Trainee SA doctors are inadequately prepared to prescribe antibiotics‚ found a survey at the universities of the Witwatersrand, Free State and Cape Town.The report says the findings come after the World Health Organisation warned last month that 12 bacteria are poised to emerge as the “greatest threat to human health” because over-prescribing means they are becoming resistant to antibiotics. About 700‚000 people around the world are killed every year by drug-resistant infections‚ and it is estimated that the toll will be 10m a year by 2050 if no action is taken.
The results of the South African survey have sparked a call for “drastic educational measures”. Adrian Brink from the UCT medical school and two University of Pretoria academics – Johan Schoeman (veterinary science) and George Muntingh (pharmacology) – say: “Existing education in SA medical schools may be augmented by standardisation‚ focusing on equipping young doctors with the necessary confidence and skills in appropriate antibiotic prescribing at an early stage of their careers.”
The report says the seven scientists who did the research said knowledge levels among students were moderate to poor. “This survey … has exposed training gaps and raises a number of important concerns about the preparedness of our future antibiotic prescribers‚” writes the lead author‚ Sean Wasserman from UCT.
“Although formal pharmacology and microbiology lectures are included in medical school curricula‚ there appears to be a failure to translate this into clinical prescribing practice and a discordance between knowledge and practice.”
The effect of inadequate preparation at medical school‚ said Wasserman‚ “may translate into widespread antibiotic misuse and perpetuate antibiotic resistance. Our findings are concerning and serve as a call for intervention”.
The editorial said any new approach would need to include dentists‚ whose antibiotic prescriptions are thought to have rocketed in the past 20 years‚ and vets. “The extensive non-therapeutic use of antibiotics in food animals … raise serious concerns‚” say Brink‚ Schoeman and Muntingh.
“Moreover‚ the major increase in the use of antibiotics in companion animals and recent evidence of the reciprocal transfer of resistant pathogens between pets and their owners should prompt urgent attention to antibiotic stewardship.”
Abstract
Background: Education of medical students has been identified by the World Health Organisation as an important aspect of antibiotic resistance (ABR) containment. Surveys from high-income countries consistently reveal that medical students recognise the importance of antibiotic prescribing knowledge, but feel inadequately prepared and require more education on how to make antibiotic choices. The attitudes and knowledge of South African (SA) medical students regarding ABR and antibiotic prescribing have never been evaluated.
Objective: To evaluate SA medical students’ perceptions, attitudes and knowledge about antibiotic use and resistance, and the perceived quality of education relating to antibiotics and infection.
Methods: This was a cross-sectional survey of final-year students at three medical schools, using a 26-item self-administered questionnaire. The questionnaires recorded basic demographic information, perceptions about antibiotic use and ABR, sources, quality, and usefulness of current education about antibiotic use, and questions to evaluate knowledge. Hard-copy surveys were administered during whole-class lectures.
Results: A total of 289 of 567 (51%) students completed the survey. Ninety-two percent agreed that antibiotics are overused and 87% agreed that resistance is a significant problem in SA – higher proportions than those who thought that antibiotic overuse (63%) and resistance (61%) are problems in the hospitals where they had worked (p<0.001). Most reported that they would appreciate more education on appropriate use of antibiotics (95%). Only 33% felt confident to prescribe antibiotics, with similar proportions across institutions. Overall, prescribing confidence was associated with the use of antibiotic prescribing guidelines (p=0.003), familiarity with antibiotic stewardship (p=0.012), and more frequent contact with infectious diseases specialists (p<0.001). There was an overall mean correct score of 50% on the knowledge questionnaire, with significant differences between institutions. Students who used antibiotic prescribing guidelines and found their education more useful scored higher on knowledge questionnaires.
Conclusion: There are low levels of confidence with regard to antibiotic prescribing among final-year medical students in SA, and most students would like more education in this area. Perceptions that ABR is less of a problem in their local setting may contribute to inappropriate prescribing behaviours. Differences exist between medical schools in knowledge about antibiotic use, with suboptimal scores across institutions. The introduction and use of antibiotic prescribing guidelines and greater contact with specialists in antibiotic prescribing may improve prescribing behaviours.
Authors
Sean Wasserman, Samantha Potgieter, Evan Shoul, Deborah Constant, Annemie Stewart, Marc Mendelson, Tom H Boyles
[link url="http://www.timeslive.co.za/sundaytimes/lifestyle/2017/05/01/Trainee-doctors-not-adequately-prepared-to-prescribe-antibiotics%E2%80%9A-study-finds"]The Times report[/link]
[link url="http://www.samj.org.za/index.php/samj/article/view/11894"]SA Medical Journal abstract[/link]
[link url="http://www.samj.org.za/index.php/samj/article/view/11902"]SA Medical Journal editorial[/link]