DEPARTMENT OF COMMUNITY HEALTH SCIENCE

PESHAWAR MEDICAL COLLEGE

SELF-MEDICATION WITH ANTIBIOTICS

AMONGST UNDERGRADUATE STUDENTS
OF PESHAWAR, PAKISTAN.

PRINCIPAL INVESTIGATOR:
Shaharyar Khan (MB15014)
CO-INVESTIGATORS:
Muhammad Daniyal (MB15047)
Muhammad Khubaib Khan (MB15012)

SUPERVISOR:

Dr. Khadija N. Abdullah

Date of Submission:
 Table of Contents
No. Section Page
No.
1. Acknowledgment 2

2. List of Table and Graphs 3

3. List of Abbreviations 4

4. Abstract 5

5. Introduction 7

6. Objectives 8

7. Methodology 9

8. Ethical Considerations 9

9. Results 10

10. Discussion 13

11. Conclusion 15

12. Bibliography 16

13. Annexure 17

1
 Acknowledgement
The investigators of this study want to acknowledge and recognize the
services of Community Health Science Department of Peshawar Medical
College. We would like to extend our gratitude to our supervisor, Dr. Khadija
N. Abdullah, in helping us to better understand the process and procedures of
research study and guiding us through every step of the way. We also want to
acknowledge the administrators of the respective institutes who let us conduct
our study in their premises and helped us through data collection in their
institutes. We also give our appreciation to participants of our study, who gave
their consent and understood their involvement as a way to recognize the
problem and help us to highlight the issues related to self medication with
antibiotics. And lastly, we also appreciate the productive discussions we had
with our colleagues.

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 List of Tables and Graphs

Contents Page
No
Figure 1 Frequency of Antibiotics self-medication by study 10
group.

Figure 2 Frequency of Antibiotics self-medication by gender.

Figure 3 Source of knowledge about the antibiotic. 11

Figure 4 Medicine source. 12

Table 1 Antibiotic used. 13

Table 2 Disease name. 13

Figure 5 Need to consult doctor before taking antibiotic. 14

Table 3 Know about any bad effects. 14

Figure 6 Reason for preference of Self-medication over 15

Prescription.

Table 4 Experience with Self-medication. 15

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 List of Abbreviations

1. SPSS----------------Statistical Package for Social Sciences

2. ERC-----------------Ethical Review Committee

4
 ABSTRACT

INTRODUCTION:
Self-medication is defined as obtaining and consuming drugs without the advice
of a physician. In Pakistan, almost every pharmacy sells drugs without a
prescription. We hope to highlight issues relating to self-medication with
antibiotics in Peshawar.

OBJECTIVES:

1. To determine the frequency of antibiotics self-medication amongst

undergraduate students of Peshawar by gender and study group.
2. To identify the level of awareness among them.
3. To identify the diseases and causes for which antibiotics were self-
medicated.
4. To identify the commonest antibiotic used for self-medication.

METHODOLOGY:

A cross-sectional descriptive study was conducted at 4 undergraduate institutes

of Peshawar. Study was conducted from 11th Dec’ 18 to 28th Feb’ 19 and a
sample size of 382 was calculated. Data was collected using a structured
questionnaire. Ethical approval was taken from IRC. Permission to collect data
was taken from the heads of respective institutes and informed consent was
taken from the participants. Data analyzed using SPSS ver.23.

RESULTS:

Total of 382 participants. Those who self-medicated (n=124) with antibiotics,

46.0% were medical and 54.0% non-medical students; And male to female ratio
was 1.5:1. Sources of antibiotic knowledge were pharmacists(32.3%),
relatives(22.6%), friends(8.1%), medical books(7.3%), internet(5.7%) and
24.2% had other sources. 63.7% knew about the side effects of antibiotics.Self-
medication was preferred because of transport problems(15.3%),no confidence
in health professionals(13.7%),unavailability of health facilities(8.9%),financial
problems(4.0%) and 58.1% had other reasons.Throat infection (41.1%) was the
commonest cause of self-medication. The commonest antibiotic used was
Penecillins(46.0%).

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CONCLUSION:

Quite high number of undergraduate students were involved in self-medication

with antibiotics disregarding the bad effects it may cause. Our findings may
have major public health policy implications in Peshawar.

