers and approved by the ethical committee of Baterjee Medical College. It was targeting the citizens and the residents of the western region of Saudi Arabia who were not working in the medical field. For the exclusion criteria, the citizens and the residents below 18-year old, healthcare providers, and mentally retarded patients were excluded. Both surveys were in Google surveys distributed electronically by social media apps to ensure the wider disruption of the surveys.

The data were transferred to and analyzed by Statistical Package for the Social Sciences software version 25. p-value > 0.5 was as considered statically significant.


Results

After applying inclusion and exclusion criteria, we got 104 responses, 67 (64.4%) were physicians. These include 16 (15.4%) consultants, 8 (7.7%) registrars, 43 (41.3%) junior doctors, and 37 (35.6%) others, such as interns, students, and pharmacists. The highest response rate by specialty account for internal medicine with 35 (33.7%) responses.

In a period of a year, only 34 (32.7%) HCP had received training regarding antibiotics. A similar number of HCP had worked in the infectious unit previously, while 70 (67.3%) did not. In the last 6 months, 43 (41.3%) either prescribed or suggested to others to use an antibiotic.

Considering the bacterial resistance as a national problem, only 6 (5.8%) HCP believed it is not a national problem, while 9 (8.7%) HCP were unsure. Meanwhile, 40 (38.5%) HCP were unsure whether they are facing this issue in their hospital or not.

Fifty-seven (85%) doctors responded to the section of confidence in decision making while dealing with prescribing an antibiotic as follows: 16 (15.4%) doctors were very confident in making an accurate diagnosis of infection or sepsis. In contrast, 8 (7.7%) were very unconfident in making such a decision. In a case of being unsure about the diagnosis or in the presence of fever without any severity criteria, 22 (21.2%) were confident in not prescribing an antibiotic, while only 8 (7.7%) were unconfident. Twenty-three (22.1%) were confident in choosing the correct antibiotics, while 10 (96%) were unconfident. More information regarding confidence is shown in Table 1.

Table 1. Confidence while prescribing an antibiotic.

Confidence while prescribing an antibiotic Very unconfident Unconfident Confident Very confident Uncertain
Making an accurate diagnosis of infection /sepsis 8 (7.7%) 5 (4.8%) 23 (22.1%) 16 (15.4%) 5 (4.8%)
Not prescribing an antibiotic if the patient has a fever but no severity criteria, and if you are not sure about your diagnosis 3 (2.9%) 8 (7.7%) 22 (21.2%) 15 (14.4%) 9 (8.7%)
Choice the correct antibiotic 5 (4.8%) 10 (9.6%) 23 (22.1%) 13 (12.5%) 6 (5.8%)
Choosing the correct dose and interval of administration 5 (4.8%) 9 (8.7%) 16 (15.4%) 17 (16.3%) 9 (8.7%)
Using a combination therapy if appropriate 6 (5.8%) 6 (5.8%) 26 (25.0%) 9 (8.7%) 10 (9.6%)
Choosing between IV and PO administration 8 (7.7%) 8 (7.7%) 18 (17.3%) 13 (12.5%) 10 (9.6%)
Interpreting microbiological results 5 (4.8%) 9 (8.7%) 15 (14.4%) 23 (22.1%) 5 (4.8%)
Planning to streamline/stop the antibiotic treatment according to clinical evolution and investigation 6 (5.8%) 5 (4.8%) 23 (22.1%) 16 (15.4%) 7 (6.7%)
Planning the duration of antibiotic treatment 6 (5.8%) 6 (5.8%) 22 (21.2%) 18 (17.3%) (4.8%)

All participants had responded to the questions of potential causes of increasing antibiotic resistance, especially in Saudi Arabia. Among the participants, 46 (44.2%) considered the increasing number of prescribing an antibiotic as one of the most important causes of bacterial resistance nowadays, whereas 42 (40.4%) claimed that the excessive use of broad-spectrum antibiotics is a very important reason, 39 (37.5%) agreed that not removing causative tools of spreading infections, such as medical devices and catheters, have a negative impact toward antibiotic efficacy. On the other hand, paying too much attention to pharmaceutical representatives/advertising, poor hand hygiene, too low dose of the antibiotic, and too long duration of antibiotics treatment were not as important as the previously mentioned causes with a percent of (34.6%), (33%), (32.7%), and (26%), respectively. Although 18 (17.3%) believed that both too long duration and too low dose are not important causes, poor hand hygiene and excessive prescription of antibiotics were unimportant for 13 (12.5%) HCP. More statistics are shown in Table 2.

