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      Comparison of knowledge and attitudes about antibiotics and resistance, and antibiotics self-practicing between Bachelor of Pharmacy and Doctor of Pharmacy students in Southern India Translated title: Comparación de conocimientos y actitudes sobre antibióticos y resistencias y auto-medicación con antibióticos entre los estudiantes de la licenciatura en farmacia y el doctorado en farmacia en el sur de India

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          Background: There is limited research on pharmacy specialization based differences with regards to usage of antibiotics. Objective: To compare the knowledge, attitude and practice of Bachelor of Pharmacy (BPharm) and Doctor of Pharmacy (PharmD) students about usage and resistance of antibiotics in Southern India. Methods: This was a cross sectional study involving final year BPharm and PharmD students studying in two private institutions located in Andra Pradesh, India. The study was conducted for the period of 3 months. The questionnaire was divided into 5 components: demographics, knowledge about antibiotic use, attitude towards antibiotic use and resistance, self-antibiotic usage, and possible causes of antibiotic resistance. The study questionnaire was assessed for reliability. Data were analysed by employing Mann Whitney and chi square tests using SPSS version 19. Results: The sample size comprised of 137 students. The response rate was 76.11% for the study. There was a significant difference in the knowledge of antibiotic use in BPharm and PharmD students (Mean score: 5.09 vs 6.18, p<0.001). The overall attitude of PharmD students about antibiotic use and resistance was positive compared to BPharm students (Mean score: 3.05 vs 2.23, p<0.05). The self-antibiotic practices was higher in BPharm students than PharmD students (36.4% vs 20%, p<0.05). A significantly high number of PharmD students believed that empirical antibiotic therapy led to antibiotic resistance (19.5% versus 48%, P<0.05). Conclusion: PharmD students were more knowledgeable about antibiotic usage and resistance compared to BPharm students who did not have accurate and the much needed information about the same. Future interventions should be targeted towards educating the BPharm students so that they can implement the acquired knowledge in their practice.

          Translated abstract

          Antecedentes: Existe poca investigación sobre la especialización en farmacia en relación al uso de antibióticos. Objetivo: Comparar el conocimiento, actitudes y práctica de los estudiantes de licenciatura en farmacia (BPharm) y de Doctor en Farmacia (PharmD) sobre el uso de antibióticos y resistencias en el Sur de India. Métodos: Este fue en un estudio transversal que envolvió a estudiantes de BPharm y PharmD de dos instituciones privadas localizadas en Andra Pradesh, India. Se realizó el estudio durante 3 meses. Se dividió el cuestionario en 5 componentes: demográficos; conocimiento sobre uso de antibióticos; actitud hacia el uso de antibióticos y resistencias; automedicación con antibióticos; y causas posibles de resistencias antibióticas. Se evaluó la fiabilidad del cuestionario. Se analizaron los datos usando test de Mann Whitney y chi cuadrado mediante el uso de un SPSS versión 19. Resultados: La muestra incluyó 137 estudiantes. La tasa de respuesta del estudio fue del 76,11%. Hubo diferencia significativa en el conocimiento sobre antibióticos entre los estudiantes de BPharm y los PharmD (puntuación media: 5,09 vs 6,18; p<0,001). La actitud general de los estudiantes de PharmD sobre el uso de antibióticos y las resistencias fue más positiva, comparado con los estudiantes de BPharm (puntuación media: 3,05 vs 2,23; p<0,05). El uso de antibióticos en automedicación fue más alto en los estudiantes de BPharm que los de PharmD (36,4% vs 20%; p<0,05). Un número significativamente mayor de estudiantes de PharmD creía que la terapéutica antibiótica empírica conducía a resistencias (19,5% vs 48%; p<0,05). Conclusión: Los estudiantes de PharmD tenían más conocimientos sobre uso de antibióticos y resistencias que los estudiantes de BPharm, que no habían recibido la información apropiada sobre este tema. Las intervenciones futuras deberían centrarse en educar a los estudiantes de BPharm para que puedan implantar el conocimiento adquirido en su ejercicio profesional.

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          Most cited references 47

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          Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

          Summary Background Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK. Methods Enterobacteriaceae isolates were studied from two major centres in India—Chennai (south India), Haryana (north India)—and those referred to the UK's national reference laboratory. Antibiotic susceptibilities were assessed, and the presence of the carbapenem resistance gene bla NDM-1 was established by PCR. Isolates were typed by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence of travel and recent admission to hospitals in India or Pakistan. Findings We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive patients had travelled to India or Pakistan within the past year, or had links with these countries. Interpretation The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed. Funding European Union, Wellcome Trust, and Wyeth.
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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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              Resistance to antibiotics: are we in the post-antibiotic era?

              Serious infections caused by bacteria that have become resistant to commonly used antibiotics have become a major global healthcare problem in the 21st century. They not only are more severe and require longer and more complex treatments, but they are also significantly more expensive to diagnose and to treat. Antibiotic resistance, initially a problem of the hospital setting associated with an increased number of hospital-acquired infections usually in critically ill and immunosuppressed patients, has now extended into the community causing severe infections difficult to diagnose and treat. The molecular mechanisms by which bacteria have become resistant to antibiotics are diverse and complex. Bacteria have developed resistance to all different classes of antibiotics discovered to date. The most frequent type of resistance is acquired and transmitted horizontally via the conjugation of a plasmid. In recent times new mechanisms of resistance have resulted in the simultaneous development of resistance to several antibiotic classes creating very dangerous multidrug-resistant (MDR) bacterial strains, some also known as "superbugs". The indiscriminate and inappropriate use of antibiotics in outpatient clinics, hospitalized patients and in the food industry is the single largest factor leading to antibiotic resistance. In recent years, the number of new antibiotics licensed for human use in different parts of the world has been lower than in the recent past. In addition, there has been less innovation in the field of antimicrobial discovery research and development. The pharmaceutical industry, large academic institutions or the government are not investing the necessary resources to produce the next generation of newer safe and effective antimicrobial drugs. In many cases, large pharmaceutical companies have terminated their anti-infective research programs altogether due to economic reasons. The potential negative consequences of all these events are relevant because they put society at risk for the spread of potentially serious MDR bacterial infections.

                Author and article information

                [1 ] UCSI University Malaysia
                [2 ] Bharat Institute of Technology-Pharmacy India
                [3 ] International Islamic University Malaysia (IIUM) Malaysia
                [4 ] Shenandoah University United States
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Pharmacy Practice (Granada)
                Pharmacy Pract (Granada)
                Centro de Investigaciones y Publicaciones Farmacéuticas (Redondela )
                March 2015
                : 13
                : 1
                : 0


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