Research Article: Is the level of knowledge a predictor of rational antibiotic use in Serbia?

Date Published: July 10, 2017

Publisher: Public Library of Science

Author(s): Olga J. Horvat, Ana D. Tomas, Milica M. Paut Kusturica, Alisa V. Savkov, Dragica U. Bukumirić, Zdenko S. Tomić, Ana J. Sabo, Yeng-Tseng Wang.


The objective of this study was to investigate the knowledge, attitudes and behavior regarding antibiotics of the general population.

The study sample consisted of adult subjects who consulted general practitioners at health centers in Serbia and agreed to complete the questionnaire. A total of 668 questionnaires were distributed; 500 respondents completed the entire questionnaire (response rate 74.85%).

The average age was 51.65 ± 16.56 years, 60.80% of the respondents were women. The median antibiotic knowledge score was 9. Predictors of adequate antibiotic knowledge were higher education level and a family member whose ocuppation was related to health-care. Overall, 58.4% of respondents believed that antibiotics could be used to treat common cold. Around a half of the respondents (47.2%) self-medicated with antibiotics at least once during their life-time, and around a quarter (24.2%) during the last treatment of infection. Patients with inadequate knowledge had 3 times higher chances of self-medicating with antibiotics compared to those with adequate knowledge. Although 98.20% of respondents claimed that antibiotic treatment should be started after a visit to a doctor and receiving a prescription, only 65.8% obtained antibiotics with prescription from a doctor during the last infection.

Although these results demonstrate that respondents had a relatively adequate level of knowledge regarding antibiotics use, some areas of misconceptions and improper behavior were identified. Therefore, further rationalization should be focused on educational campaigns targeting the behavior of patients with regard to antibiotic use.

Partial Text

Antimicrobial resistance is a global public health problem of the 21st century because bacterial resistance to antibiotics is associated with increased morbidity and mortality of serious infections and health care costs. According to the report of the National Reference Laboratory for Antimicrobial Monitoring and Surveillance, Serbia belongs to a group of European countries with the highest rates of resistance [1, 2].

This study aimed to reflect the state of knowledge and behavior regarding antibiotic use of the Serbian general population, as well as to elucidate factors influencing the main outcomes of interest. To the best of our knowledge, this is the first detailed study of this type conducted in Serbia.

Despite the fact that almost two-thirds of the respondents showed adequate knowledge about antibiotics, this study identified a number of erroneous perceptions that include thinking of antibiotics as useful in the treatment of common cold and that the treatment lasts until the symptoms disappear. Educational level and family member whose occupation was related to health care were found to be important indicators of the adequate antibiotic knowledge. Improper antibiotic behavior patterns, such as irregular use and stopping treatment as soon as the symptoms subsided, were also common among the respondents. Although respondents with adequate knowledge on antibiotics were more likely to report appropriate behavior with regard to antibiotic use, notable number of patients with adequate knowledge reported some aspect of improper behavior. Due to the noted discrepancy between patients’ knowledge and behavior regarding use of antibiotics in our study, the next step in further rationalization of the use of antibiotics should be targeted educational campaign focused on the behavior of patients in regard to antibiotic use, and constructive inclusion of physicians, pharmacists and other health care providers, who are trustworthy components of any health education and promotion programs. This kind of intervention would significantly act on the achievement of a higher degree of control of antibiotics use, but also on decrease of antibiotic resistance, which is an alarming problem in Serbia.




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