Four solutions had been suggested by most of the HCPs. The first, availability of local/national resistance data (61) (58.7%), the second, availability of local/national guidelines/policies/protocol (61) (58.7%), the third, educational sessions on prescribing (56) (53.8%), and the fourth, presence of an antimicrobial management team (50) (48.1%). In contrast, 32 (30.8%) were neutral toward the restriction of prescription of all antibiotics. Moreover, 19 (18.3%) believed that it is not helpful and 11 (10.6%) thought it is very unhelpful. Meanwhile, the percentage of supporting the restriction of certain antibiotics had increased to 36.5%, while unhelpful percentage had declined to 9.6%. More solutions and their statistics are shown in Table 3.

Table 2. Potential causes for resisitance.

Potential causes for resistance Very important Important Neutral Unimportant Very unimportant
Too many antibiotic prescriptions  46 (44.2%) 8 (7.7%) 27 (26.0%) 13 (12.5%) 10 (9.6%)
Too many broad-spectrum antibiotics used  42 (40.4%) 18 (17.3%) 27 (26%) 6 (5.8%) 11 (10.6%)
Too long duration of antibiotics treatment 27 (26%) 23 (22.1%) 27 (26%) 18 (17.3%) 9 (8.7%)
Too low dose of antibiotic 22 (21.2%) 18 (17.3%) 34 (32.7%) 18 (17.3%) 12 (11.5%)
Excessive use of antibiotic in livestock 36 (34.6%) 17 (16.3%) 22 (21.2%) 10 (9.6%) 19 (18.3%)
Poor hand hygiene 29 (27.9%) 14 (13.5%) 35 (33.0%) 13 (12.5%) 13 (12.5%)
Not removing the focus of infection (e.g. medical devices or catheters)  39 (37.5%) 24 (23.1%) 23 (22.1%) 9 (8.7%) 9 (8.7%)
Paying too much attention to pharmaceutical representatives/advertising 28 (26.9%) 18 (17.3%) 36 (34.6%) 16 (15.4%) 6 (5.8%)

Table 3. Measures to improve antibiotic prescribing.

Measures to improve antibiotic prescribing Very helpful Helpful Neutral Unhelpful Very unhelpful
Educational sessions on prescribing 56 (53.8%) 23 (22.1%) 13 (12.5%) 7 (6.7%) 5 (4.8%)
Availability of local/national guidelines/ policies/protocol  61 (58.7%) 15 (14.4%) 14 (13.5%) 9 (8.7%) 5 (4.8%)
Availability of local/national resistance data 61 (58.7%) 18 (17.3%) 15 (14.4%) 6 (5.8%) 4 (3.8%)
Computer-aided prescribing 36 (34.6%) 25 (24.0%) 26 (25.0%) 12 (11.5%) 5 (4.8%)
Presence of an antimicrobial management team 50 (48.1%) 26 (25.0%) 20 (19.2%) 6 (5.8%) 2 (1.9%)
Readily accessible advice from infection control team 45 (43.3%) 27 (26.0%) 21 (20.2%) 10 (9.6%) 1 (1%)
Advice from senior colleagues 34 (32.7%) 27 (26.0%) 30 (28.8%) 10 (9.6%) 3 (2.9%)
Speaking to pharmaceutical representative 29 (27.9%) 26 (25.0%) 28 (26.9%) 11 (10.6%) 10 (9.6%)
Restriction of prescription of certain antibiotics  38 (36.5%) 28 (26.9%) 23 (22.1%) 10 (9.6%) 5 (4.8%)
Restriction of prescription of all antibiotics 17 (16.3%) 25 (24.0%) 32 (30.8%) 19 (18.3%) 11 (10.6%)
Regular audit and feedback on antibiotic prescribing on your ward 41 (39.4%) 31 (29.8%) 22 (21.2%) 8 (7.7%) 2 (1.9%)

