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Original Research (Original Article) 


Waleed Alsowayan et al, 2020;4(3):629–634.

International Journal of Medicine in Developing Countries

Knowledge, attitude, and practice in regards to antibiotic use in upper respiratory tract infections among the general population in Saudi Arabia

Waleed Alsowayan1, Ahad Mesfer Halzaa2*, Sarah Ali Alatwi3, Afaf Nasser Hamoud Alokayli4, Ghusoon Fathi Al-Moaibed5, Maram Saidan Saad Alharbi4, Afnan Abdulraheem Ali6

Correspondence to: Ahad Mesfer

*Najran University, Najran , Saudi Arabia.

Email: ahadmessver_994 [at] outlook.com

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

Received: 26 November 2019 | Accepted: 31 December 2019


ABSTRACT

Background:

Inappropriate and excessive use of antibiotics is associated with an increasing prevalence of antibiotic resistance. The present study investigated the role of knowledge and use of antibiotics toward Upper Respiratory Tract Infections (URTIs) across the population of Saudi Arabia under the general objective of understanding the knowledge, attitude, and practice toward antibiotics use in respiratory tract infections among adult Saudi population, Saudi Arabia, 2018–2019.


Methodology:

A randomized cross-sectional study was conducted among the adult Saudi population. Data were gathered by using specific designed electronic questionnaires translated to Arabic with close-ended multiple-choice questions to assess knowledge, attitude, and practice toward antibiotics use in respiratory tract infection. The final sample size was 725. The questionnaire was divided into two key parts. The analysis was carried out using Statistical Package for the Social Sciences version 25, where significance was allowed at a 5% level.


Results:

Among the study subjects, 13.1% were smokers, while the rest were non-smokers. More than 90% of the study respondents claimed to have some background information about antibiotics. A higher proportion of males reported being affected by the respiratory disease at least once as compared to the proportion of females. Laryngitis was the most common type of URTI at 59%. There was no significant association between knowledge that antibiotics cure bacterial infections, and the criteria used to stop using antibiotics (p-value > 0.05).


Conclusion:

The knowledge about antibiotics could be considered misleading among the Saudi population due to the high number of respondents with misconceptions about the antibiotics being the cure for the viral disease when to stop using antibiotics, and unprofessional prescription of anti-biotic in curing URTIs.


Keywords:

Knowledge, attitude, practice, antibiotic use, upper respiratory tract infections.


Introduction

Upper respiratory tract infections (URTIs) refer to infection involving the upper respiratory tract, such as otitis media, pharyngitis, sinusitis, and acute bronchitis [1]. It is estimated that the disease is the most common among adults, who generally suffer from severe URTI two to five times a year [2] although viral etiologies for the majority of URTI Antibiotics are frequently prescribed for these illnesses [3,4]. Inappropriate and excessive use of antibiotics is associated with an increasing prevalence of antibiotic resistance [5]. Many factors contribute to the misuse and overuse of antibiotics such as patient requests, bad habits of self-treatment, non-compliance, and Patients’ experience with antibiotics, inadequate patient education [6,7]. Antibiotic resistance has become a global problem of public health with a clinical and economic burden [8]. The World Health Organization has reported the increase in antibiotic resistance worldwide, and this problem leads to a surge in morbidity and mortality rates [9]. The current study is aimed to assess knowledge, attitudes, and practices on antibiotic use in regards to upper respiratory tract infections among the general population in different parts of Saudi Arabia.


Subjects and methods

A randomized cross-sectional study was conducted among adult Saudi population within the different regions of Saudi Arabia 2019, the data were gathered by using specific design electronic questionnaires translated to Arabic with close-ended multiple-choice questions to assess knowledge, attitude, and practice toward antibiotics use in respiratory tract infections among adult Saudi population. The main inclusion criteria were Saudi aged 18 or older recruited into the study out of their own will. By agreeing to participate in the present study, one was considered to have given consent for the participation. Information privacy and confidentiality was maintained through not sharing respondent information with third parties and only using the gathered information for research purposes. The final sample size was 725. The questionnaire was divided into two key parts; the first part gathered demographic information, while the second part gathered information about URTIs and behaviors likely to increase the risk of contracting URTIs. The analysis was carried out using Statistical Package for the Social Sciences version 25, where significance was allowed at a 5% level. Chi-square test goodness of fit and association were the main analyses carried out.


