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A study on the relationshipbetween improved patientknowledge andcompliance with antibiotic
use
Cathar ina Colette Beukes
Supervisor: Professor A.G.S. Gous
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Background:
Antibiotic resistance is fast becoming amajor health challenge. Patients need
to be educated on the origin of thismedical crisis and need to changetheir attitude toward antibiotic use.
Health professionals need to helppatients improve antibiotic complianceand identify problem areas.
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Objectives:
The aim of this study was to determine whether abetter understanding of resistance formation andpatient education on responsible use of antibioticswill improve patient compliance towards antibioticuse.
To achieve the aim of the study: Determined the patients compliance on antibiotic use by
the self-pill count feedback method. Determined whether the provision of more antibiotic
information to the patient correlated to better complianceand
Other reasons for non-compliance were also recorded. Compared the findings of the study with other similar
antibiotic compliance studies.
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Methodology:
The study was conducted at a privatehospital in Gauteng. Patients receivingantibiotic prescriptions were divided into
two groups. Group A received a leaflet withtheir antibiotic prescription with informationon how to use antibiotics responsibly. GroupB did not receive any additional informationon antibiotic use. Both these groups werecontacted via e-mail and asked to completea survey to test their knowledge andattitude towards antibiotics.
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Antibiotics: Wise-up and take responsibility Antibiotics are the first line of defence against many infections, however, overusing or misusing antibiotics can cause treatment failure in
future.
What are antibiotics?
Antibiotics are used for treating many less serious to life-threatening diseases caused by bacterial infections. Taking antibiotics when youdon't need to, can lead to antibiotic-resistance. Antibiotics are only effective against bacterial infections, certain fungal infections and somekinds of parasites. Most infections result from either bacteria or viruses. Antibiotics are not effective against viral infections!
Common bacterial infections cause severe upper-respiratory-tract infections e.g. pneumonia, wound and skin infections and urinary tractinfections.
Common colds, influenza, most ear infections and stomach flu are caused by viral infections. These can be treated by anti-viral drugs or
by treating the symptoms.
How does antibiotic resistance develop?
Penicillin was introduced in the first part of the 20th century and since then scientists have developed many more antibiotics to help stopthe spread of infectious disease. Antibiotics have saved millions of lives but because of frequent use, often for conditions or infections thataren't caused by bacteria, the bacteria have become resistant to many commonly used antibiotics.Resistance develops when an antibiotic fails to kill all of the bacteria it targets. The surviving bacteria adapt and become more resistant tothat particular drug. Doctors then needs to prescribe stronger antibiotics, but the bacteria quickly learn to defend themselves against themore potent drugs as well, creating a cycle in which increasingly powerful drugs are required to treat infections.Experts are working to develop new antibiotics and to keep pace with antibiotic-resistant strains of bacteria, but bacteria adapt quickly.
Antibiotic-resistant bacteria continue to be a global health concern and using antibiotics wisely is an important part of preventing thedevelopment of resistance.
Consequences of antibiotic resistance
As an increasing amount of bacteria become resistant to first line treatments, the consequences become severe. Illnesses last longer, andthe risk of complications and death increases. The inability to properly treat a particular infection leads to longer periods in which aperson is contagious and able to spread the resistant bacterial strains to others.Because of first line treatment failures, doctors have to resort to less-conventional antibiotics, many of which are much more costly andhave more side-effects.Many other factors need to be considered, including the increased costs associated with prolonged illnesses, direct expense for additionallaboratory tests, treatments and hospitalization, and the indirect costs from loss of income or time away from family.
Safeguard effective antibiotics: What you can do
Finishing your prescribed course of antibiotics is utmost importance.
Using antibiotics too often or incorrectly is a major cause of the increase in resistant bacteria. Here are some things you can do topromote proper use of antibiotics:
Understand when antibiotics should be used.Don't expect to take antibiotics every time you're sick. Antibiotics are effective in
treating bacterial infections, but they're not useful against viral infections, such as colds, acute bronchitis, or the flu. And even somecommon minor bacterial ailments, such as mild ear infections, don't benefit much from antibiotics.
Don't pressure your doctor for antibiotics if you have a viral illness. Talk to your doctor about ways to relieve the symptoms ofyour viral infection.
Take antibiotics exactly as prescribed.Follow your doctor's instructions when taking prescribed medication, including how manytimes a day and for how long. Never stop treatment a few days early if you start feeling better a complete course of antibiotics isneeded to kill all of the harmful bacteria. A shortened course of antibiotics often only kills the most vulnerable bacteria, while allowingrelatively resistant bacteria to survive.
