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      Antibiotic Use: A Cross-Sectional Study Evaluating the Understanding, Usage and Perspectives of Medical Students and Pathfinders of a Public Defence University in Malaysia

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          Abstract

          Background: Antimicrobial prescribing behaviors are often influenced by the local culture and prescribing appropriateness of medical doctors and other health care professionals. Globally, antimicrobial utilization practices have a profound impact on antimicrobial resistance and are a tremendous public health concern. The aim of this survey was to explore the knowledge and attitudes of medical students from the National Defence University of Malaysia regarding antimicrobial usage and antimicrobial resistance. Research design and methods: This was a cross-sectional study. The study population consisted of undergraduate medical students in each year group from the National Defence University of Malaysia. Students receive limited formal training on the use of antibiotics in their curriculum, and most of this learning is opportunistic whilst on clinical placement. Universal sampling was used as the study population was small. Data were collected utilizing a previously validated instrument regarding antibiotic use. Simple descriptive statistics were used to generate frequencies and percentages with SPSS V21. This research was approved by the Centre for Research and Innovation Management, National Defence University of Malaysia. Results: 206 questionnaires were distributed with a response rate of 99.03%, 54% (110) male, and 46% (94) female. Out of the respondents, 65% (132) had used antibiotics in the last year. Respondents displayed a moderate level of knowledge about antibiotics. Conclusions: This study revealed that the older the student was, or when the year of study and total knowledge score was higher, the students were less likely to stop antimicrobials when they felt better or use leftover antibiotics without consulting a doctor. Therefore, the nearer the students were to graduation, the better their knowledge and skills were, and this translated into their own behaviors regarding use of antimicrobials. This finding has clear implications for curriculum design and the inclusion of formal teaching throughout the medical program on antimicrobial use and antimicrobial resistance (AMR). However, more research is needed on this topic, including the prescribing habits and antibiotic use of practicing doctors.

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          Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.

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            Antibiotics and Bacterial Resistance in the 21st Century

            Dangerous, antibiotic resistant bacteria have been observed with increasing frequency over the past several decades. In this review the factors that have been linked to this phenomenon are addressed. Profiles of bacterial species that are deemed to be particularly concerning at the present time are illustrated. Factors including economic impact, intrinsic and acquired drug resistance, morbidity and mortality rates, and means of infection are taken into account. Synchronously with the waxing of bacterial resistance there has been waning antibiotic development. The approaches that scientists are employing in the pursuit of new antibacterial agents are briefly described. The standings of established antibiotic classes as well as potentially emerging classes are assessed with an emphasis on molecules that have been clinically approved or are in advanced stages of development. Historical perspectives, mechanisms of action and resistance, spectrum of activity, and preeminent members of each class are discussed.
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              The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America.

              The ongoing explosion of antibiotic-resistant infections continues to plague global and US health care. Meanwhile, an equally alarming decline has occurred in the research and development of new antibiotics to deal with the threat. In response to this microbial "perfect storm," in 2001, the federal Interagency Task Force on Antimicrobial Resistance released the "Action Plan to Combat Antimicrobial Resistance; Part 1: Domestic" to strengthen the response in the United States. The Infectious Diseases Society of America (IDSA) followed in 2004 with its own report, "Bad Bugs, No Drugs: As Antibiotic Discovery Stagnates, A Public Health Crisis Brews," which proposed incentives to reinvigorate pharmaceutical investment in antibiotic research and development. The IDSA's subsequent lobbying efforts led to the introduction of promising legislation in the 109 th US Congress (January 2005-December 2006). Unfortunately, the legislation was not enacted. During the 110 th Congress, the IDSA has continued to work with congressional leaders on promising legislation to address antibiotic-resistant infection. Nevertheless, despite intensive public relations and lobbying efforts, it remains unclear whether sufficiently robust legislation will be enacted. In the meantime, microbes continue to become more resistant, the antibiotic pipeline continues to diminish, and the majority of the public remains unaware of this critical situation. The result of insufficient federal funding; insufficient surveillance, prevention, and control; insufficient research and development activities; misguided regulation of antibiotics in agriculture and, in particular, for food animals; and insufficient overall coordination of US (and international) efforts could mean a literal return to the preantibiotic era for many types of infections. If we are to address the antimicrobial resistance crisis, a concerted, grassroots effort led by the medical community will be required.
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                Author and article information

                Journal
                Antibiotics (Basel)
                Antibiotics (Basel)
                antibiotics
                Antibiotics
                MDPI
                2079-6382
                19 September 2019
                September 2019
                : 8
                : 3
                : 154
                Affiliations
                [1 ]Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia; kibria@ 123456upnm.edu.my (G.M.K.); snnl2003@ 123456gmail.com (S.N.N.B.L.); nur.syamirah.aishah@ 123456gmail.com (N.S.A.B.O.); shahidah2013@ 123456gmail.com (S.L.B.A.)
                [2 ]Department of Basic Health, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, Kuantan 25200, Malaysia; nazara@ 123456iium.edu.my
                [3 ]School of Medicine, Swansea University, Swansea, Wales SA2 8PP, UK; j.mckimm@ 123456swansea.ac.uk
                [4 ]Department of Surgery, Macerata Hospital, University of Macerata, Via Giovanni Mario Crescimbeni, 28, 62100 Macerata MC, Italy; massimosartelli@ 123456infectionsinsurgery.org
                [5 ]Eastern Medical College, Comilla, Kabila, Dhaka-Chittagong Highway, Burichang 3520, Bangladesh; zakirulislamcom7@ 123456gmail.com
                Author notes
                [* ]Correspondence: runurono@ 123456gmail.com ; Tel.: +60-10-926-5543
                Author information
                https://orcid.org/0000-0002-6124-7993
                https://orcid.org/0000-0002-9046-6183
                https://orcid.org/0000-0002-8949-5067
                https://orcid.org/0000-0003-3202-7542
                https://orcid.org/0000-0001-7203-2675
                https://orcid.org/0000-0003-3153-1333
                https://orcid.org/0000-0002-7594-5231
                https://orcid.org/0000-0003-2421-9261
                https://orcid.org/0000-0002-9296-1946
                Article
                antibiotics-08-00154
                10.3390/antibiotics8030154
                6784178
                31546812
                6c703e8f-1555-4fb2-bd62-fbd14abe4dd7
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 12 August 2019
                : 15 September 2019
                Categories
                Article

                antimicrobial,antibiotic,use,knowledge,attitude,practice,medical students,malaysia,antimicrobial resistance,antibiotic resistance

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