| BackgroundAntibiotics are widely used to treat infection and protect the health. As one of the most popular drugs, antibiotic is only next to cardiovascular drug in the international market. In China, roughly 10 out of top 15 drugs in use and sale come from antibiotics. However, irrational and overuse of antibiotics lead not only to the emergence of resistant bacteria but also to economic loss and adverse reactions, which is a rapidly increasing global problem that have attracted public attentions.Generally, it is physicians that to determine when or how antibiotics should be used. But under some circumstance, patients or their family members might practice self-medication (the use of any non-prescription medicine), including types of antibiotics, ways to use, procedures and dosage. Although much emphasis has been put on the inappropriate antibiotic usage inside hospitals, little is put in the households where the problem is more serious.Many studies concerning the antibiotic use and self-medication were carried out in other countries, but very few had been performed in china. Moreover, the foreign studies were based on different populations and methods, and included the prevalence of self-medication, types and sources of antibiotics, aims, medical knowledge, influencing factors etc; while the limited reports in China was only about exam of medical knowledge, experience of self-medication, which was not community-oriented studies and did not reach the status of antibiotic use, particularly self-medication, and its influencing factors.ObjectivesThe objectives of this study were to estimate the prevalence of antibiotic use and self-medication in community inhabitants, and to identify the factors associated with such misuse; Furthermore, to explore the measures against irrational use of antibiotics, and to motivate the rational use in the whole society.(1) To estimate the prevalence and distribution of antibiotic use and self-medication in Changsha based on a survey in a representative community; to assess the degree of irrationality of antibiotic usage both on the professional level and administrative level; to describe the basic characteristics of antibiotic use in community, and analyze the factors associated with such misuse; to provide bases for preventing from or controlling the irrational use.(2) To analyze the process of self-medication and its influencing factors by interviewing family decision makers. To describe the basic characteristics of family decision makers, accordingly to provide bases for education of healthcare. (3) To estimate the status of antibiotic sale and administration, purchase with prescription or not and its influencing factors by random sampling in pharmacies, accordingly to provide bases for controlling the purchase without prescription.(4) Based the studies above, to give suggestion to the inhabitants, pharmacies, hospitals, institutions of community service, departments of medicine administration, for the rational antibiotics use.Methods(1) Place:Xianjia Community (Yuelu District, Shangsha city, Hunan Province) was selected as the survey area by consulting to some specialist and administrative managers. There was a resident population of about 12,000, approximately 4020 households, among which were there 1292 households involved in the survey.A sample of 5 large scale retail pharmacies, located in the 5 different administrative regions of Changsha, was selected in the survey. All of them were more than 150 m2 in size, operating more than 3000 types of drugs, having sales of over 10000 per day and purchasers over 500 per day. The top 3 purchasers of every hour (from 9 a.m to 6 p.m) were included in the survey, if customer refused the interview, the person close behind was selected. A total of 1327 individuals (about 260 from each pharmacy) were finally involved in the survey. (2) Tools:Two questionnaires, "antibiotic use in community"and "antibiotic purchase in pharmacies", were developed specifically for this survey. The questionnaires were carefully designed on the base of correlating references, interviewing the object person, specialist assessing, repeatedly testing and modifying.Items involved in the questionnaire "antibiotic use in community" were:①The demographic characteristics of inhabitants in the community, and their status of health, economy, and medical insurance.②The overall status of antibiotic usage and self-medication. That was the occurrence rate of antibiotic usage, self-medication, and the types, ways, reasons of the usage, effects and side-effects after the use.③The rationalities of antibiotics usage. That was the occurrence rate of self-edification and irrational usage (without indication or wrong selection, method, procedure).④The demographic characteristics of decision makers in family, and their knowledge, attitude, habits towards antibiotic usage, and enjoyment of medical service.Items involved in the questionnaire "antibiotic purchase in pharmacies" were:①The demographic characteristics of the purchasers, and their status of health, economy, and medical insurance.②The overall status of antibiotic purchase.③The purchaser's knowledge towards antibiotic usage.(3) Process:The community survey was conducted mainly by household visiting, the well-trained investigators identified the decision makers (persons who played a decisive role in drug usage to all the family members), then guided them to complete the questionnaire. The pharmacy survey was performed mainly by interviewing and guiding customers to complete the questionnaire.