KEYWORDS:

Antibiotics, self-medication, undergraduate

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INTRODUCTION:
Self-medication is defined as obtaining and consuming drugs without the
advice of a physician either for diagnosis, prescription or surveillance of
treatment. [1] This includes acquiring medicines without a prescription,
resubmitting old prescriptions to purchase medicines, sharing medicines with
relatives or members of one's social circle or using leftover medicines stored at
home. [2]

Self-medication is a common practice around the world, [3] particularly in

developing countries. [4,5] Self-medication with antibiotics is a major contributor
to the development of resistance to antibiotics [6,7]. Prevalence of self-medication
is likely to be influenced by the health system organization, including the
availability of physicians who are able to prescribe and the health literacy of the
population.[8] In economically deprived communities, most episodes of illnesses
are treated by self-medication.[9,10] In developing countries, private pharmacies
are the predominant drug dispensers and "prescription-only" drugs are available
for sale in informal drugstores as well as in official pharmacies without a
prescription. [11]

In Pakistan, almost every pharmacy sells drugs without a prescription; a

phenomenon seen in many developing countries. [12] Consequently, antibiotics
and potentially habit forming medicines are easily available to the common
man. This together with poor awareness leaves the layman uninformed about
the potentially lethal effects of some of these drugs. [13] Antibiotic resistance is
an extending worldwide problem. [14,15] There is paucity of literature regarding
self-medication in Pakistan and no measures have been taken to address this
problem. [13] Research studies help in making policies for the betterment of
people. In our literature review we found only one study done in Karachi city
which focused on the objective we had in mind for our study but it included any
kind of medication and not only antibiotics. [13] So, we conducted this study to
highlight issues relating to self-medication of antibiotics in Peshawar city of
Pakistan.

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OBJECTIVES:
1. To determine the frequency of antibiotics self-medication amongst
undergraduate students of Peshawar by gender and study group.
2. To identify the level of awareness regarding antibiotics self-medication
among them.
3. To identify the diseases and causes for which antibiotics were self-medicated.
4. To identify the commonest antibiotic used for self-medication.

8
METHODOLOGY:
A cross-sectional descriptive study was conducted in 4 of the undergraduate
institutes of Peshawar. We did non-probability purposive sampling for the
selection of institutes. Before we started with data collection from our
sample populous, we conducted a pilot study in one of the institute with
convenience sampling of the participants. The collected data was analyzed
and collection tool was refined accordingly as we deemed it appropriate for
our study.

The study was conducted from 11th Dec’ 18 to 28th Feb’ 19. A sample size
of 382 was calculated using EpiInfo 7 App. from population of 76459
undergraduate students of Peshawar at the time. With expected frequency of
50% and acceptable margin of error 5%. Ethical approval was taken from
Institutional Review Committee. Also permission to collect data was taken
from the heads of respective institutes and informed consent was taken from
the participants of the study. After acquiring approval and permissions, data
was collected using a structured modified questionnaire with inclusion
criteria of students enrolled in the respective institutes and exclusion criteria
of students who were absent from the university on the day of data collection
and those who were on drug therapy with some other drugs.

The collected data was analyzed using SPSS ver.23. We used descriptive
statistics to get the mean, frequencies and percentages. Inferential Statistics
using Pearson Chi-Square Test for the relation of institutes or gender with
self-medication. P <0.05 was considered statistically significant.

ETHICAL CONSIDERATIONS:
 Approval from ERC was taken.
 Facilitation approval was taken from heads of the institutes in which we
conducted our research.
 The participants of the study were students who were respected and their
data kept confidential.
 Informed consent of the students was taken for the study.

9
RESULTS:

We collected data from total of 382 participants with a mean age of 21.0±1.7
years. 46.0% were medical and 54.0% were non-medical students who self-
medicated with antibiotics (Figure: 1);
Out of which, 59.7% were male and 40.3% were female.(M:F=1.5:1)
(Figure: 2)
There is no significant difference between non-medical students and medical
students who self-medicated with antibiotics (p=0.069 using Pearson Chi-
Square Test).

There is again no significant difference between Males and Females who self-
medicated with antibiotics. (p=0.155 using Pearson Chi-Square Test.)

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Pharmacist is an easy access for knowledge regarding drugs thus 32.26%
students source for antibiotic knowledge was a Pharmacist and the second
highest know source of knowledge for the students was Relative, 22.58%. as
shown in the Figure 3:

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The major source of antibiotics for those who self-medicate was pharmacy
(66.94%). Second to Pharmacy was a Relative (14.52%) as shown in the
Figure:4.

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The commonest antibiotic used by the students was penicillins.
16.1% didn’t even know the name of antibiotic they took for their symptoms as
shown in the Table 1.

