AWARENESS, KNOWLEDGE, AND PRACTICE OF

COMMUNITY RESIDENTS ON ANTIMICROBIALS AND THE DEVELOPMENT OF

ANTIMICROBIAL RESISTANCE
Teresa May B. Bandiola1,2,3; Rosaline B Amoin1,2,3; Jon Paulo F. Bautista1,2,3; Janine Aliza B. Birog1,2,3; Jasper D.
Cayanga1,2,3; and Juneve F. Tejada1,2,3
1College of Pharmacy, 2Research Development and Innovation Center, 3Our Lady of Fatima University

*Corresponding author. Tel.No. 9617729.

*E-mail address: bandiolateresamayb@gmail.com
*Present address: Our lady of Fatima university-College of Pharmacy, Lagro, Quezon City
ABSTRACT
Objectives: This study aimed to assess the awareness, knowledge, and practice of the residents in Greater
Lagro, Quezon City, on antimicrobials and the development of antimicrobial resistance.
Methodology: A questionnaire-based survey was conducted on 340 residents in Greater Lagro, Quezon City,
Philippines, whereby their awareness, knowledge, and practices regarding antimicrobial use and the
development of antimicrobial resistance was assessed by using a five point Likert scale, whose responses
ranged from strongly agree to strongly disagree, no knowledge to very knowledgeable and always to
never. A self-made validated survey instrument was used. (Awareness: =0.84; Knowledge: =1.02;
Practices-self-medication: =0.83; Practices- Doctors prescription: =0.682). Simple descriptive statistics was
then applied which include percentage, mean, and standard deviation.
Findings: The study showed that the respondents had little awareness regarding antimicrobials and
antimicrobial resistance. They were partly knowledgeable that the inappropriate use of antibiotics could lead to
ineffective treatment as well as antimicrobial resistance. Furthermore, the respondents were uncertain that they
could get trustworthy information about antimicrobials from doctors and pharmacists, and were also uncertain if
expensive antimicrobials are more effective than the cheaper ones. Alarmingly, poor practices on the use of
antimicrobials were also observed. Malpractices such as non-compliance to complete antibiotic therapy for
seven days, not discarding the leftover antibiotics, and giving away leftover antibiotic drugs were noted. These
practices could contribute to antimicrobial resistance.
Conclusion: The misuse of antimicrobials and the development of antimicrobial resistance are fundamental
public health problems, and necessary plans and actions to combat these should be taken into action
immediately.
Keywords: Antimicrobials, Antimicrobial Resistance, Antibiotics
INTRODUCTION
Long before antimicrobials were discovered, infection had been linked to many causes of death such as
the epidemics of smallpox, leprosy, tuberculosis, and diphtheria in ancient Greece and Egypt, the pandemic of
black plague that swept through Asia, Europe, and Africa in the 14th century, and the epidemic of syphilis in
1490s as a highly contagious venereal disease in Spain, Italy, and France. This was until the accidental
discovery of Penicillin on 1929 by Alexander Fleming and its introduction to therapy on 1938 by Florey and
Chain, which opened doors to the development of new antibiotics for various forms of infection.
Antimicrobial resistance (AMR) is the resistance of a microorganism to an antimicrobial drug that
was originally effective for the treatment of infections caused by it. Resistant microorganisms (including
bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as
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antibacterial drugs, antifungals, antivirals, and antimalarials, so that standard treatments become ineffective
and infections persist, increasing the risk of spread to others (WHO, 2015). It is a broader term,
encompassing resistance to drugs to treat infections caused by other microbes as well, such as parasites (e.g.
malaria), viruses (e.g. HIV), and fungi (e.g.Candida) while antibiotic resistance refers specifically to the
resistance to antibiotics that occurs in common bacteria that cause infections. Mechanisms underlying
microbial resistance to cell wall synthesis inhibitors involve the production of antibiotic-inactivating
enzymes, changes in the structure of target receptors, increased efflux via drug transporters, and decreases in
the permeability of microbes cellular membranes to antibiotics.
WHOs 2014 report on global surveillance of antimicrobial resistance revealed that antibiotic
resistance is no longer a prediction for the future; it is happening right now, across the world, and is putting
at risk the ability to treat common infections in the community and hospitals. Without urgent and coordinated
action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries,
which have been treatable for decades, can once again kill (WHO, 2015).
When infections become resistant to first-line drugs, more expensive therapies must be used. A
longer duration of illness and treatment, often in hospitals, increases health care costs as well as the
economic burden on families and societies. The inappropriate use of antimicrobial drugs, including in animal
husbandry, favors the emergence and selection of resistant strains, and poor infection prevention and control
practices contribute to further emergence and spread of antimicrobial resistance.
Owing to this, the greater challenge that the humankind has to face is to continue designing strategies to
combat microbial resistance. This includes the use of antibiotic combinations, the introduction of new (and
often expensive) chemical derivatives of established antibiotics, and efforts to avoid the indiscriminate use or
misuse of antibiotics.
Therefore, with this research, the researchers aimed to go to the basic, which is to assess the consumers
awareness, knowledge, and practice that lead to anti-microbial resistance, in the area of Greater Lagro, Quezon
City, Philippines.
MATERIALS AND METHODS

Respondents
The study involved adult residents of Greater Lagro, Quezon City, Philippines. A sample of 340 respondents
was used in the research.

