(P-109) Misuse of Antimicrobials in the Rural Population of a District in South India

Background: Misuse of antimicrobials includes the inappropriate use of antimicrobials due to self-medication (SMA), use of leftover antimicrobials (LOA) from previous prescriptions or non-compliance. This has serious consequences like emergence of antibiotic resistance and increased economic burden due to therapy failure, prolonged hospitalization or repeated doctor consultations.

Objectives: To determine the misuse of antimicrobials in rural population of Kanchipuram district of Tamil Nadu, India by ascertaining prevalence of SMA, non-compliance with antimicrobial therapy and reuse of LOA.

Methods: Our hospital based cross-sectional survey was conducted between January-March 2020 in Out-Patient Departments of Saveetha Medical College & Hospital, Kanchipuram district, Tamil Nadu, India. A structured validated questionnaire was used to collect data from a convenience sample of 270 patients and their relatives. A picture collage of various antimicrobials were shown to participants for better recall. Data analysis was done using SPSS version 25. Pearson’s Chi-square test was used to determine associations between different variables.

Results: One-third of participants (37.4%) reported SMA in past 6 months. SMA was commonly practiced to treat cold, cough and fever. Self-medicated antimicrobials were mostly recommended by (68.3%) and obtained from (76.5%) pharmacists. Better educated participants were practicing SMA significantly more (p=0.01) than their counterparts. Only 10% participants reported changing the dose of self-medicated antimicrobials and most of them did so on feeling better (53.6%). Educated participants did not significantly (p=0.001) change dose of antimicrobials as compared to lesser educated ones. Around 15% did not complete the course of self-medicated or prescribed antimicrobials. Forgetfulness was most common reason for not completing the course. Better educated participants (p=0.02) and those without family members in health professions (p=0.03) finished the course significantly more than their counterparts. Around half (51%) reported having LOA from previous prescriptions. Buying of extra antimicrobials (75%) and not completing the course (35%) were common reasons for LOA. The LOA were commonly stored in a closed cupboard (47.4%) or left open in a room (24.4%).

Conclusions: The misuse of antimicrobials was found to be high in Kanchipuram district. Education had a positive impact on appropriate use of antimicrobials. Misuse can be lowered by approaching societal-cultural practices through community education, supply-demand chain through stricter regulations of pharmacies, and enforcing health policies for rational use of antimicrobials.