A total of 282 people of non-healthcare providers (NHCP) participated in the survey for the public; 161 (57.1%) females and 121 (42.9%) males (Table 4). The main age group was between 25 and 36 years old (30.9%). Most of the participants were living in Jeddah and Makkah, 106 (37.6%) and 98 (34.8%), respectively. More information is shown in Table 4. As the antibiotic is effective in treating bacterial infections, 165 (58.5%) thought it is used to treat viral infection. Also, more than half (155) (55%) believed that the antibiotic is helpful in the case of influenza, flu, and cough. Although 259 (91.8%) agreed that the excessive use of antibiotics decreases its efficiency, the participants were given three diseases to choose from whether they treated by antibiotics or not. The three diseases were acute bronchitis, pneumonia, and the common cold. More than half of participants (259) (56.4%) choose pneumonia. When asked what the reasons for this excessive use of antibiotics, participants were given the chance to choose more than one answer. The main reasons that arose in the answers to this question were: Patients believe that the antibiotic accelerates the healing process, 220 (78%) agreed. Others (112) (39%) thought that the health system and medical laws have a lot of gaps regarding antibiotics. The next question in the survey was whether people thought that Saudi Arabia faces a problem of high antibiotic-resistant bacteria. A total of 198 (70.2%) people agreed that Saudi Arabia does face this problem. This comes with no surprise based on the answers given in the questions before.

Table 4. People participated in the survey according to the region, age, Qualification, degree and gender.

Percentage
Region
Jeddah 37.6%
Yanbu 8.5%
Medina 7.8%
Makah 34.8%
Rabigh 0.4%
Others 11%
Age
18–25 26.6%
26–35 30.9%
36–45 22.7%
46–55 19.9%
Qualification
High School 17.7%
Diploma 5.3%
Bachelor’s degree 68.8%
Master’s Degree 6.0%
Ph.D. 1.1%
Others 1.1%
Gender
Male 121 (42.9%)
Female 161 (57.1%)

Moreover, almost 259 (90%) thought that the overuse of antibiotics can aggravate the problem of bacteria resistant to antibiotics. Only 205 (72.7%) believed that the resistant bacteria affect their health and their family's health which shows that more awareness has to be made concerning this issue. Getting information from the right source is an important key to get the right information and the use of the right medication. More than half of the participants (167) (59.2%) said that they got the antimicrobial information from the doctor.

The majority of participants got their information from the medications’ description, while 35.8% get their information from Pharmacists, and the rest are between getting information from the internet, friends, and family, (35.8%) and (30.5%), respectively. More details are shown in Table 5.

Almost 275 (97%) agreed that it is crucial that the community be aware of the use of antibiotics. This is a good sign that the public is ready to improve their knowledge about antibiotics use.

More than half (153) (54.3%) of NHCP claimed that they stop taking the counter as soon as the complaints disappear. Even, most of them (66.3%) purchased the antibiotic by prescription from the pharmacy which means the correct duration to take it would be written. Only 30.5% of participants claim they take it from the pharmacy without a prescription. The last part of the survey was about if NHCP would ask the doctor to prescribe them antibiotics and if the doctor would agree and prescribe them antibiotics, the answer was mostly no.


Discussion

Various causes of the increasing number of bacterial resistances have been addressed by many authors (Table 2). The first being the prescription-related causes from different perspectives such as poor judgment from the physician which leads to misuse of the antibiotics and selling the antibiotics without prescription (OTC) [59,11]. A literature review of 72 articles from different countries including Saudi Arabia published by Arwa Alumran in 2012 regarding the overuse of antibiotics among the children with upper respiratory tract infection. They emphasize the misuse of antibiotics by commonly prescribing it for viral infections [8]. In our study, 8 physicians out of 57 were unconfident in not prescribing an antibiotic if there is no obvious indication and 9 physicians were unsure. Even though these numbers are not high, a more focused study on primary health care units in 2002 in Saudi Arabia found that in the case of 87% of upper respiratory tract infections in the adult, which is more commonly caused by viruses, they have prescribed an antibiotic [8].

Generally, the concept of treating viral infections with an antibiotic is more pronounced among the general population and it overlaps with OTC. In a study carried on by SharafaldeenBin Nafisah in Saudi Arabia in 2017, 166 out of 473 participants from the general population (35.5%) believed that the antibiotics could treat mainly viral infections [11]. Nevertheless, 31.8% thought it is used for analgesia. In the western region of Saudi Arabia, we found that 165 participants out of 282 (58.5%) believed that the viral infection is treated by an antibiotic. Almost similar percent was present when we asked whether the antibiotic is speeding up the recovery from the common cold, influenza, flu, and cough or not, 55% agreed. These huge percentages of wrong beliefs aggravate the problem of antibiotic misuse. Especially, when those patients seek an antibiotic from pharmacies without a prescription. Although it is illegal in Saudi Arabia to sell any antibiotics as OTC, it has been found that only one pharmacy out of 88 applied this rule in Riyadh [12].