Results

Out of the 725 sample respondents, 13.1% were smokers, while the rest were non-smokers. Central region inhabitants were the highest from our sample, consisting of 39.7%, while respondents from the Southern region were 7.7%, which was the lowest represented region. See Table 1, which presents demographic information of the study participants.

More than 90% of the study respondents claimed to have had some background information about antibiotics, while more than 70% of the respondent claimed that antibiotics could cure bacterial infections. More than half of the respondents wrongfully claimed that antibiotics could cure viral diseases (Figure 1).

A higher proportion of males reported being affected by the respiratory disease at least once as compared to the proportion of females. Gender and incidence of respiratory disease were significantly associated with a 5% level of significance p = 0.001. Smokers were also more affected by respiratory infections than non-smokers (50.5% versus 61.1%, respectively). The smoking condition was also associated with respiratory infection p = 0.041 (See Table 2).

There was no significant association between type of URTI and region of the respondents p > –0.05, which was also the case with age and education level p > 0.05 in both cases (See Table 3).

Table 1. Respondents demographics

Variable Freq. (%)
Gender
Female 565 (77.9)
Male 160 (22.1)
Age
18–30 495 (68.3)
30–40 135 (18.6)
40–50 64 (8.8)
50–60 24 (3.3)
60> 7 (1.0)
Smoking
Smoker 630 (86.9)
Non-smoker 95 (13.1)
Area
Central 288 (39.7)
Eastern 83 (11.4)
Northern 80 (11.0)
Southern 56 (7.7)
Western 218 (30.1)
Education level
Higher education 478 (66.0)
Intermediate/Primary 28 (3.8)
Secondary 219 (30.2)
Background in Antibiotic usage
No 44 (6.1)
Yes 681 (93.9)
Use of antibiotics without the doctor’s consent
Five times> 117 (16.1)
Never 344 (47.4)
1–3 times 192 (26.5)
3–5 times 72 (9.9)
When to stop using antibiotics
A few days after recovery 98 (13.5)
After the doctor’s consultation 317 (43.7)
After antibiotics are over 137 (18.9)
After symptoms have disappeared 173 (23.9)

Laryngitis, however, is the most common type of URTI at 59%, as per Figure 2. There was no significant association between gender and respondents’ reported method of stopping the usage of antibiotics. The proportion of individuals who have never taken antibiotics without medical prescription and consulted doctors before stopping the use of antibiotics was highest, however, as seen in Table 4. There was no significant association between knowledge that antibiotics cure bacterial infections and the criteria used to stop using antibiotics p > 0.05.


Discussion

Antibiotics have, for a long period, been used in the neutralization and fighting off bacterial infections not only in the respiratory tract but also in other parts of human anatomy. However, as noted in a wide array of literature, inappropriate use and inability to take the full dose of antibiotics as per recommendation leads to the medication becoming ineffective in the long run since bacteria cope with the fight off the medication. The current study aimed at understanding the knowledge of antibiotics, and its use within the respiratory tract among citizens of Saudi Arabia. The study only utilized chi-square tests for the association as the only inference method, while all other applied methods were descriptive. The sample was diverse based on age groups, gender, regions of Saudi Arabia, and education levels of the study participants.

Figure 1. Bar chart of antibiotics as a cure for viral infections (**More than half of the respondents wrongfully claimed that antibiotics could cure viral diseases).

Figure 2. Most reported type of URTI.

Table 2. Chi-square association for demographic variables and incidence of respiratory disease.

Variable Yes (%) p-value
Gender 0.001
Female 275 (48.7)
Male 101 (63.1)
Age 0.000
18–30 220 (44.4)
30–40 95 (70.4)
40–50 37 (57.8)
50–60 18 (75.0)
60> 7 (85.7)
Smoking 0.041
Non smoker 318 (50.5)
Smoker 58 (61.1)
Area 0.258
Central 150 (52.1)
Eastern 36 (43.4)
Northern 49 (61.3)
Southern 28 (50.0)
Western 113 (51.8)
Education level 0.110
Higher education 256(56.9)
Intermediate/Primary 18 (64.3)
Secondary 102 (46.6)

Table 3. Association between respondents’ demography and reported URTI.