Never take antibiotics without a prescription. You might be tempted to use leftover medication the next time you get sick. Thismight be the incorrect antibiotic for you infection and an incomplete course.
Protect yourself from infection in the first place.Good hygiene can go a long way in preventing infection. Wash your handsthoroughly with soap and water, especially after using the toilet, changing a diaper or handling raw meat or poultry. Keep foodpreparation areas clean.
Antibiotic resistance is a pressing, global health problem. Nearly all bacterial infections are becoming resistant to commonly usedantibiotics. When you abuse antibiotics, the resistant micro-organisms that you help create can cause new and hard-to-treat infections.That's why the decisions you make about antibiotic useunlike almost any other medicine you takeextend far beyond your reach.Responsible antibiotic use protects the health of your family, neighbours and ultimately the global community.
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Dear Pretoria East Hospital Pharmacy Patient,
We would like to follow-up on the use of your antibiotics received at
our pharmacy on ________. A questionnaire survey has beencompiled to measure patients adherence to antibiotic prescriptioninstructions and also the information received from the pharmacist orassistant that issued your prescribed antibiotics.
We would appreciate it if you could take 3 minutes to answer the 11questions. This survey aims to determine how we can improve ourservice to patients and ensure that patients receive the necessary
information regarding the medication they need to take.
All patient information will be kept confidential and will only be usedfor the purposes of the study. No names are asked in thisquestionnaire and all data will be saved anonymously.
Your consent to partake in this study will be given by completing the
questionnaire below and returning it to the sender. Your participationwould be greatly appreciated.
Please first answer the questions, next 'copy' the text with the givenanswers. Click on the reply button, then 'paste' thecompleted questionnaire before clicking on the send button.
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1. Have you finished you antibiotic course?YesNo
If you answered 'No', please specify how many of the tablets or how much of thesuspension do you have left over?
2. Did you finish the antibiotics in the prescribed time?YesNo
3. The following might be possible reasons for not finishing theprescribed antibiotics. Choose the most appropriate option.
You felt better before the antibiotic course was finishedThe antibiotics made you feel worseThe antibiotic course was too longYou did not know for how long to take your antibioticsYou did not receive the whole antibiotic courseYou had trouble taking the antibiotics because of tablet size or flavourYou forgot to take the antibioticOther reasons or when answeringYesto question 1.Please explain when choosing 'Other reasons':
4. Do you know what happens when one does not finish acourse of antibiotics?Yes
NoIf your answer is 'Yes', what do you think would happen?
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5. What have you done with left-over antibiotics in the past?Kept it for future useThrew it awayGave it to someone that needed antibiotics6. What would you do with left-over antibiotics in future?
7. Would you ask your doctor for antibiotics when you have acommon cold?YesNoHave you asked your doctor for antibiotics when having a common cold in thepast?
8. Did you receive an 'Antibiotics: wise-up and take responsibility'brochure from your pharmacist?
Did you read the brochure? (answer from drop-down menu)YesNo9. What is the most important lesson you learned by reading the
'Antibiotics: wise-up and take responsibility' brochure?
10. In what way would you change your use of antibiotics, if youwould change anything?
11. Would you prefer to receive more information on responsibleantibiotic use?
YesNo
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Results:
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274Patients
138Received additional
antibiotic information
136Received no
additional antibioticinformation
39 responses=
39 participants99 no response
40 responses=
40 participants96 no response
32 read theadditional information
=Group Aa
7 did not read theadditional
information=Group Ab
40 did not receiveadditional information
=Group B
24 adult participants8 child participants
4 adult participants3 child participants
31 adult participants9 child participants
71 adult patients28 child patients
71 adult patients25 child patients
Participant response rate
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A total of 79 patients participatedin the study. Group A with 39
participants and Group B with 40participants completed thequestionnaire and reported on
their antibiotic usage andknowledge
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0
2
4
6
8
10
12
14
%o
fpatientprescriptio
ns
0-14y
ears
15-19
year
s
20-29
year
s
30-39
year
s
40-49
year
s
50-59
year
s
60-69
year
s
70-79
year
s
80-89
year
s
Age group
Male
Female
Patient age distribution
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1. Have you finished your antibioticcourse?
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Question Sample(N) 79 Yes % No % Grouptotal
1. Have you
finishedyour
antibiotic
course?