The second cause is the lack of knowledge. Besides the examples mentioned above regarding viral infection, we found that although 91.1% of public participants believed that antibiotics are overused and 91.8% believed that overuse will decrease the efficacy of the drugs in future, more than half (60.3%) said that they have never heard about bacterial resistance to the antibiotics. Similar incongruity found in another study as they found 63.6% purchased an antibiotic without prescription, 62% of the state that purchasing an antibiotic should be with a prescription written by the physician only [13]. These examples reflect the contrariness between the ideas and the attitude toward the antibiotics. Lack of knowledge also has an impact on the attitude toward the antibiotics. We found that 54.3% of patients discontinue the antibiotics as soon as the symptoms disappear. In another study, 28.9% would stop as they feel an improvement [13]. In our study, 97.5% of public participants agreed that there is a demand for increasing the community awareness of antibiotics and bacterial resistance. The lack of knowledge is not only with the public but also with some physicians. For example, in our study, we found 11 out of 57 physicians either unconfident or very unconfident with taking the decision of discontinuation of the antibiotics based on clinical evaluation and investigations. The majority probably because of lack of training since 32.7% of all healthcare participants did not involve in a training program for antibiotics in a period of 1 year.

Table 5. Participant’s source of information regarding antibiotics use.

No Yes
Can antibiotics be used to treat bacterial infections? 70 (24.8%) 212 (75.2%)
Can antibiotics be used to treat viral infections? 117 (41.5%) 165 (58.5%)
Do you think that the use of antibiotics helps in the treatment of flu, cough, influenza and other diseases faster?  127 (45%) 155 (55%)
Have you ever heard of resistance bacteria? 112 (39.7%) 170 (60.3%)
Do you think that excessive intake of antibiotics will in the future reduce the possibility of treating some of the diseases that have been treated in the past? 23 (8.2%) 259 (91.8%)
Do you think newer and higher-priced antibiotics are more effective than their lowest-priced counterparts 191 (67.7%) 91 (32.3%)
Do you know what a test is for determining the effectiveness of a farm-based antibiotic, such as urine, feces, and blood 153 (54.3%) 129 (45.7%)
Do you think that antibiotics are overused? 25 (8.9%) 257 (91.1%)
Are there useful bacteria inside our bodies? 2 (7%) 280 (99.3%)
Do you think that Saudi Arabia faces a problem of high antibiotic-resistant bacteria? 84 (29.8%) 198 (70.2%)
Do you think that the overuse of antibiotics can aggravate the problem of bacteria resistant to antibiotics? 34 (12.4%) 247 (87.6%)
Do you think resistant bacteria affect your health and your family's health? 77 (27.3%) 205 (72.7%)
Do you think it is important that the community be aware of the use of antibiotics? 7 (2.5%) 275 (97.5%)
Do you think it is necessary to give lectures to increase awareness of antibiotics and resistant bacteria? 8 (2.8%) 274 (97.2%)
Do you think voluntary volunteer campaigns create a fertile environment for spreading rumors? 145 (51.4%) 137 (48.6%)
Depend on high temperature to take the antibiotic 184 (65.2%) 98 (34.8%)
Do you stop taking the antibiotic as soon as the complaint disappears? 129 (45.7%) 153 (54.3%)
Have you ever used an over-the-counter antibiotic? 113 (40.1%) 169 (59.9%)
Do you ask your doctor to prescribe an antibiotic for you when you get cold? 204 (72.3%) 78 (27.7%)
If yes, did your doctor respond to you and prescribe you an antibiotic? 194 (68.8%) 88 (31.2%)

Table 6. Participants’ awareness of antibiotics side effects.

Questions No Yes
When used antibiotics worry about side effects 217 (77%) 65 (23%)
Stop using antibiotics when exposed to side effects 246 (87.2%) 36 (12.8%)
If the damage is as much as the benefits of the antibiotic, I prefer not to use it 242 (85.8%) 40 (14.2%)
If you experience side effects while using antibiotics, I consult with my doctor 275 (97.5%) 7 (2.5%)

The third cause is self-medication; it has been found that the source of information the patients use is highly associated with self-medication [14]. Different sources mentioned by the patients, such as a doctor, pharmacist, the paper attached to the medication, internet, and the relatives [11,13,15,14]. In a cross-sectional study conducted in Riyadh in 2017, they found that 227 participants obtained an antibiotic without prescription. Ninety-two percent purchased it based on the opinion of the pharmacist [11]. In our study, we found that 35.8% of all public participants use the pharmacist as a primary source of information. Almost similar percent, 30.5% of participants get their information from the internet and 14.8% get their information from relatives, either family or friends. Another cause is left-over antibiotics found to be associated with self-medication. It has been found that 44.7% of patients keep left-over antibiotics for future use [13]. Another cause of self-medication is a lack of or inappropriate knowledge regarding antibiotics. Although some researchers found that total knowledge was negatively associated with self-medication, others showed it is a predictor of self-medication [13,16].

