World Health Organization , 2014. Global Report on Antimicrobial Resistance. 61. doi: 10.1007/s13312-014-0374-3.
Laxminarayan R et al., 2020. The Lancet Infectious Diseases Commission on antimicrobial resistance: 6 years later. Lancet Infect Dis 20: e51–e60.
Blaskovich MAT, 2018. The fight against antimicrobial resistance is confounded by a global increase in antibiotic usage. ACS Infect Dis 4: 868–870.
World Health Organization , 2015. Global Action Plan on Antimicrobial Resistance 10. doi: 10.1128/microbe.10.354.1.
Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA, 2018. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A 115: 3463–3470.
Levy SB, Marshall B, 2004. Antibacterial resistance worldwide: causes, challenges and responses. Nat Med 10: 122–129.
O’Neill J, 2014. Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Wellcome Collection.
Barbosa TM, Levy SB, 2000. The impact of antibiotic use on resistance development and persistence. Drug Resist Update 3: 303–311.
Aminov RI, Otto M, Sommer A, 2010. A brief history of the antibiotic era: lessons learned and challenges for the future. Front Microbiol 1: 1–7.
Austin DJ, Kristinsson KG, Anderson RM, 1999. The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance. PNAS USA 96: 1152–1156.
Bronzwaer SLAM et al., 2002. A European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis 8: 278–282.
Goossens H, Ferech M, Vander Stichele R, Elseviers M, 2005. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 365: 579–587.
van Houten CB et al., 2019. Antibiotic misuse in respiratory tract infections in children and adults—a prospective, multicentre study (TAILORED Treatment). Eur J Clin Microbiol Infect Dis 38: 505–514.
Zaas AK, Garner BH, Tsalik EL, Burke T, Woods CW, Ginsburg GS, 2014. The current epidemiology and clinical decisions surrounding acute respiratory infections. Trends Mol Med 20: 579–588.
Tillekeratne G, 2017. Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians. BMC Fam Pract 18: 37.
Chandrasiri et al., 2013. A multi centre laboratory study of Gram negative bacterial blood stream infections in Sri Lanka. Ceylon Med J 58: 56–61.
Shapiro D et al., 2017. Burden and seasonality of viral acute respiratory tract infections among outpatients in southern Sri Lanka. Am J Trop Med Hyg 97: 88–89.
Sheng T, Wijayaratne GB & Dabrera TM, 2019. Point-prevalence study of antimicrobial use in public hospitals in southern Sri Lanka identifies opportunities for improving prescribing practices. Infect Control Hosp Epidemiol 40: 224–227.
World Health Organization (WHO) , 2004. How to Investigate the Use of Medicines by Consumers. Available at: http://www.who.int/drugresistance/Manual1_HowtoInvestigate.pdf.
Guest G, MacQueen KM, Namey EE, 2012. Applied Thematic Analysis. Thousand Oaks, CA: SAGE Publications, Inc. Available at: https://www.doi.org/10.4135/9781483384436.
Mallah N, Badro DA, Figueiras A, Takkouche B, 2020. Association of knowledge and beliefs with the misuse of antibiotics in parents: a study in Beirut (Lebanon). PLoS One 15: e0232464.
Byrne MK, Miellet S, McGlinn A, Fish J, Meedya S, Reynolds N, van Oijen AM, 2019. The drivers of antibiotic use and misuse: the development and investigation of a theory driven community measure. BMC Public Health 19: 1425.
Hermsen ED, MacGeorge EL, Andresen M-L, Myers LM, Lillis CJ, Rosof BM, 2020. Decreasing the peril of antimicrobial resistance through enhanced health literacy in outpatient settings: an underrecognized approach to advance antimicrobial stewardship. Adv Ther 37: 918–932.
Swe MMM, Hlaing PH, Phyo AP, Aung HH, Smithuis F, Ashley EA, Cheah PY, 2020. Evaluation of the forum theatre approach for public engagement around antibiotic use in Myanmar. PLoS One 15: e0235625.
Ahmed R et al., 2020. The drugs don’t work: evaluation of educational theatre to gauge and influence public opinion on antimicrobial resistance. J Hosp Infect 104: 193–197.
Saliba-Gustafsson EA, Röing M, Borg MA, Rosales-Klintz S, Lundborg CS, 2019. General practitioners’ perceptions of delayed antibiotic prescription for respiratory tract infections: a phenomenographic study. PLoS One 14: e0225506.