Group
Aa31 96.88% 1 3.12% 32
(100%)Group
Ab 5 71.43% 2 28.57% 7 (100%)Group B 34 85% 6 15% 40
(100%)Total 70 88.61% 9 11.39% 79
(100%)
Group Aa, who was provided additional
information on antibiotic use and readthrough the brochure, showed a bettercompliance to the antibiotic regimen
prescribed.
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2. Did you complete the antibiotics in
the prescribed time?
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Question Sample(N) 79 Yes % No % Grouptotal
2. Did you
complete theantibiotics in
the
prescribed
time?
Group
Aa30 93.75% 2 6.25% 32
(100%)Group
Ab 5 71.43% 2 28.87% 7 (100%)Group B 33 82.50% 7 17.50% 40
(100%)Total 68 86.08% 11 13.92% 79
(100%)
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3: The following might be possible reasons for notfinishing the prescribed antibiotics. Choose themost appropriate option.
You felt better before the antibiotic course was finished 5 31%
The antibiotics made you feel worse 1 6%
The antibiotic course was too long 3 19%
You did not know for how long to take your antibiotics 0 0%
You did not receive the whole antibiotic course 0 0%
You had trouble taking the antibiotics because of tablet size 1 6%
You forgot to take the antibiotic 3 19%
Other reasons or when answering Yes to question 1. 3 19%
N = 16 100%
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6%19%
19% 6%
19%31%
The patient felt better before the
antibiotic course was finished
The antibiotics made the patient feel
wose
The antibiotic course was too long
The patient had trouble taking theantibiotics because of tablet size or
flavourThe patient forgot to take the antibiotic
Other reasons
Reportedreasons for patient non-compliance
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Participants gave various reasonsfor not being compliant. Most
patients stopped taking theirantibiotics as soon as they feltbetter.
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4: Do you know what happenswhen one does not finish a course
of antibiotics? What do you thinkwill happen?
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79 Participants
58Participants
Know whyone completeantibiotics73.42%
18Antibioticswill stopworking
21Participants
Dont know
why onecompleteantibiotics
26.58%
18Participant
s
Group B
3Participants
:
Group Ab
1Patient willbecomeimmuneto the
antibiotic
5No answer
15The
infectionwill notclear up
19Resistancewill develop
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79 Participants
58 Participants
Know why one completeantibiotics73.42%
18Antibioticswill stopworking
12Group Aa
21 Participants
Dont know why onecomplete antibiotics
26.58%
18Participants
Group B
3Participants:
Group Ab
1Patient will
become immuneto the antibiotic
5No answer
15The infection
will notclear up
19Resistancewill develop
5Group B
1Group Ab
13Group Aa
5Group B
1Group Ab
4Group Aa
9Group B
2Group Ab
3Group Aa
2Group B
0Group Ab
0Group Aa
1Group B
0Group Ab
73.42% 26.58%
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79 Participants
58 Participants
Know why one completeantibiotics73.42%
18Antibioticswill stopworking
31.03%
12Group Aa
66.67%
21 Participants
Dont know why onecomplete antibiotics
26.58%
18Participants
Group B85.71%
3Participants:
Group Ab14.29%
1Patient will
become immuneto the antibiotic
1.72%
5No answer
8.62%
15The infection
will notclear up
25.86%
19Resistancewill develop
32.76%
5Group B
27.77%
1Group Ab
5.56%
13Group Aa
68.84%
5Group B
26.31%
1Group Ab
5.26%
4Group Aa
26.67%
9Group B
60%
2Group Ab
13.33%
3Group Aa
60%
2Group B
40%
0Group Ab
0%
0Group Aa
0%
1Group B
100%
0Group Ab
1%
73.42% 26.58%
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79 Participants
58 ParticipantsKnow why one
completeantibiotics73.42%
18Antibioticswill stopworking31.03%
12Group Aa
66.67%
21 ParticipantsDont know why
one completeantibiotics
26.58%
18Participants
Group B85.71%
3Participants:
Group Ab14.29%
1Patient will
become immuneto the antibiotic
1.72%
5No answer
8.62%
15The infection
will notclear up
25.86%
19Resistancewill develop
32.76%
5Group B
27.77%
1Group Ab
5.56%
13Group Aa
68.84%
5Group B
26.31%
1Group Ab
5.26%
4Group Aa
26.67%
9Group B
60%
2Group Ab
13.33%
3Group Aa
60%
2Group B
40%
0Group Ab
0%
0Group Aa
0%
1Group B
100%
0Group Ab
1%
73.42% 26.58%
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When compared to Group Ab, whoreceived additional information onantibiotic use and did not read
through the brochure, and GroupB, who received no additionalinformation on antibiotic use, amuch higher percentage of Group
Aa was able to give valid reasonsas to why one should complete anantibiotic course.
