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Knowledge, Perceptions, and Attitudes Regarding Antibiotic Use for Lower Respiratory Tract Infections: Insights from Patients in Sri Lanka

David T. van MelleAmsterdam University Medical Center, Department of Global Health, Amsterdam, The Netherlands;
Amsterdam Institute of Global Health, Amsterdam, The Netherlands;

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Guus ten AsbroekAmsterdam University Medical Center, Department of Global Health, Amsterdam, The Netherlands;
Amsterdam Institute of Global Health, Amsterdam, The Netherlands;
Duke Global Health Institute, Durham, North Carolina;

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Robert RolfeDuke Global Health Institute, Durham, North Carolina;
Duke University School of Medicine, Department of Medicine, Durham, North Carolina;

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Sky VanderburgDuke University School of Medicine, Department of Medicine, Durham, North Carolina;
University of California San Francisco, Department of Medicine, San Francisco, California;

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Yohanna W. AbeysingheFaculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Chathuh HalloluwaFaculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Helen L. ZhangDuke University School of Medicine, Department of Medicine, Durham, North Carolina;

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Truls OstbyeDuke Global Health Institute, Durham, North Carolina;
Duke University School of Medicine, Department of Family Medicine and Community Health, Durham, North Carolina;

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Ruvini KurukulasooriyaFaculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Tianchen ShengDuke Global Health Institute, Durham, North Carolina;
Duke University School of Medicine, Department of Medicine, Durham, North Carolina;

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Sewwandi KanchanaFaculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Gaya WijayaratneFaculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Champica BodinayakeDuke Global Health Institute, Durham, North Carolina;
Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Ajith NagahawatteDuke Global Health Institute, Durham, North Carolina;
Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Melissa H. WattDuke Global Health Institute, Durham, North Carolina;
University of Utah School of Medicine, Department of Population Health Sciences, Salt Lake City, Utah

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Christopher W. WoodsDuke Global Health Institute, Durham, North Carolina;
Duke University School of Medicine, Department of Medicine, Durham, North Carolina;

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Vijitha de SilvaDuke Global Health Institute, Durham, North Carolina;
Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Gayani TillekeratneDuke Global Health Institute, Durham, North Carolina;
Duke University School of Medicine, Department of Medicine, Durham, North Carolina;
Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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ABSTRACT.

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.

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Author Notes

Address correspondence to David van Melle, Thérèse Schwartzeplein 14-2, 1073 JM Amsterdam, The Netherlands. E-mail: david.vanmelle@gmail.com

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: david.vanmelle@gmail.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: g.tenasbroek@aighd.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: robert.rolfe@duke.edu, tianchen.sheng@duke.edu, and chris.woods@duke.edu. 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: sky.vanderburg@ucsf.edu. Yohanna W. Abeysinghe, Chathuh Hallowluwa, Ruvini Kurukulasooriya, Sewwandi Kanchana, and Gaya Wijayaratne, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mails: yoshiabeysinghe@gmail.comchathuh90@gmail.com, ruhunasearch@gmail.com, sewwandiduke@gmail.com, and gayabw@yahoo.co.uk. Helen L. Zhang, Duke University School of Medicine, Department of Medicine, Durham, NC, E-mail: helen.zhang1@pennmedicine.upenn.edu. 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: truls.ostbye@duke.edu. 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: bodinayake@gmail.com, ajithnagahawatte@yahoo.co.uk, melissa.watt@hsc.utah.edu, and pvijithadesilva123@yahoo.com. 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: gayani.tillekeratne@duke.edu.

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