Descriptive Study on Parents’ Knowledge, Attitudes and Practices on Antibiotic Use and Misuse in Children with Upper Respiratory Tract Infections in Cyprus

Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi street, Larissa 41222, Greece.
International Journal of Environmental Research and Public Health (Impact Factor: 2.06). 08/2011; 8(8):3246-62. DOI: 10.3390/ijerph8083246
Source: PubMed


Upper respiratory tract infections (URTIs) are common in children and represent a significant cause of antibiotic abuse which contributes to the development of antibiotic resistance. A survey was conducted in Cyprus in 2006 to assess parents' and pediatricians' Knowledge, Attitude and Practices (KAP) concerning the role of antibiotics in children with URTIs. A school-based stratified geographic clustering sampling was used and a pre-tested KAP questionnaire was distributed. A different questionnaire was distributed to paediatricians. Demographic factors associated with antibiotic misuse were identified by backward logistic regression analysis. The parental overall response rate was 69.3%. Parents (N = 1,462) follow pediatricians advice and rarely administer antibiotics acquired over the counter. Although a third expects an antibiotic prescription for URTI symptoms, most deny pressuring their doctors. Low parental education was the most important independent risk factor positively related to antibiotic misuse (OR = 2.88, 95%CI 2.02 to 4.12, p < 0.001). Pediatricians (N = 33) denied prescribing antibiotics after parental pressure but admit that parents ask for antibiotics and believe they expect antibiotic prescriptions even when not needed. In conclusion, Cypriotic parents trust their primary care providers. Although it appears that antibiotic misuse is not driven by parental pressure, the pediatricians' view differs.

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    • "Neither a Swedish prospective cohort study nor a Norwegian survey observes an association between antibiotic consumption and immigration background [32,33]. A Cyprian cross-sectional-study finds a higher inappropriate antibiotic use by children with immigration background [34]. Furthermore, data of an Italian cohort-study suggests a significant higher antibiotic prescribing rate for URTIs for children with immigration background [27]. "
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    ABSTRACT: Background Medicines to treat common colds (CC) and upper respiratory tract infections (URTI) are widely used among children, but there are only few data about treatments actually applied for these diseases. In the present study we analyze the prevalence and correlations of self-medicated and prescribed drug use for the treatment of CCs and URTIs among children and adolescents in Germany. Methods Medicine use during the week preceding the interview was recorded among 17,450 children (0–17 years) who participated in the drug interview of the 2003–2006 German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The definition of CCs and URTIs in the present study included the WHO-ICD-10 codes J00, J01.0, J01.9, J02.0, J02.9, J03.0, J03.9, J04.0, J06.8, J06.9, J11.1, J11.8, R05 and R07.0. Using the complex sample method, the prevalence and associated socio-demographic factors of self-medication, prescribed medicines and antibiotics were defined. Results 13.8% of the participating girls and boys use drugs to treat a CC or an URTI. About 50% of this group use prescribed medications. Among the users of prescribed medication, 11.5% use antibiotics for the treatment of these diseases. Looking at all prescribed medicines we find associations with younger age, immigration background, and lower social status. Antibiotic use in particular is associated with female sex, higher age, residency in the former East Germany and immigration background. Conclusions The use of medicines to treat CCs or URTIs is widespread among children and adolescents in Germany. Thus, longitudinal studies should investigate the risks associated with this drug use. Differences in socio-demographic variables regarding exposure to antibiotic use indicate that there could be an implausible prescribing behavior among physicians in Germany.
    Full-text · Article · Aug 2014 · BMC pharmacology & toxicology
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    • "We found that 79% of parents thought that antibiotics could cure infections caused by viruses, a higher percentage than was found in a pan-European study (54%) [25]. Further, half of the parents in the present study believed that antibiotics could shorten the duration of URTI symptoms, similar to the findings of a study conducted in Cyprus (48%) [26] but higher than previous findings in the United States (19%) [27]. A major concern is that nearly half of the parents in the present study thought that taking antibiotics in advance could protect children from the common cold. "
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    ABSTRACT: The purpose of the study was to investigate parents' perceptions of antibiotic use for their children, interactions between parents and physicians regarding treatment with antibiotics, and factors associated with parents self-medicating children with antibiotics. A cross-sectional study was conducted in vaccination clinics in two rural Chinese counties. Primary caregivers (the child's parents in 97% of cases) visiting these clinics for the vaccination of their young children were given a 55-item structured questionnaire to collect information on the parents' knowledge and attitudes regarding when, why, and how to use antibiotics and on their practices of purchasing antibiotics and medicating children. Of the 854 participating primary caregivers, 79% thought antibiotics could cure viral infections, and half believed that antibiotics could shorten the duration of upper respiratory tract infection. Parents reported a median of two hospital visits for their children during the previous 6 months, equal to the median number of antibiotic prescriptions received from physicians. Sixty-two percent of the parents had self-medicated their children with antibiotics. Living in rural villages (Adj OR = 1.643, 95% CI: 1.108-2.436), raising more than one child (Adj OR = 2.174, 95% CI: 1.485-3.183), increasing age of child (Adj OR = 1.146, 95% CI: 1.037-1.266), purchasing antibiotics without a prescription (Adj OR = 6.264, 95% CI: 4.144-9.469), storing antibiotics at home (Adj OR = 2.792, 95% CI: 1.961-3.975) and good adherence to physicians' advice (Adj OR = 0.639, 95% CI: 0.451-0.906) were independently associated with self-medicating behavior. Low levels of knowledge on the use of antibiotics and a high prevalence of self-medicating children with antibiotics were observed among parents in rural China. Interventions for the rational use of antibiotics in children should focus on strengthening mass health education, improving effective communication between physicians and patients, and enforcing supervision of the sale of antibiotics in retail pharmacies.
    Full-text · Article · Feb 2014 · BMC Infectious Diseases
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    ABSTRACT: To assess the impact of intervention on antibiotic misuse in children, parents' and pediatricians' knowledge, attitudes, and practices (KAP) concerning antibiotic use were evaluated pre- and postintervention in Larnaca (Cyprus) and Limassol (Cyprus). Concurrently, pediatricians documented upper respiratory tract infection (URTI) visits and pharmacists provided antibiotic consumption data. Intervention was implemented for parents and pediatricians residing in Larnaca. The consumption/URTI incidence index was significantly reduced in Larnaca but not in Limassol. Parental responses to a KAP questionnaire remained unchanged; therefore, antibiotic consumption reduction is attributable to pediatricians' education.
    Full-text · Article · Dec 2011 · Antimicrobial Agents and Chemotherapy
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