Ovnat Tamir S, Shemesh S, Oron Y, Marom T, 2017. Acute otitis media guidelines in selected developed and developing countries: uniformity and diversity. Arch Dis Child 102: 450–457.
Russell S, 2005. Treatment-seeking behaviour in urban Sri Lanka: trusting the state, trusting private providers. Soc Sci Med 61: 1396–1407.
Teixeira Rodrigues A, Roque F, Falcão A, Figueiras A, Herdeiro MT, 2013. Understanding physician antibiotic prescribing behaviour: a systematic review of qualitative studies. Int J Antimicrob Agents 41: 203–212.
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Antibiotic resistance is an emerging global public health threat. One of the main drivers of this threat is the inappropriate use of antibiotics. In Sri Lanka, antibiotic consumption is increasing, but little is known locally about how patients perceive antibiotics. We conducted a qualitative study to gain a better understanding of the knowledge, perceptions, and attitudes of patients regarding antibiotics and antibiotic resistance. Semi-structured interviews involving 18 patients with lower respiratory tract infection (LRTI) admitted to a large, public tertiary care hospital in southern Sri Lanka were conducted. Interviews were analyzed to identify themes regarding the patients’ knowledge of LRTI etiology and treatment, perceptions and attitudes toward LRTI treatment, including antibiotics, and patient–physician communication. Most patients mentioned multiple care visits and the use of multiple pharmaceuticals prior to admission. Patients sought a quick resolution to their ailments and frequently visited several private physicians to obtain a satisfying answer. Self-medication was also common. Patients reused prescriptions for antibiotics, kept antibiotics for later use after prematurely stopping their course of treatment, and bought over-the-counter antibiotics. Patients’ knowledge of disease etiology and antibiotics was poor. Only a few patients were aware of antibiotic resistance. Despite the desire to receive more information regarding disease and treatment, patient–provider communication was limited and mainly confined to prescription instructions. This qualitative study performed in Sri Lanka suggests that inappropriate use of antibiotics is a multifactorial problem. To improve antibiotic use, a multifactorial approach that includes educating the public, increasing awareness among physicians, and implementing systems-level changes to restrict access to antibiotics is urgently needed.
Financial support: This study was supported by the National Institute of Allergy and Infectious Diseases (K23AI125677 to L.G.T.). Site support was provided by the Duke Global Health Institute and the Duke Hubert-Yeargan Center for Global Health.
Authors’ addresses: David van Melle, Amsterdam University Medical Center, Department of Global Health, Amsterdam, The Netherlands, and Amsterdam Institute of Global Health, Amsterdam, The Netherlands, E-mail: email@example.com. Guus ten Asbroek, Amsterdam University Medical Center, Department of Global Health, Amsterdam, The Netherlands, Amsterdam Institute of Global Health, Amsterdam, The Netherlands, and Duke Global Health Institute, Durham, NC, E-mail: firstname.lastname@example.org. Robert Rolfe, Tianchen Sheng, and Christopher W. Woods, Duke Global Health Institute, Durham, NC, and Duke University School of Medicine, Department of Medicine, Durham, NC, E-mails: email@example.com, firstname.lastname@example.org, and email@example.com. Sky Vanderburg, Duke University School of Medicine, Department of Medicine, Durham, NC, and University of California San Francisco, Department of Medicine, San Francisco, CA, E-mail: firstname.lastname@example.org. Yohanna W. Abeysinghe, Chathuh Hallowluwa, Ruvini Kurukulasooriya, Sewwandi Kanchana, and Gaya Wijayaratne, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mails: email@example.com@gmail.com, firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Helen L. Zhang, Duke University School of Medicine, Department of Medicine, Durham, NC, E-mail: email@example.com. Truls Ostbye, Duke Global Health Institute, Durham, NC, and Duke University School of Medicine, Department of Family Medicine and Community Health, Durham, NC, E-mail: firstname.lastname@example.org. Champica Bodinayake, Ajith Nagahawatte, Melissa H. Watt, and Vijitha de Silva, Duke Global Health Institute, Durham, NC, and Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mails: email@example.com, firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Gayani Tillekeratne, Duke Global Health Institute, Durham, NC, Duke University School of Medicine, Department of Medicine, Durham, NC, and Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mail: email@example.com.