Table 1: Antibiotic Used

Frequency

Penecillins 57

Macrolides 17

Fluoroquinolones 15

Cephalosporins 7

Tetracyclines 5

Azoles 2

Nitroimidazoles 1

Don't know 20

Total 124

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Throat infection being the commonest cause but some (12.9%) didn’t know the
exact pathology and still went for antibiotic self-medication. (Table 2)

Table 2: Disease Name

Frequency Percent

Throat infection 51 41.1

Chest infection 18 14.5

Don't know 16 12.9

GIT problem 8 6.5

Skin infection 7 5.6

Flu 8 6.5

Tooth infection 3 2.4

Fever 2 1.6

Ear infection 3 2.4

Wound infection 1 .8

Allergy 1 .8

Anal fissure 1 .8

Cough 1 .8

Flu, Cough 1 .8

Flu, Throat infection 1 .8

Infection 1 .8

Sinusitis 1 .8

Total 124 100.0

89.5% students agreed to the need of consulting a doctor before taking

antibiotic. (Figure 5)

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63.7% knew about the side effects of antibiotics and only 36.3% didn’t know
about any side effects of the antibiotics they took. (Table 3)

Table 3: Know about any Bad Effects

Frequency Percent

Yes 79 63.7

No 45.00 36.30

Total 124 100.0

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 Few specified reasons mentioned, in the legend of Figure 6 below, for
preference of self-medication are the obvious ones encountered by the
majority.

Even though they, in total, constitute 41.9% , still 58.1% had some other
reasons which need to be explored so to effectively deal with the issue of
self-medication with antibiotics.

Surprisingly, 77.4% students agreed that they had great experience with the
antibiotic self-medication and only 5.6% disagreed to it. Shown in the Table 4.

Table 4: Experience with Self-Medication

Frequency Percent

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 Strongly Agree 30 24.2

Agree 66 53.2

Neither Agree Nor Disagree 21 16.9

Disagree 5 4.0

Strongly Disagree 2 1.6

DISCUSSION:
An appropriate knowledge about any type of antibiotic for certain kind of
illness could only be sort from a doctor who follow your case.

Any other source of knowledge could be misleading one to use an

inappropriate antibiotic that doesn’t help but aggravate the problem.

which should have been the lowest as they should provide drugs only upon
prescription but are not doing so.

which could be the major reason for the developing resistance in many bacteria
compelling doctors to instead prescribe other groups of antibiotics now.

that could be another reason for the growing resistance to antibiotics as not
every antibiotic works against every kind of bacteria.

This could be exploited for the better.

But still they opted for self-medication, which would definitely result in overt
side effects and resistance of those inappropriate antibiotics for their illness.

That could be the their deduction from apparent results; but the underlying
resistance and occult side-effects would be there with miss-dosing,
inappropriate antibiotic and its use for inaccurate duration.

Limitations of our study were that we used non-randomised sampling

and for participation in our study. The study was done in educated
people of our society and on other hand, we have no idea about the
practice of antibiotic self-medication amongst laymen, which could be
worse. However, our sample was of a considerable size to almost
tackle those limitations.

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CONCLUSION:
32.5% undergraduate students self-medicated with antibiotics, this is
alarming figure considering the literate society of ours. Health
Education campaigns relating the topic of antibiotic self-medication
need to be commonly done to further decrease this percentage. Even
though 89.52% agreed to visit a doctor prior to using any antibiotics,
more than half still chose to self-medicate. More researches should be
done to find out the culprit reasons for antibiotic self-medication. Our
study shows that pharmacists and pharmacies play a major role in
dispensing antibiotics without any form of prescription. The
concerned authorities should take action to regulate the dispensing of
antibiotics and other prescription-only drugs in the pharmacies. Our
findings may have major public health policy implications in
Peshawar, if not in whole KhyberPakhtunKhwa province. Our study
could be a good reference for further large scale researches, perhaps at
province level, regarding the use of antibiotics.

BIBLIOGRAPHY:
1. Montastruc JL, Bagheri H, Geraud T, Lapeyre-Mestre M.
[Pharmacovigilance of self-medication]. Therapie 1997; 52: 105-10.

2. Filho L, Antonio I, Lima-Costa MF, Uchoa E. Bambui Project: a qualitative

approach to self-medication. Cad Saude Publica 2004; 20: 1661-9.

3. Sonam Jain, Reetesh Malvi, Jeetendra Kumar Purviya. Concept of self-

medication: a review. Int J Pharm Biol Arch. 2011; 2(3): 831-836.

