Document Type : Original Article


1 Indian Council of Medical Research - Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India

2 Department of Community Medicine, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India


BACKGROUND: Contribution to antibiotic resistance can happen at two interfaces – doctor
prescribing antibiotics inadvertently or patient’s usage of antibiotics inadvertently. This study was
conducted among diabetic inpatients in a rural tertiary health center in Kolar, South India, to assess
the various practices related to antibiotic use and to explore the possible reasons for these practices
with regard to antibiotic use.
MATERIALS AND METHODS: An exploratory sequential mixed‑methods study was conducted
with an initial cross‑sectional quantitative study followed by qualitative in‑depth interviews during
August–September 2019. A pretested semi‑structured questionnaire was used to capture the
sociodemographic, disease‑, and treatment‑related characteristics and practices related to antibiotic
use. An open‑ended interview guide was used to conduct in‑depth interviews. The practices to
antibiotic use were reported using frequency (percentage). Manual descriptive content analyses were
done by two investigators separately to identify codes under the broad topic “reasons for adopted
practices with regard to antibiotic use.”
RESULTS: Of the 152 diabetic inpatients interviewed, 20 (13.2%) felt that antibiotics are safe drugs
and can be used commonly. Among these inpatients, seven (4.6%) knew that antibiotics can kill
bacteria and four (2.6%) perceived ‘antibiotic resistance’ as a big problem in India. The practice
of checking the expiry date before using antibiotics was seen in 21 (13.8%) and 44 (29%) of them
finished the full course of antibiotics. A total of six codes were identified under the broad theme of
“reasons for adopted practices with regard to antibiotic use” among diabetic inpatients.
CONCLUSIONS: Less than one‑third of them completed the antibiotic course given by the doctor, and
almost everyone was ready for over‑the‑counter purchase of antibiotics offered by the pharmacist.
The reasons for such practices were mostly attributed to the “partial drug purchases” and “incomplete
advice by the doctor.” There is an urgent need to plan and deliver an interventional package to enhance
the knowledge and inculcate good antibiotic usage practices among these high‑risk populations.


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