Assessing Knowledge, Attitudes and Practices on Antibiotics amongst University Graduates in Bhutan: A Cross-Sectional Survey

Introduction: Concerns about antibiotic resistances is increasing. Antibiotic misuses mostly result from inadequate knowledge impacting attitudes and practices. The literature on this subject is limited in Bhutan. It is of immense importance to understand the gap and target interventions. Therefore, we assessed the knowledge, attitudes and practices (KAP) on antibiotics amongst Bhutanese university graduates in 2016.

Methods: The survey was conducted through a self-administered online questionnaire after seeking consent. The questionnaire was developed by the investigators using past literature.

Results: Of the 2,229 invited graduates, only 220 (≈10%), 52.3% (115) males, completed the survey. Internet was the commonest source of information on antibiotics. Only 51% (113) showed good knowledge with a mean score of 15.5 (range 2-30). Penicillin, amoxicillin and cotrimoxazole were correctly identified as antibiotics by 63.6%, 78.7% and 21.4% but 11.4%, 35% and 31.8% misidentified atenolol, paracetamol and ibuprofen as antibiotics respectively. Side effects of antibiotics were poorly recognized. Fifty-four percent (119) showed good attitude score. About 39% (85), 35% (76) and 46% (101) misconceived that antibiotics would be required for common cold, all fevers and all small clean-cut wounds respectively. Almost 91% knew that antibiotic courses should be completed, 12% thought that antibiotics can be stopped when patients improve and 31.8% repeated antibiotics for similar illnesses. Although 76% knew that antibiotics shouldn’t be bought without a prescription, 28% were able to get them. About 44.1% revealed that the dispensing pharmacists did not explain adequately about antibiotics. Unfortunately, 43.6% suggested others to take antibiotics during illnesses and 60% used topical antibiotics.

Conclusion: KAP on antibiotics amongst Bhutanese graduates was unsatisfactory except few good specific practices. Health authorities should educate public on antibiotics and other medicines.