(4) All of the original data was imput in Epidata database and analyzed by SPSS11.5. The majority of the results in the questionnaire were described as frequency or constituent ratio. The bases for grouping were:the similar patients having antibiotics usage and self-medication or not; purchasing in the pharmacies with prescription or not. The data was analyzed by chi-square test (single variable) and logistic regression (multi-variables) to estimate the possible influencing factors to antibiotics usage, self-medication and purchasing under prescription.ResultsCommunity surveyA survey was practically conducted in 1322 households, among which there were 45 refusing to participate in interview. The mean response rate in community was 96.7%. A total of 1270 households (3835 individuals) were finally used to statistic analysis.1. The basic characteristics of the samples(1) The demographic characteristics of household members:Among the 3835 respondents, male accounted for 48.5%(1859/3835), female accounted for 51.5%(1976/3835). The eldest was 93-year-old, and the youngest was 1, with an average age of 37.4±18.5; 34.6% of the samples had acquired college degree or above,20.1% were workers.(2) The demographic characteristics of household decision makers:Among the 1270 decision makers towards antibiotics usage, female accounted for 66.4%(843/1270), male accounted for 33.6%(427/1270); the eldest was 78, and the youngest was 19, with an average age of 41.2+-11.8; 43.1% of the decision makers had acquired college degree or above,24.5% were workers.(3) The characteristics of respondents families:34.2% had an average monthly income of 1000-2000 yuan.69.3% had a medical cost of 500-1000 yuan in the last year.2. The rate of antibiotics use and self-medication occurrenceThere were at least 1person in 476 households that had used antibiotics in the last 1 month. The total population of antibiotics use was 560 (14.6%,560/1270), among which were there 472 that admitted to self-medication (12.3%,472/1270).3. The basic characteristics of antibiotics usageAmoxicillin was the most commonly used antibiotics in the respondents, representing 21.5% of total drugs. Diseases or syndrome of respiratory system was the major cause of antibiotics usage (56.8%). Side-effects occurred in 12.67% of the users. The rate of irrational antibiotics usage was 74.1% on the administrative level, and 72.3% on the professional level.4. The status of antibiotics storage 68.7% of households had kept antibiotics in house, most of which were amoxicillin and roxithromycin. The majority of households had only one kind of antibiotics kept,13 households had four kinds of antibiotics kept.5. The knowledge, attitude and behavior of household decision makers(1) The knowledge towards antibiotics use:64.3% of the respondents had passed the examination. As chi-square test shown, who having a higher likelihood to pass the exam were:decision makers ranging froml 8 to 40 years old, the persons having received higher education, teachers and administrative managers, persons holding a position, and those having medical insurance. Logistic regression analysis demonstrated that the higher level of education, better self-evaluation and more guidance from others were significantly correlated with higher passing rate.(2) The attitudes towards antibiotics usage:21.6% of the respondents agreed to use antibiotics to treat light malaise,30.6% thought the antibiotics could be bought without prescription. On the basis of chi-square test, a higher percentage of active antibiotics users were females, the aged, people with lower level of education, peasants, the retired and unemployment. Users of self-medication were more likely to be the aged, people with lower level of education, retired, and low grades in the exam.(3) The habits and behaviors of antibiotics user:40.8% of the respondents often went to pharmacies for drugs,86.2% had the experiences of self-medication with oral preparation or injection of antibiotics.13.3% had admitted to modify the prescriptions usually. chi-square test illustrated the persons more likely going to pharmacies for antibiotics were:the female, those more than 65-year-old, with primary school degree or below, or the retired. Persons prone to modify the prescriptions were:female, those with junior high school degree or below, peasants, and the unemployment.6. The influencing factors of antibiotics useThere were 212 respondents having the syndromes of upper respiratory tract (represented as nasal obstruction, rhinorrhea, sneezing, dry cough, pharynx itching and pharyngalgia), among which were there 177 individuals had used antibiotics. The statistic analysis was based on the 212 sufferers and their related families.As chi-square test tests shown, a higher proportion of antibiotics usage occurred in the following circumstance:the users were female, persons less than 18 years old, those with a primary school degree or below, students, the unemployment; decision makers were more than 65 years old, with low level of education, being office workers; families contained the aged or children, patients with chronic disease, a worse self-evaluated decision maker; decision makers had poor knowledge of drug usage, or had higher frequency in antibiotics purchase and preserve, modifying doctor's prescriptions, or had a positive attitude in antibiotic usage and self-medication.Logistic regression analysis demonstrated that the following factors were associated with household antibiotic usage:the users with younger age and lower education degree, the decision makers with older age and lower education degree, decision makers more likely to purchase and save drugs, modify doctor's prescriptions, having a positive attitude in antibiotic usage and self-medication.7. The influencing