Sampling Technique
Systematic sampling technique was employed. The researchers conducted the survey on December 15 and
16, 2015.

Instruments Used
A self-made questionnaire survey instrument was employed to assess the respondents awareness,
knowledge and practices to antibiotics leading to antimicrobial resistance. The series of questions were
analysed by using a 5-point Likert scale, whose responses ranged from strongly agree to strongly
disagree, no knowledge to very knowledgeable and always to never. A Filipino translation was
also included on the questionnaire in order for the respondents to understand each question easily.
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Validation of Instrument
Prior to the study, the questionnaire was validated by subject experts for its content and relevance. To attain
a high degree of validity, a dry-run was conducted. Pre-testing was done on 20 respondents who were not
included in the study. Internal consistency was evaluated using Cronbachs alpha. [Awareness Question:
=0.84 (Good); Knowledge Question: =1.02 (Excellent); Practices-self medication: =0.83(Good);
Practices- Doctors prescription: =0.682 (Acceptable)]

Data Gathering Procedure

On the day of the survey, the researchers gave the respondents a survey questionnaire with the assurance
that all answers would be treated with confidentiality. No time limit was given for the respondents to ensure
careful response to each question. The researchers attended to respondents in answering the questions that
seemed unclear to them. To attain high percentage of returns, the researchers personally distributed the
questionnaire. Questionnaires were then retrieved from the respondents as soon as they finished answering.

Statistical Tool
Simple descriptive statistics was applied which include percentage, mean, and standard deviation.

RESULTS
The response rate was 100% among the 340 respondents who participated in the survey. The results are
tabulated in Table 1, Table 2, Table 3, and Table 4.
Table 1. Assessment of Awareness on Antimicrobials and Antimicrobial Resistance
Questions
Mean
Verbal Interpretation
1.Antimicrobial/antibiotics are used to treat a
lot of illnesses.
2.01
SOMEWHAT AGREE
2. I have used Antimicrobial/antibiotics at
some point of my life.
1.67
SOMEWHAT AGREE
3.Antimicrobial/antibiotics must be purchased
with a prescription.
1.56
SOMEWHAT AGREE
4. I should stop taking antimicrobial/
antibiotics when I feel better.
2.71
UNDECIDED
5. Friends recommend antimicrobial/antibiotics
to me.
3.00
UNDECIDED
6. I recommend antimicrobial/antibiotics to my
friends.
3.06
UNDECIDED
7. I follow the doctors instruction when taking
antimicrobial/antibiotics.
1.48
STRONGLY AGREE
8. Everyone has a role to play to ensure that
antibiotics remain effective.
1.50
STRONGLY AGREE
As presented in Table 1, the respondents somewhat agreed that antimicrobials are used to treat a lot of
illnesses (xx =2.01), that they have used antimicrobials at some point of their lives (xx=1.67), and that
antimicrobials must be purchased with a prescription (xx=1.57). Though following doctors prescription, they
were undecided that they should stop antimicrobials when they feel better (xx=2.71), that their friends
recommend antimicrobials to them (xx=3.00), and that they recommend antimicrobials to their friends (xx=3.06).
But they strongly agreed that they should follow the doctors instruction when taking antimicrobials (xx=1.48)
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and that everyone has a role to play to ensure that antibiotics remain effective (xx=1.50).
Table 2. Assessment of Knowledge on Antimicrobials and Antimicrobial Resistance
Questions
Mean
Verbal Interpretation
1. I am familiar with the classification of
antimicrobial/antibiotics.
2. Inappropriate/ Incorrect use of antibiotics
can lead to Ineffective treatment.
3. I know how to properly store
antimicrobial/antibiotics suspensions.
4. If taken too often, antibiotics are less likely
to work in the future.
5. An antibiotic will always be effective in the
treatment of same infection in the future.
6. Bacteria are germs that cause common cold
and flu.
7. I am familiar with Antimicrobial Resistance.
8. I am familiar that I can get antimicrobial
resistance from poultry products I eat.
9. I am familiar that I can get antimicrobial
resistance when I make contact with
contaminated water.
10. I am familiar that a lot of people die due to
Antimicrobial Resistance.

