Medical students' attitude towards antibiotics misuse in Hong Kong

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Background Antibiotics resistance is a major public health threat worldwide. Super bugs, for example, drug resistant tuberculosis or Staphylococcus aureus, are increasingly common in the communities. Hong Kong is one of the areas which have the highest antibiotics resistant strains prevalence rate in the world. Irrational use of antibiotics is an important contributing factor to the emergence of antibiotics resistance. Physician stewardship in the prescription of antibiotics is pivotal in the prevention of antibiotics resistance emergence. Medical students are going to be practicing doctors after graduation from medical school. But few studies had been conducted to investigate their knowledge and attitude towards antibiotics resistance and use, and relations with anticipated antibiotics prescription behaviour. Method 145 medical students at the University of Hong Kong were recruited in this study to complete a self-administered questionnaire. There were in total 14 questions in this questionnaire, covering 2 major themes 1.Self-report of current and past antibiotic use and behaviour; 2.Anticipated prescription behaviour of antibiotics upon graduation and practice in the future. Chi-square test was used to investigate the association between attitude and knowledge of antibiotics with their anticipated prescription behavior upon graduation and practice. Multivariable logistic regression model was used to adjust for potential confounders. Results 67.6 % of the participants hold the correct knowledge of the proper use of antibiotics. Compare with the participants who hold the wrong knowledge, they were to 0.18 times more likely to inappropriately prescribe antibiotics for non-complicated Upper respiratory tract infections (URTI). (OR: 0.18, 95 % CI: (0.08, 0.43); p <0.001). Respectively 33.6 % and 4.9% of all the participants perceived the severity of antibiotics resistance in Hong Kong as “Severe” and “Very severe “. Those who rated “Severe” or above were 0.37 times more likely to inappropriately prescribe antibiotics for non-complicated URTIs compared with the participants who rated “Neutral” or below. (OR: 0.37, 95 % CI: (0.15, 0.91); p = 0.03). Logistic regression model was employed to test the interaction effect. Result showed that clinical training significantly interacted with antibiotics knowledge (p < 0.01)and perceived severity of antibiotics resistance (p = 0.02) in their relations with inappropriate prescription for non-complicated URTIs. Conclusion For the medical students who have received clinical training, those who were more aware of the severity of antibiotics resistance in Hong Kong were less likely to inappropriately prescribe antibiotics for non-complicated URTI. For the medical students who have not received clinical training, correct knowledge of antibiotic use is associated with less inappropriate antibiotics prescription behaviour. These suggest that knowledge and attitude towards antibiotics resistance and use are important factors that may impact on physician stewardship in antibiotics use in the community.