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5: What have you done with left-over antibiotics in the past?
Kept it for future use
Threw it away
Gave it to someone that needed antibiotics
6. What would you do withleft-over antibiotics in future?
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Participants kept left-over antibiotics for future use
Patientskept
left-overantibiotics
forfuture use
n=19
9Patientsreceived
a brochureand
read theleafletGroup
Aa
3Patients receiveda brochure butdid not readthe leaflet
GroupAb
7Patients did not
receive aleaflet
Group B
2patients will
throw awaytheir
left-overantibioticsin future
7 patientswill completetheir antibiotic
courses infuture
1 patientwill complete
theantibioticcourse in
future
6 patients willstill keep their
left-overantibiotics
for future use
2 patients willstill keep their
left-overantibiotics
for future use
1 patient willthrow away the
left-overantibioticsin future
Futurebehaviour
Futurebehaviour
Past behaviour
Futurebehaviour
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Patients keptleft-over
antibiotics forfuture use
n=19
9Patients receiveda brochure andread the leaflet
Group Aa
3Patients received a
brochure butdid not readthe leafletGroup Ab
7Patients did not
receive aleaflet
Group B
2patients willthrow away their
left-over antibioticsin future
7 patientswill completetheir antibiotic
courses in future
1 patientwill complete theantibiotic course
in future
6 patients willstill keep their
left-over antibiotics
for future use
2 patients willstill keep their
left-over antibiotics
for future use
1 patient willthrow away the
left-over antibiotics
in future
77.78%+ve
change inbehaviour
n=7
0%+ve
change inbehaviour
n=0
14.29%+ve
change inbehaviour
n=1
Futurebehaviour
Futurebehaviour
Past behaviour
Futurebehaviour
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Patients keptleft-over
antibiotics forfuture use
n=19
9Patients receiveda brochure andread the leaflet
Group Aa
3Patients received a
brochure butdid not readthe leafletGroup Ab
7Patients did not
receive aleaflet
Group B
2patients willthrow away their
left-over antibioticsin future
7 patientswill completetheir antibiotic
courses in future
1 patientwill complete theantibiotic course
in future
6 patients willstill keep their
left-over antibiotics
for future use
2 patients willstill keep their
left-over antibiotics
for future use
1 patient willthrow away the
left-over antibiotics
in future
77.78%+ve
change inbehaviour
n=7
0%+ve
change inbehaviour
n=0
14.29%+ve
change inbehaviour
n=1
Futurebehaviour
Futurebehaviour
Past behaviour
Futurebehaviour
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Participants threw away left-over antibiotics
Participantsthrew awayleft-overantibiotic
49
17Participansreceived a
leaflet
Group Aa
4Participantreceived a
leaflet but did notread the leaflet
Group Ab
28Participantsreceived no
leafletGroup B
12 participantswill complete theantibiotic course
in future
5 participantswill throw away
left-overantibiotics
4 Participantswill throw away
left-overantibiotics
2 Participantswill complete theantibiotic course
in future
26 Participantswill throw away
left-overantibiotic
Past behaviour
Future behaviour Future behaviour
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Participantsthrew away left-over antibiotic
49
17Participansreceived a
leaflet
Group Aa
4Participantreceived a
leaflet but did notread the leaflet
Group Ab
28Participantsreceived no
leafletGroup B
12 participants willcomplete the
antibiotic course infuture
5 participants willthrow away left-over antibiotics
70.59%+vechange inbehaviour
n=12
4 Participants willthrow away left-over antibiotics
0%+ve change inbehaviour
n=0
2 Participants willcomplete the
antibiotic course infuture
26 Participants willthrow away left-over antibiotic
7.14%+vechange inbehaviour
n=2
Past behaviour
Future behaviour Future behaviour
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Participantsthrew away left-over antibiotic
49
17Participansreceived a
leaflet
Group Aa
4Participantreceived a
leaflet but did notread the leaflet
Group Ab
28Participantsreceived no
leafletGroup B
12 participants willcomplete the
antibiotic course infuture
5 participants willthrow away left-over antibiotics
70.59%+vechange inbehaviour
n=12
4 Participants willthrow away left-over antibiotics
0%+ve change inbehaviour
n=0
2 Participants willcomplete the
antibiotic course infuture
26 Participants willthrow away left-over antibiotic
7.14%+vechange inbehaviour
n=2
Past behaviour
Future behaviour Future behaviour
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Participant will giveleft-over antibiotic tosomeone who might
need antibiotics
3
3Participants
received a leaflet
Group Aa
3Participants will complete thecourse of antibiotics in future
Participants gave left-over antibiotics to someone in need of antibiotics
Past behaviour
Future behaviour
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Participant will giveleft-over antibiotic tosomeone who might
need antibiotics3
3Participants
received a leaflet
Group Aa
3Participants will complete thecourse of antibiotics in future
100%+ve change to
behaviour
n=3
Past behaviour
Future behaviour
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Participant will giveleft-over antibiotic tosomeone who might
need antibiotics3
3Participants
received a leaflet
Group Aa
3Participants will complete thecourse of antibiotics in future
100%+ve change to
behaviour
n=3
Past behaviour
Future behaviour
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Participant always completethe antibiotic course with no
left-over antibiotics
10
5Participants received a
leafletGroup Aa
5Participants did not receive a
leafletGroup B
5Participants will complete the
antibiotic course in future
5Participants will complete the
antibiotic course in future
100%+ve participant behaviour
100%+ve participant behaviour
Future behaviour
Participants always complete an antibiotic course
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78% of Group Aa intended tochange their future behaviour
with regards to left-overantibiotics. These patients arecommitted to being completelycompliant in future.
