title: Antibiotic use and resistance: a cross-sectional study exploring knowledge and attitudes among school and institution personnel in Tbilisi, Republic of Georgia.
abstract: BACKGROUND
  The Republic of Georgia lacks regulations regarding drug prescriptions. In pharmacies, all drugs except psychotropic medication are sold legally without prescription anti-, including anti-tuberculosis agents. Due to the lack of adequate policies and regulations, the big share of responsibility regarding antibiotic education lies with the general public. This study examines public knowledge and attitudes toward antibiotic use and resistance in the Republic of Georgia among personnel from government schools and other public institutions.
  
  
  METHODS
  This cross-sectional study was conducted in June 2011 using a quantitative questionnaire. Convenience sampling method was used. Participants included 250 individuals aged 21-80 years, from government schools and public institutions. Participants were from Tbilisi as well as the surrounding rural and urban areas. Respondents provided demographic data along with statements on knowledge and attitudes towards antibiotic use and resistance. Poisson and logistic regression models were used to study the relationship between knowledge, attitude outcomes and socio-demographic characteristics.
  
  
  RESULTS
  The overall response rate was 75% (n = 187), of which 80% were female. Approximately 91% of respondents had used antibiotics at least once and 55% agreed that antibiotics speed up recovery from common colds. A number of respondents (55%) reported having received antibiotics without previously consulting a doctor and 62% reported having purchased antibiotics without a prescription. Respondents demonstrated some misunderstanding around the terms 'bacteria' and 'virus.' About 52% of participants agreed that antibiotics are effective against bacteria; however, 55% also agreed that antibiotics are effective against viruses. Trust in doctors was high at 80%. More knowledge was associated with a lower probability of having purchased antibiotics without medical consultation.
  
  
  CONCLUSIONS
  The study findings demonstrate that respondents have several misconceptions and lack knowledge on proper antibiotic use and resistance. High proportion of people use antibiotics without a medical prescription or consultation, while having high trust in the medical personnel. We believe that the high level of trust in doctors shown by our respondents should be acknowledged by the Georgian government, health care providers and public health policy professionals. Furthermore, the information should be utilized in future educational and antibiotic resistance awareness raising campaigns.
authors.affiliation: AIETI Medical School, Chonkadze St. N24, 0114, Tbilisi, Georgia. ketokandelaki@yahoo.com.|, Chonkadze St. N24, 0114, Tbilisi, Georgia. ketokandelaki@yahoo.com.
authors.forename: Ketevan
authors.initials: K
authors.lastname: Kandelaki
authors.affiliation: Global Health (IHCAR)/Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 17177, Stockholm, Sweden. cecilia.stalsby.lundborg@ki.se.
authors.forename: Cecilia Stålsby
authors.initials: CS
authors.lastname: Lundborg
authors.affiliation: Global Health (IHCAR)/Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 17177, Stockholm, Sweden. gaetano.marrone@ki.se.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Marrone
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D005846:Georgia (Republic); D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D015203:Reproducibility of Results; D012574:Schools
chemical_list: D000900:Anti-Bacterial Agents