Variable p-value
Gender 0.100
Age 0.076
Smoking condition 0.011
Region 0.101
Education Level 0.072

Table 4. When to stop using antibiotic medication.

Variable After consulting a doctor (%) p-value
Gender 0.205
Female 256 (45.3)
Male 61 (38.1)
Age 0.031
18–30 231 (46.7)
30–40 51 (37.8)
40–50 23 (35.9)
50–60 8 (33.3)
60> 4 (57.1)
Smoking 0.008
Non-smoker 275 (43.7)
Smoker 42 (44.2)
Area 0.258
Central 150 (52.1)
Eastern 36 (43.4)
Northern 49 (61.3)
Southern 28 (50.0)
Western 113 (51.8)
Education level 0.367
Higher education 212 (44.4)
Intermediate/Primary 12 (42.9)
Secondary 63 (28.8)
Background information about antibiotics use 0.009
No 16 (36.4)
Yes 301 (44.2)
Antibiotics cure a bacterial infection 0.431
No 63 (43.2)
Yes 254 (43.9)
Antibiotics cure a viral infection 0.008
No 158 (47.7)
Yes 159 (40.4)
Taking antibiotics without medical prescription 0.000
5 times> 28 (23.9)
Never 196 (57.0)
1–3 times 73 (38.0)
3–5 times 20 (27.8)
High fever warrants taking antibiotics 0.000
No 190 (46.5)
Yes 127 (40.2)

The fact that 93.9% of the respondents claimed to have some background knowledge in antibiotic use could explain why more than half (52.6%) of the respondents claimed to have used antibiotics at least once without a prescription from the doctor. The finding could also be explained by the fact that 66% of the respondents claimed to have higher education degrees. While most of the respondents claimed to have knowledge about antibiotics and prescribed for themselves antibiotics, an equally large proportion of respondents indicated that they could be described as antibiotics misusers as 56.3% claim they stopped using antibiotics for reasons other than the doctor’s opinion. To be precise, 37.4% claim they stop using antibiotics when symptoms have disappeared or a few days after they feel better. That gender is associated with the incidence of respiratory infection could be explained by the higher proportion of males reported to experience respiratory disorders than females. This is also possible given that 28.7% (46/114) of the males in the present study are smokers, while 8.7% (49/516) are smokers. Smoking has been documented to increase the incidence of bacterial pathogens in the upper respiratory tract [10,11]. Our findings also showed that a larger proportion of people above 50 years of age had experienced at least one form of URTI (average 80%). Advanced age is a known risk factor for URTI as per the studies by Revai et al. [13]; Kline and Bowdish [12]. Smoking was once again significantly associated with the type of upper respiratory tract infection, with the highest percentage being the laryngitis type. It is, however, reassuring that the proportion of people who disagreed that high fever calls for the use of antibiotics and required doctors’ prescriptions to stop using antibiotics was higher than the proportion who agreed. Misuse of antibiotics is still high in Saudi Arabia [14].


Conclusion

The knowledge about antibiotics could be considered misleading among the Saudi population due to the high number of respondents with misconceptions about the antibiotics curing viral disease when to stop using antibiotics, and unprofessional prescription of anti-biotic in curing URTIs. Misconceptions about the use of antibiotics in the general public contribute to the many issues with the use of antibiotics for URTI and other diseases globally.


List of Abbreviations

URTI Upper Respiratory Tract Infections

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 research was done after the approval of security forcec hospital on 24 oct 2019 [ H-01-R-069].


