Antibiotic Use Awareness and Practices in the Indian Community During Later Stages of COVID-19 Pandemic: A Cross-Sectional Survey




Drug Resistance, Microbial, Antimicrobial stewardship, Health knowledge, Attitudes, Practices, COVID 19, Antibiotic Use, Awareness, Indian Community, Antibiotic Resistance, Overuse, Self-Medication, Azithromycin, Regulations, Healthcare Professionals, Public Health, Infection, Stewardship Programs, Rational Use


Background: An increased overuse of antibiotics coupled with dearth of newer alternatives has worsened antibiotic resistance in LMIC’s like India. The prescription of antibiotics for symptoms similar to COVID-19 infection has aggravated the problem of antibiotic overuse, further worsening antibiotic resistance. This study aims at understanding not only the extent of overuse, but also the social patterns and causes of over-prescription or self medication of antibiotics in India.

Methods: A cross-sectional survey of the knowledge, attitude and practices on antibiotic use was conducted from September to October, 2022, using a Google form questionnaire. A virtual snowball technique was used to recruit respondents.

Results: A total of 309 responses were received (56% female and 44% male). 59.5% of the respondents were between 15 to 30 years. Surprisingly, in spite of a majority of respondents (around 70%) having a health sciences background, 67.8% of respondents falsely believe that antibiotics speed up recovery from most coughs and colds. 94.8% of respondents had used antibiotics in the last one year. 17.2% of respondents had taken antibiotics without the prescription of a doctor. The most common antibiotic used on prescription and self-medication was Azithromycin. Only 20.7% of respondents took antibiotics on suspicion of having COVID-19, with the most common one being Azithromycin.

Conclusion: The study highlights that a greater knowledge on antibiotic use does not necessitate better attitude towards their cautious and rational use. The use of antibiotics for self-limiting indications like cough, cold and sore throat needs to be restricted through stricter regulations.


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Abat C, Gautret P, Raoult D. Benefits of antibiotics burden in low-income countries. Proc Natl Acad Sci USA.2018;115(35):E8109-E8110.

Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci USA. 2018; 115(15):E3463-E3470.

Shallcross LJ, Davies DS. Antibiotic overuse: a key driver of antibiotic resistance. Br J Gen Pract.2014;64(629):604-5.

World Health Organization. Antibiotic resistance. Available from: Last Updated: 2021 17 Nov. Cited: 2022 23 Sept.

World Health Organization. Antibiotic resistance: global report on surveillance. Available from: Last Updated: 2014. Cited: 2022 23 Sept.

Antibiotic Resistance Collaborators. Global burden of bacterial antibiotic resistance in 2019: a systematic analysis. Lancet. 2022; 399(10325):629-655.

Liu Q, Jing W, Liu M, Liu J. Health disparity and mortality trends of infectious diseases in BRICS from 1990 to 2019. J Glob Health. 2022; 12:04028.

Klein EY, Tseng KK, Pant S, Laxminarayan R. Tracking global trends in the effectiveness of antibiotic therapy using the Drug Resistance Index. BMJ Glob Health. 2019; 4(2):e00

Sulis G, Batomen B, Kotwani A, Pai M, Gandra S. Sales of antibiotics and hydroxychloroquine in India during the COVID-19 epidemic: An interrupted time series analysis. PLoS Med. 2021; 18(7):e1003682.

Kotwani A, Joshi J, Lamkang AS. Over-the-Counter Sale of Antibiotics in India: A Qualitative Study of Providers' Perspectives across Two States. Antibiotics (Basel). 2021; 10(9):1123.

Indian Council of Medical Research (ICMR). Antibiotic Stewardship Program Guidelines. Available from: Cited: 2022 24 Sept.

World Health Organization. Clinical management of COVID-19. Available from: Last Updated: 2020 27 May. Cited: 2022 24 Sept

Hamers RL, van Doorn HR. Antibiotic consumption in low-income and middle-income countries. Lancet Glob Health. 2018; 6(7):e732.