factors of antibiotics self-medicationAmong the 212 respondents having upper airway syndromes in the last 1 month,159 individuals admitted to have self-medication,18 individuals used antibiotics under prescriptions, and 35 individuals did not use any antibiotics. The statistic analysis concerning influencing factors of self-medication was based on the 212 sufferers and their related families.As chi-square test shown, a higher proportion of antibiotics usage occurred in the following circumstance:the patients were female, less than 18 years old, those with a primary school degree or below,without medical insurance; decision makers were more than 65 years old, with low level of education; families contained patients with chronic disease, lower monthly income, could not undertake medical cost; decision makers had poor knowledge of drug usage, or had higher frequency in antibiotics purchase and preserve, modifying doctor's prescriptions, or had a positive attitude in antibiotic usage and self-medication, or frenquently experienced effective antibiotic self-medication,or had better self-evaluated in knowledge,or suggested doctor to prescribe antibiotics for commom cold,or had a positive attitude to light symptoms medication,or did not care the report about drug adverse reaction,or were little trained on proper self-medication.Logistic regression analysis demonstrated that the following factors were associated with household antibiotic self-medication:the patients with younger age and lower education degree;the decision makers with older age, decision makers more likely to purchase drugs, modify doctor's prescriptions, having a positive attitude in antibiotic usage and self-medication, or frenquently experienced effective antibiotic self-medication, not satisfied with medication guidance in hospital.Pharmacy surveyA total of 1327 customers were interviewed and 1292 questionnaires were collected with a mean response rate of 97.4%. The statistic analysis was performed on the basis of the available 1285 questionnaires.1. The demographic characteristics of the sampleAmong the 1285 respondents, male accounted for 36.5%(469/1285), female accounted for 63.5%(816/1285). The eldest was 85-year-old, and the youngest was 18 with an average age of 49.8±18.5; 37.2% of the respondents had acquired high school degree or above,32.1% was workers.2. The rate of antibiotics purchase and purchase with prescriptionThe rate of antibiotics purchase in pharmacies was 25.3%(325/1285), 15.1%(49/325) of the purchaser had doctor's prescription.241 respondents had bought the POM antibiotics,18.7%(45/241) of whom had prescription, while 81.7%(196/241) had not.3. The status of antibiotics purchaseAmoxicillin was the most commonly purchased antibiotics, accounting for 10.5% of the total purchase.20.0% of the respondents (65/325) bought antibiotics for storage in the house.80.0% for the demand of themselves or their family members. The purchasers without prescription mainly aimed to treat light syndromes (such as nasal obstruction, rhinorrhea, sneezing, dry cough, pharynx itching and pharyngalgia), while the purchasers with prescription targeted to a worse illness (represented as bronchitis, amygdalitis, bronchopneumonia etc). Among the 196 individuals who bought POM antibiotics without prescription, 69 (35.2%) were more likely to take the previous prescription as a basis.4. The knowledge towards antibiotics use67.0%(861/1285)of the pharmacy customers had passed the examination. Only 23.8%(306/1285) understood the law of sale concerning POM antibiotics.5. The influencing factors to POM antibiotics usage under prescriptionAs chi-square test shown, the purchasers with prescription were more likely to be:who had acquired a college degree or above, had an average monthly income more than 2000 yuan, got a high grade in the exam, knew well about the law of sale.Logistic regression analysis demonstrated that purchasers under prescription were more likely to be:those had a higher average monthly income, knew better about the law of sale. Conclusions1. It is suggested that antibiotics use and self-medication has become a popular phenomenon in society based on the survey in community. The higher rate of irrational usage and side-effects implies the possibility of serious consequence.2. The factors associated with antibiotics use and self-medication are:the demographic characteristics of the drug users and family decision makers, attitudes and habits of decision makers towards antibiotics usage, lack of guidelines in the hospital, breaking the sale regulation by pharmacy.3. The rate of antibiotics POM purchase with prescription is lower in pharmacies.4. There are many incorrect viewpoint and behavior in antibiotic use knowledge,attitudes and habits in general population.5. The main reasons with antibiotics self-medication are:the patients with younger age and lower education degree;the decision makers with older age and lower education degree; the decision makers with no proper attitudes and habits in use drugs, not satisfied with medication guidance in hospital.6. The interventions are required in ordered to reduce antibiotice irrationnal in general population:educational campaign for community population, drugs sale management in pharmacy, medication guidance to patients in hospital.New ideas1. For the first time, antibiotics use, self-medication and the influencing factors were studied base on community.2. For the first time, the strategies taking household as a unit and family decision maker as a interviewee were used in the survey.3. Suggestions were made on controlling misuse in community.
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