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Public Knowledge and Attitude towards Antibiotic Overuse: A Systematic Review

Research Background

Excessive use of antibiotics is currently a common phenomenon worldwide, and it has important public health repercussion. Antibiotic is a drug of anti-microbial family. Anti-microbial is the medicine that kills or prevent the growth of pathological organism, namely virus, bacteria, fungus. In the group of anti-microbial agents’ antibiotic is the most common drug used to treat bacterial infection over the globe. Antibiotic word meaning “against life”. Antibiotic is a chemical substance produce by a microorganism that kills or inhibit the growth of other microorganisms. 

Antibiotic treatment is suitable for potential proven bacterial infection (e.g. strep throat and streptococcus pyogenic disease). But not a viral infection. Antibiotics not considered the recommended remedy for frequent sore throats, which are caused by a virus. Some other examples of viral infection that do not benefit from antibiotic treatment include common cold, flu (Influenza), Bronchitis most cough, some ear infection, some sinus infection. 

Administration of antibiotics consists of a set of activities that aim to optimise their use through choosing the most appropriate medicine for a particular treatment and its doses, route and time of administration, and minimizing undesirable events. Such as toxicity and bacterial resistance. However antibiotic misuse sometimes calls abuse or overuse, refers to misuse or overuse of antibiotics which has a potentially severe side effect on health.

Since the introduction of first effective antimicrobials in, there has been persistent growth and spread of drug-resistant bacteria, broadly referred to as antimicrobial resistance (AMR). AMR defined as phenomena where infection caused by a microorganism such as bacteria can survive exposer to medicine which would normally inhibit their growth or kill them. But taking an antibiotic for a viral infection would not cure the disease, may cause unnecessary and harmful side effects to promote antibiotics resistance.

Due to anti-microbial resistance, patients are in quite a danger of infection. Worldwide due to resistance operations like as caesareans, hip replacements, appendix removal and routine surgery are at high risk, increase hospital stay of a patient which results in early death. An AMR study in found that people died each year globally due to infection which is not cured by an antibiotic, globally, Million death is estimated to occur due to AMR infection, which will cost trillion to the global economy.  Recent estimates stated that cost for treatment of antibiotic-resistant only the USA over billion annually.  Overusing antibiotics also unnecessarily places patients' risk for antibiotic-related side effects such as diarrhoea and allergic reaction. Nearly deaths in a year in Europe and deaths in the USA were due to antibiotic resistance.


According to a previous study conducted in the Saudi Arabia, we have identified different factors which influenced or predicted antibiotic overuse. These factors include clinical confusion of illness, patient’s interest anticipated, and overall poor awareness about the consequences of unnecessary use of antibiotics Limited knowledge of relevant risks may also be considered a risk factor for antibiotics misuse.,  Additionally, patients may perceive a viral diagnosis and physician refuse to prescribe antibiotics.

But patients trivializing due to over concern for their illness. Due to the lack of knowledge for the usage of antibiotics, a substantial number of people fail to complete a full course of antibiotics. When patients feel relatively better, some of them save a few medicines for future self-medication. Failure to complete a full antibiotic course, microorganism will recover again as a result of resistance to antibiotic develop Molecular. Most of the cases people do not

The objective of this study, through a systematic review of the public knowledge, attitude, behaviour as well as factors affecting prescription behaviour of doctors in high income, middle income, and low-income countries.

What is the public knowledge, perception and attitude regarding antibiotic overuse?

How, if at all, do attitudes regarding antibiotic overuse shift after the public engage in a different program?

What solution does an informed public recommendation to reduce antibiotics?

What kind of factors influencing to doctor for prescribing antibiotics?

The use of antibiotics is high around the globe, and it is the leading cause of resistance. The physicians prescribe most of the cases antibiotic without confirmation of the diagnosis. Lack of knowledge of antibiotics is the main factor of overuse or misuse among people, unusually low and middle-income countries. We know that individuals with viral infections usually recover without the need for antibiotics. However, frequently patients with viral infections take antibiotics unnecessarily.

In high-income countries, patients have easy access to second-generation antibiotics which is much more costly than first-generation antibiotics. However, in developing countries where disease prevalence is high patients, most of the time cannot afford the cost. The World Health Organisation (WHO) has declared that the world is now in the post-antibiotic era. Where minor infection and accident now cost life because antibiotics no longer can manage the situation. Most of the private pharmacies in low and middle-income countries run by an untrained person like India and Bangladesh. Even sometimes, they do not have a drug license. 

Those countries have government laws regarding the control of antibiotics but not correctly implemented. In addition to that, very few programs are running regarding awareness of knowledge, attitude, and perception of people on antibiotics. Due to antibiotic resistance, the highest percentage of death occurs in Sub Sahara. Where law regarding dispensing present but practically not active. People are living below the margin, and lack of knowledge and health facility is minimal. Antibiotic-resistant is a quickly worsening problem worldwide. World Health Organisation published a Global action plan on antibiotic resistance for proper use of antibiotics to maximise both their current effect on their chances of being available for the future generation.

To ensure proper understanding and awareness, the risk of antibiotic misuse is a challenge for both the prescriber and patient. This study is an important source of information, which is essential for low and middle-income countries because of the limited availability of locally relevant high-level evidence and little experience with evidence-based guideline development.

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