The fourth is nonadherence to infection control. It is believed that this problem will lead to the spread of resistant bacterial infection [12]. Nonadherence to infection control could occur in different scenarios, such as suboptimal hand hygiene and not removing the contaminated objects from patients’ rooms [10,12]. A prospective observational study conducted in Hera general hospital in Makkah in 2011 regarding the practice of hand hygiene among the health care professionals [17]. The overall compliance rate was 50.3% [17]. Regarding the importance of hand hygiene, we found that 41.3% of healthcare participants agreed about the relation between bacterial resistance and hand hygiene. A higher percent, 60.6% agreed that not removing contaminated objects plays an important role in increasing the rate of bacterial resistance.

Antimicrobials stewardship is a collection of interventions to control the uses of antimicrobial drugs including the antibiotics (Table 3) [18]. Although different programs exist, some practices are commown, such as control the prescriptions and increase the education level of the community [18]. A study was done in a tertiary care university hospital in the Western region of Saudi Arabia published in 2016 to evaluate the effectiveness of such programs in reducing the costs and incidence of multi-drug resistance [19]. The interventions they made were; restriction of antibiotics that most likely to be prescribed in emergency bases, such as meropenem, piperacillin/tazobactam, and amikacin; referral of prescriptions of the restricted antibiotics to antibiotics approval team (AAT) or infectious disease (IDS) team be approved before dispensing; and in case of disapproval, the physician was encouraged to change the class of the drug or to discuss the case with AAT or IDS. The departments included in the study included the Surgical Department, the Obstetrics and Gynecology Department, the Medical Department, the Critical Care Unit, the Medical Intensive Care Unit, and the Surgical Intensive Care Unit. They achieved a 67.2% reduction in the consumption of restricted antibiotics. As a result of the reduction in consumption of the antibiotics, the overall costs decreased too. Also, the mortality rate had not negatively affected by restricted antibiotics. Conversely, it decreased from 90.83 (±10.12) deaths per 10,000 in 2011 to 75.25 (±17.46) in 2015. Moreover, microbiological data showed an overall reduction in all MDR infections especially Acinetobacter baumannii [19]. As shown in the study mentioned above, decrease the unnecessary use of antibiotics is an effective solution to counteract bacterial resistance. In our study, 63.5% of all HCP agreed that the restriction of certain antibiotics is either a helpful or very helpful solution. Another issue is the education either of the public or the healthcare worker. In 2017, Chang [20] published a study conducted in a university hospital in Taiwan. They evaluated the bacterial resistance and the number of prescriptions before and after applying the educational program for healthcare workers. A marked reduction was observed in the consumption of total inpatient antibiotics by 13% [20]. Also, the rate of carbapenem-resistant Acinetobacter baumannii decreased from 70.8% to 29.6% in a period of 7 months [20]. This study highlights the importance of training programs; hence that 37% of surveyed HCP in our study did not engage in any training program regarding antibiotics. Luckily, 75.9% of HCP and 97.2% of public participants agreed and were open to having lectures and education programs of antibiotics.

The involvement of pharmacists in stewardship is critical since they are one of the most common sources of information for the public and one of the major dispensing points of antibiotics. A scoping review published in 2018 to assess the perception and attitude of community pharmacists toward antibiotics [21]. They concluded and reassured the presence of conflict between the perception and the attitude [21]. Even though the community pharmacist showed a good knowledge of the antibiotics and they are aware of the emerging problem of bacterial resistance, they still dispense the antibiotics without prescription for unjustified reasons [21].


Conclusion

Establishing well-constructed stewardship is critical in Saudi Arabia with the involvement of the whole community, including healthcare providers. We also would like to stress the importance of using multimedia and social media to increase awareness of the community. Moreover, we encourage concerned entities in Saudi Arabia to increase the supervision of the community pharmacies regarding dispensing the antibiotics.

Fortunately, Saudi Arabia took a few steps forward to counteract this global issue. We encourage other researchers to do further studies to follow up with Saudi Arabian stewardship.