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7: Would you ask your doctor forantibiotics when you have acommon cold?
Yes
NoHave you asked your doctor for antibiotics when having a
common cold in the past?
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N=79 Group Past % Future %Group Aa 22/32 68.75% 32/32 100%Group Ab 4/7 57.14% 4/7 57.14%Group B 32/40 80% 32/40 80%
Participants who do not put pressure on doctors to prescribeantibiotics in viral infections
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0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Group Aa Group Ab Group B
Past
Pressure from participants to get antibiotics prescriptions for viral infections
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0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Group Aa Group Ab Group B
Past
Future
Pressure from participants to get antibiotics prescriptions for viral infections
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0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Group Aa Group Ab Group B
Past
Future
Pressure from participants to get antibiotics prescriptions for viral infections
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Group Aa showed a 100% changein attitude when it comes to
pressurizing medical practitionersinto prescribing antibiotics forminor illness, colds and flu.
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9: In what way would you change your useof antibiotics, if you would change
anything?N =32 Statement
#
Statement
15 Nr. 1 Nothing Participants did complete
course in prescribed time and
have not asked for antibiotics
from a medical practitioner
10 Nr. 2 One should always complete
the course
(1 overlap statement Nr 4 and
1 overlap with Nr 5)
2 Nr. 3 One should only use
antibiotics when it is
necessary
4 Nr. 4 One should use antibioticsfor bacterial infections and
not for viral infections
(1 overlap statement Nr 2)
2 Nr. 5 One should not pressure a
medical practitioner for an
antibiotic prescription when
having a flu
(1 overlap with statement Nr
2)
1 No answer provided
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10: What is the most important lessonyou learned by reading the
'Antibiotics: wise-up and takeresponsibility' brochure?
N
=32
Statemen
t #
Statement
12 Nr. 1 Antibiotics has no effect
on viruses and should
only be used for bacterial
infections, not colds and
flu
(1overlap with statement
Nr 2)
12 Nr. 2 All bacteria need to be
killed by the antibiotic
and the course should be
completed to reduce
antibiotic resistance
(1overlap with statement
Nr 1)
(2overlap with statement
Nr 3)
7 Nr. 3 One should not over use
antibiotics
(2 overlap with statement
Nr 2)
3 Nr. 4 Nothing learned1 Nr. 5 Patients will become
immune to antibiotics
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ld f
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11: Would you prefer to receive moreinformation on responsible antibiotic use?
Answer Group Gender/Age GroupFemale Male Children
Yes Group Aa 12 7 7Group Ab 1 1 3Group B 11 8 4
Total: 54
(68.35%) Total: 24(70.59%) Total: 16(64%) Total: 14(70%)No Group Aa 2 3 1
Group Ab 1 1 0Group B 7 5 5
Total: 25
(31.64%) Total: 10(29.41%) Total: 9(36%) Total: 6(30%)Total: 100% 100% 100% 100%
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8/13/2019 D3-P3- A Study on the Relationship Between Improved Patient Knowledge & Compliance With Antibiotic Use
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8/13/2019 D3-P3- A Study on the Relationship Between Improved Patient Knowledge & Compliance With Antibiotic Use
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8/13/2019 D3-P3- A Study on the Relationship Between Improved Patient Knowledge & Compliance With Antibiotic Use
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