Awad AI, Aboud EA. Knowledge, attitude and practice towards antibiotic use among the public in Kuwait. PLoS One. 2015; 10(2):e0117910.

Russom M, Bahta M, Debesai M, Bahta I, Kessete A, Afendi A et al. Knowledge, attitude and practice of antibiotics and their determinants in Eritrea: an urban population-based survey. BMJ Open. 2021; 11(9):e046432.

Bhardwaj K, Shenoy S, Baliga S, Unnikrishnan B, Baliga BS. Knowledge, attitude, and practices related to antibiotic use and resistance among the general public of coastal south Karnataka, India–A cross-sectional survey Clin Epidem and Glob Hlth. 2021;11:100717.

Alkhalifah HM, Alkhalifah KM, Alharthi AF, Elzahrany YR, Aljuhani MA. Knowledge, attitude and practices towards antibiotic use among patients attending Al Wazarat health center. J Family Med Prim Care. 2022; 11(4):1299-1307.

Akhtar Z, Mah-E-Muneer S, Rashid MM, Ahmed MS, Islam MA, Chowdhury S, et al. Antibiotics Use and Its Knowledge in the Community: A Mobile Phone Survey during the COVID-19 Pandemic in Bangladesh. Antibiotics 2021, 10, 1052.

André M, Vernby A, Berg J, Lundborg CS. A survey of public knowledge and awareness related to antibiotic use and resistance in Sweden. J Antimicrob Chemother. 2010; 65(6):1292-6.

Napolitano F, Izzo MT, Di Giuseppe G, Angelillo IF. Public knowledge, attitudes, and experience regarding the use of antibiotics in Italy. PLoS One2013; 8(12):e84177.

Peng D, Wang X, Xu Y, Sun C, Zhou X. Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey, Glob Health Action. 2018;11:1, 1496973.

Gupta MK, Vohra C, Raghav P. Assessment of knowledge, attitudes, and practices about antibiotic resistance among medical students in India. J Family Med Prim Care. 2019; 8(9):2864-2869.

Nguyen LS, Dolladille C, Drici MD, Fenioux C, Alexandre J, Mira JP et al. Cardiovascular Toxicities Associated With Hydroxychloroquine and Azithromycin: An Analysis of the World Health Organization Pharmacovigilance Database. Circulation. 2020; 142(3):303-305.

Langford BJ, So M, Raybardhan S, Leung V, Soucy JR, Westwood D et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect. 2021; 27(4):520-531.

Cho HJ, Hong SJ, Park S. Knowledge and beliefs of primary care physicians, pharmacists, and parents on antibiotic use for the pediatric common cold. Soc Sci Med. 2004; 58(3):623-9.

World Health Organization. WHO AWaRe Antibiotic categorization. Available from: Last updated: 2019. Cited: 2022 27 Oct.

Khelgi A, Huchchannavar R, Mathew MM, Anandam S. Knowledge, attitude and practice regarding antibiotic use and antibiotic resistance among the rural public in Mangaluru, India. J Prev Epidemiol. 2022; 7(2):e26162.

Yunita SL, Yang H-W, Chen Y-C, Kao L-T, Lu Y-Z, Wen Y-L et al. Knowledge and practices related to antibiotic use among women in Malang, Indonesia.Front. Pharmacol. 2022; 13:1019303.

The horizontal bar chart titled "Socio-Demographic Characteristics of Respondents" shows that the majority correctly believe antibiotics can increase AMR (68%), kill commensal bacteria (91.2%), and have serious side effects (88%), while most (94%) correctly disagree that antibiotics speed up recovery from most coughs and colds.


2024-05-31 — Updated on 2024-07-09

How to Cite

Ghosh, H., & Gupta, K. (2024). Antibiotic Use Awareness and Practices in the Indian Community During Later Stages of COVID-19 Pandemic: A Cross-Sectional Survey. International Journal of Medical Students, 12(2), 133–140.



Original Article