Acknowledgments

We would like to thank Batterjee Medical College specially the ethical committee department for their effort for this work to be done. We also would like to thank Dr. Abdulrahim Samer Yaghmour, Dr. Mohammed Marwan Abdulghani, Dr. Tahani S. (A.Z.) Fahmi, Dr. Hayfaa Amer Husni for the data collection.


List of Abbreviations

AAT Antibiotics approval team
IDS Infectious disease
NHCP Non-healthcare providers

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The ethical approving body is Dr. Ikhlas Sindi from Batterjee Medical College. The date: 06-01-2018. The letter number: RES-2018-0000000.


Author details

Eyad Khalil Alsulaimani1, Adel Mahmoud Hajjay2, Lujein Fareed Idris3, Duoaa Mohammed Sakabomi4, Mashaal Amer Husni5

  1. King Abdulazziz University, Jeddah, Saudi Arabia
  2. Batterjee Medical College, Jeddah, Saudi Arabia
  3. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  4. Al Noor Specialist Hospital, Makkah, Saudi Arabia
  5. Saudi German Hospital, Jeddah, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alsulaimani EK, Hajjay AM, Idris LF, Sakabomi DM, Husni MA. Evaluation of the knowledge of bacterial resistance and antibiotics among population and healthcare providers in the western region in Saudi Arabia. IJMDC. 2020; 4(3): 605-611. doi:10.24911/IJMDC.51-1574450478


Web Style

Alsulaimani EK, Hajjay AM, Idris LF, Sakabomi DM, Husni MA. Evaluation of the knowledge of bacterial resistance and antibiotics among population and healthcare providers in the western region in Saudi Arabia. http://www.ijmdc.com/?mno=74909 [Access: March 29, 2020]. doi:10.24911/IJMDC.51-1574450478


AMA (American Medical Association) Style

Alsulaimani EK, Hajjay AM, Idris LF, Sakabomi DM, Husni MA. Evaluation of the knowledge of bacterial resistance and antibiotics among population and healthcare providers in the western region in Saudi Arabia. IJMDC. 2020; 4(3): 605-611. doi:10.24911/IJMDC.51-1574450478



Vancouver/ICMJE Style

Alsulaimani EK, Hajjay AM, Idris LF, Sakabomi DM, Husni MA. Evaluation of the knowledge of bacterial resistance and antibiotics among population and healthcare providers in the western region in Saudi Arabia. IJMDC. (2020), [cited March 29, 2020]; 4(3): 605-611. doi:10.24911/IJMDC.51-1574450478



Harvard Style

Alsulaimani, E. K., Hajjay, . A. M., Idris, . L. F., Sakabomi, . D. M. & Husni, . M. A. (2020) Evaluation of the knowledge of bacterial resistance and antibiotics among population and healthcare providers in the western region in Saudi Arabia. IJMDC, 4 (3), 605-611. doi:10.24911/IJMDC.51-1574450478



Turabian Style

Alsulaimani, Eyad Khalil, Adel Mahmoud Hajjay, Lujein Fareed Idris, Duoaa Mohammed Sakabomi, and Mashaal Amer Husni. 2020. Evaluation of the knowledge of bacterial resistance and antibiotics among population and healthcare providers in the western region in Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (3), 605-611. doi:10.24911/IJMDC.51-1574450478



Chicago Style

Alsulaimani, Eyad Khalil, Adel Mahmoud Hajjay, Lujein Fareed Idris, Duoaa Mohammed Sakabomi, and Mashaal Amer Husni. "Evaluation of the knowledge of bacterial resistance and antibiotics among population and healthcare providers in the western region in Saudi Arabia." International Journal of Medicine in Developing Countries 4 (2020), 605-611. doi:10.24911/IJMDC.51-1574450478



MLA (The Modern Language Association) Style

Alsulaimani, Eyad Khalil, Adel Mahmoud Hajjay, Lujein Fareed Idris, Duoaa Mohammed Sakabomi, and Mashaal Amer Husni. "Evaluation of the knowledge of bacterial resistance and antibiotics among population and healthcare providers in the western region in Saudi Arabia." International Journal of Medicine in Developing Countries 4.3 (2020), 605-611. Print. doi:10.24911/IJMDC.51-1574450478



APA (American Psychological Association) Style

Alsulaimani, E. K., Hajjay, . A. M., Idris, . L. F., Sakabomi, . D. M. & Husni, . M. A. (2020) Evaluation of the knowledge of bacterial resistance and antibiotics among population and healthcare providers in the western region in Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (3), 605-611. doi:10.24911/IJMDC.51-1574450478