2.40

LITTLE KNOWLEDGE

3.07

SOME KNOWLEDGE

2.82

SOME KNOWLEDGE

2.77

SOME KNOWLEDGE

2.70

SOME KNOWLEDGE

2.95
2.65

SOME KNOWLEDGE
SOME KNOWLEDGE

2.43

LITTLE KNOWLEDGE

2.61

SOME KNOWLEDGE

2.78

SOME KNOWLEDGE

Table 2 showed that the respondents had little knowledge or familiarity regarding the classification of
antimicrobials (xx=2.40) and little knowledge or familiarity that they can get antimicrobial resistance from
poultry products that they eat (xx=2.43). They also had some knowledge that the inappropriate use of
antimicrobials can lead to ineffective treatment (xx=3.07), some knowledge on how to properly store antibiotic
suspensions (xx=2.82), some knowledge that if taken too often, antibiotics are less likely to work in the future
(xx=2.77), some knowledge that an antibiotic will always be effective in the treatment of the same infection in
the future (xx=2.70), some knowledge that bacteria are germs that cause common cold and flu ( xx=2.95), some
knowledge or familiarity regarding antimicrobial resistance (xx=2.65), some knowledge or familiarity that they
can get antimicrobial resistance when they make contact with contaminated water ( xx=2.61), and lastly, they also
had some knowledge or familiarity that a lot of people die due to antimicrobial resistance (xx=2.78).
Table 3. Assessment of Self-Medication Practices on Antimicrobials and Antimicrobial Resistance
Questions
Mean
Verbal Interpretation
1. When I have colds, I should take antibiotics
to prevent getting a more serious illness.
2.68
UNDECIDED
2. When I get fever, antibiotics help me to get
better more quickly.
2.76
UNDECIDED
3. When I forget to take my antibiotics, I skip
doses.
2.98
UNDECIDED
4. I get trustworthy information on
antimicrobials/antibiotics from a doctor.
1.74
SOMEWHAT AGREE
5. I get trustworthy information on
1.89
SOMEWHAT AGREE
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antimicrobials/antibiotics from a pharmacist.

6. Branded antimicrobial/antibiotics are better
than generic.
7. Expensive antimicrobial/antibiotics are more
effective than cheaper ones.
8. Whenever I take an antibiotic, I contribute to
the development of antibiotic resistance.
9. Antibiotics are safe drugs; hence they can be
commonly used.

2.69

UNDECIDED

2.58

UNDECIDED

2.42

SOMEWHAT AGREE

2.83

UNDECIDED

Results in Table 3 showed that the respondents were undecided that when they have colds, they should take
antibiotics to prevent from getting a more serious illness ( xx=2.68), undecided that when they get a fever,
antibiotics help them to get better more quickly ( xx=2.76), undecided that when they forget to take their
antibiotics, they skip doses (xx=2.98), undecided if branded antimicrobials are better than generic ones ( xx=2.69),
undecided if expensive antimicrobials are more effective than cheaper ones ( xx=2.58), and lastly, they were
undecided if antibiotics are safe drugs and that they can be commonly used ( xx=2.83). Furthermore, they also
somewhat agreed that they could get trustworthy information about antimicrobials from doctors ( xx=1.74) and
pharmacists (xx=1.89) and they somewhat agreed that whenever they take an antibiotic, they contribute to the
development of antibiotic resistance (xx=2.42).
Table 4. Assessment of Doctors Prescription Practices on Antimicrobials and Antimicrobial Resistance
Questions
Mean
Verbal Interpretation
a) Do you stop taking the antibiotics before the
7-days treatment?
2.29
USUALLY
b) Do you keep the remaining antibiotics for
the next time you get sick?
SOMETIMES
2.56
c) Do you discard the remaining, leftover
medication?
2.98
SOMETIMES
d) Do you give the leftover antibiotics to your
family member/ friend/relative?
3.02
SOMETIMES
Table 4 revealed that the respondents usually stop taking the antibiotics before the 7-day treatment ( xx=2.29).
Sometimes, they keep the remaining antibiotics for the next time they get sick ( xx=2.56), discard the remaining
leftover medication (xx=2.98), and give the leftover medication to their family members/friends/relatives
(xx=3.02).
DISCUSSION
The study provides useful information about the awareness, knowledge, and practices of respondents
with respect to antimicrobial resistance and usage, which may be utilized to plan suitable educational
interventions that aim at improving the antimicrobial prescribing and use.
The study showed that the respondents had little awareness regarding antibiotics and antimicrobial
resistance. They were partly knowledgeable that the inappropriate use of antibiotics could lead to ineffective
treatment as well as antimicrobial resistance.
Furthermore, the respondents were uncertain that they could get trustworthy information on
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antimicrobials from doctors and pharmacists and also uncertain if expensive antimicrobials are more effective
than the cheaper ones.
Alarmingly, poor practices on the use of antimicrobials were also observed. Malpractices such as noncompliance to complete antibiotic therapy for seven days, not discarding of leftover antibiotics, and giving
away leftover antibiotic drugs were noted. These practices could contribute to antimicrobial resistance.
CONCLUSION
Misuse of antimicrobials and the development of antimicrobial resistance are public health problems,
and necessary plans and actions to combat these should be taken into action immediately. Improvement on the
promotion and evaluation of medical practice guidelines, restriction of antibiotic use, and development of new
antibiotics are some of the steps required.
Above all, the public, health care providers, and leaders are encouraged to change the dynamics on
antibiotic usage, and the need to educate the consumers must be a top priority before all antimicrobials become
ineffective because of antimicrobial resistance.
ACKNOWLEDGEMENT
The researchers would like to thank the entire OLFU-College of Pharmacy and the residents of Greater Lagro,
Quezon City who whole-heartedly devoted their time to the study, and above all, to the Almighty Father for
bestowing the researchers enthusiasm and wisdom throughout the research.
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