Author details

Waleed Alsowayan1, Ahad Mesfer Halzaa2, Sarah Ali Alatwi3, Afaf Nasser Hamoud Alokayli4, Ghusoon Fathi Al-Moaibed5, Maram Saidan Saad Alharbi4, Afnan Abdulraheem Ali6

  1. Department of Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia
  2. Medical Intern, Najran University, Najran, Saudi Arabia
  3. Medical Intern, Tabuk University, Tabuk, Saudi Arabia
  4. Medical Intern, Alfarabi College, Riyadh, Saudi Arabia
  5. King Faisal University, Al Ahsa, Saudi Arabia
  6. Batterjee Medical College, Jeddah, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alsowayan W, Halzaa AM, Alatwi SA, Alokayli ANH, Al-Moaibed GF, Alharbi MSS, Ali AA. Knowledge, attitude, and practice in regards to antibiotic use in upper respiratory tract infections among the general population in Saudi Arabia. IJMDC. 2020; 4(3): 629-634. doi:10.24911/IJMDC.51-1574924783


Web Style

Alsowayan W, Halzaa AM, Alatwi SA, Alokayli ANH, Al-Moaibed GF, Alharbi MSS, Ali AA. Knowledge, attitude, and practice in regards to antibiotic use in upper respiratory tract infections among the general population in Saudi Arabia. http://www.ijmdc.com/?mno=75765 [Access: March 29, 2020]. doi:10.24911/IJMDC.51-1574924783


AMA (American Medical Association) Style

Alsowayan W, Halzaa AM, Alatwi SA, Alokayli ANH, Al-Moaibed GF, Alharbi MSS, Ali AA. Knowledge, attitude, and practice in regards to antibiotic use in upper respiratory tract infections among the general population in Saudi Arabia. IJMDC. 2020; 4(3): 629-634. doi:10.24911/IJMDC.51-1574924783



Vancouver/ICMJE Style

Alsowayan W, Halzaa AM, Alatwi SA, Alokayli ANH, Al-Moaibed GF, Alharbi MSS, Ali AA. Knowledge, attitude, and practice in regards to antibiotic use in upper respiratory tract infections among the general population in Saudi Arabia. IJMDC. (2020), [cited March 29, 2020]; 4(3): 629-634. doi:10.24911/IJMDC.51-1574924783



Harvard Style

Alsowayan, W., Halzaa, . A. M., Alatwi, . S. A., Alokayli, . A. N. H., Al-Moaibed, . G. F., Alharbi, . M. S. S. & Ali, . A. A. (2020) Knowledge, attitude, and practice in regards to antibiotic use in upper respiratory tract infections among the general population in Saudi Arabia. IJMDC, 4 (3), 629-634. doi:10.24911/IJMDC.51-1574924783



Turabian Style

Alsowayan, Waleed, Ahad Mesfer Halzaa, Sarah Ali Alatwi, Afaf Nasser Hamoud Alokayli, Ghusoon Fathi Al-Moaibed, Maram Saidan Saad Alharbi, and Afnan Abdulraheem Ali. 2020. Knowledge, attitude, and practice in regards to antibiotic use in upper respiratory tract infections among the general population in Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (3), 629-634. doi:10.24911/IJMDC.51-1574924783



Chicago Style

Alsowayan, Waleed, Ahad Mesfer Halzaa, Sarah Ali Alatwi, Afaf Nasser Hamoud Alokayli, Ghusoon Fathi Al-Moaibed, Maram Saidan Saad Alharbi, and Afnan Abdulraheem Ali. "Knowledge, attitude, and practice in regards to antibiotic use in upper respiratory tract infections among the general population in Saudi Arabia." International Journal of Medicine in Developing Countries 4 (2020), 629-634. doi:10.24911/IJMDC.51-1574924783



MLA (The Modern Language Association) Style

Alsowayan, Waleed, Ahad Mesfer Halzaa, Sarah Ali Alatwi, Afaf Nasser Hamoud Alokayli, Ghusoon Fathi Al-Moaibed, Maram Saidan Saad Alharbi, and Afnan Abdulraheem Ali. "Knowledge, attitude, and practice in regards to antibiotic use in upper respiratory tract infections among the general population in Saudi Arabia." International Journal of Medicine in Developing Countries 4.3 (2020), 629-634. Print. doi:10.24911/IJMDC.51-1574924783



APA (American Psychological Association) Style

Alsowayan, W., Halzaa, . A. M., Alatwi, . S. A., Alokayli, . A. N. H., Al-Moaibed, . G. F., Alharbi, . M. S. S. & Ali, . A. A. (2020) Knowledge, attitude, and practice in regards to antibiotic use in upper respiratory tract infections among the general population in Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (3), 629-634. doi:10.24911/IJMDC.51-1574924783