4. Bennadi Darshana. Self-medication: a current challenge. J Basic Clin

Pharm. 2013; 5(1): 19-23.

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5. Moses Ocan, Ekwaro A, Ebuku, Freddie Bwanga, Dickens Akena, Sennono
Richard, Jasper Ogwal-Okeng, Celestino Obua. Household antimicrobial
self-medication: a systematic review and meta-analysis of the burden, risk
factors and outcomes in developing countries. BMC Public Health. 2015;
15: 742.

6. Daniel J Morgan, Iruka N, Okeke, Ramanan Laxminarayan, Eli N

Perencevich, Scott Wei-senberg. Non-prescription antimicrobial use
worldwide: a systematic review. Lancet Infect Dis. 2011; 11(9): 692-701.

7. Global Antibiotic Resistance Partnership (GARP)-India Working Group.

Rationalizing anti-biotic use to limit antibiotic resistance in India. Indian J
Med Res. 2011; 134: 281- 94.

8. Jean-Louis Montastruc, Emmanuelle Bondon-Guitton, Delphine Abadie,

Isabelle Lacroix, Aurélia Berreni, Grégory Pugnet, Geneviève Durrieu,
Laurent Sailler, Jean-Paul Giroud, Christine Damase-Michel.
Pharmacovigilance, risks and adverse effects of self-medication. Thérapie.
2016; 71(2): 257-62.

9. 1. Sclafer J, Slamet LS, de Visscher G: Appropriateness of self-medication:

method development and testing in urban Indonesia. J Clin Pharm Ther
1997, 22(4):261-272 2.

10.Geissler PW, Nokes K, Prince RJ, Achieng RO, Aagaard-Hansen J, Ouma

JH: Children and medicines: self-treatment of common illnesses among Luo
schoolchildren in western Kenya. Soc Sci Med 2000, 50:1771-1783.

11.van der Geest S. Non-information for patients: selling drugs in developing

countries. Pharmacy Int 1983; 4: 42-44.

12.Chang FR, Trivedi PK. Economics of self-medication: theory and evidence.

Health Econ 2003; 12: 721-39.

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13.Zafar SN, Reema S, Sana W, Akbar JZ, Talha V, Mahrine S, et al. Self
medication amongst university students of Karachi: Prevalence, knowledge
and attitudes. J Pak Med Assoc 2008;58:214-7.

14. Felmingham D, Gruneberg RN. The Alexander project 1996–1997: latest

susceptibility data from this international study of bacterial pathogens from
community lower respiratory track infections. Journal of Antimicrobial
Chemotheraphy 2000;45:191–203.

15. Pradier C, Dunais B, Carsentil-Etesse H, Dellamonica P. Pneumococcal

resistance patterns in Europe. European Journal of Clinical Microbiology
Infected Diseases 1997;16:644–7.

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 ANNEXURE 1:
Data collection Pro Forma
Self-medication with antibiotics amongst undergraduate students of Peshawar.

Disclaimer: Rest assured that this information collected from you is solely for research purpose; it will not
be shared with any third party.

Demography:
Age: ______
Gender: □Male □Female
Education: □ Medical □ Non-Medical
Institute name: _______________________________________________________

1. Have you used any antibiotics during last three months that were not prescribed by the Doctor?
□Yes
□ No

If yes, please proceed to answer rest of the questionnaire. If no, thank you, you can stop here.

2. Write the specific names of the Antibiotics you used.

_________________________________________________________________

3. What were the reasons for using antibiotics? (Disease)

_________________________________________________________________

4. What was the source of those medicines?

□ Pharmacy
□ Relative
□ Friend
□Other, please mention below:
______________________________________________________________________

5. What were the dose and duration of the antibiotics you used?
__________________________________________________________________

6. How did you know that the antibiotics you used were for the certain problems you had?
□From Pharmacist
□From Friend
□From Relative
□From Internet
□From Medical book
□Other, please mention below:
______________________________________________________________________

7. Do you think your experience with self-medication was useful?

Tick the correct box:

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Strongly Agree Agree Neither Agree Disagree Strongly
nor Disagree Disagree

8. Do you know about any bad effects of antibiotics?

if yes, then name some:
______________________________________________________________________
______________________________________________________________________
9. Do you think that you need to consult doctor before you take antibiotics?
□Agree
□Disagree

10. What is the main reason that you prefer self-medication over prescription?
Encircle your answer
□ Transport problem
□ Financial problem
□ Unavailability of health facilities
□ No confidence in health professionals
□ Other, please mention below:
______________________________________________________________________
Thank you

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