Knowledge, attitudes and practices towards antibiotic use in upper respiratory tract infections among patients seeking primary health care in Singapore.
Patients' expectations can influence antibiotic prescription by primary healthcare physicians. We assessed knowledge, attitude and practices towards antibiotic use for upper respiratory tract infections (URTIs), and whether knowledge is associated with increased expectations for antibiotics among patients visiting primary healthcare services in Singapore.



Data was collected through a cross-sectional interviewer-assisted survey of patients aged ≥21 years waiting to see primary healthcare practitioners for one or more symptoms suggestive of URTI (cough, sore throat, runny nose or blocked nose) for 7 days or less, covering the demographics, presenting symptoms, knowledge, attitudes, beliefs and practices of URTI and associated antibiotic use. Univariate and multivariate logistic regression was used to assess independent factors associated with patients' expectations for antibiotics.



Nine hundred fourteen out of 987 eligible patients consulting 35 doctors were recruited from 24 private sector primary care clinics in Singapore. A third (307/907) expected antibiotics, of which a substantial proportion would ask the doctor for antibiotics (121/304, 40 %) and/or see another doctor (31/304, 10 %) if antibiotics were not prescribed. The majority agreed "antibiotics are effective against viruses" (715/914, 78 %) and that "antibiotics cure URTI faster" (594/912, 65 %). Inappropriate antibiotic practices include "keeping antibiotics stock at home" (125/913, 12 %), "taking leftover antibiotics" (114/913, 14 %) and giving antibiotics to family members (62/913, 7 %). On multivariate regression, the following factors were independently associated with wanting antibiotics (odds ratio; 95 % confidence interval): Malay ethnicity (1.67; 1.00-2.79), living in private housing (1.69; 1.13-2.51), presence of sore throat (1.50; 1.07-2.10) or fever (1.46; 1.01-2.12), perception that illness is serious (1.70; 1.27-2.27), belief that antibiotics cure URTI faster (5.35; 3.76-7.62) and not knowing URTI resolves on its own (2.18; 1.08-2.06), while post-secondary education (0.67; 0.48-0.94) was inversely associated. Those with lower educational levels were significantly more likely to have multiple misconceptions about antibiotics.



Majority of patients seeking primary health care in Singapore are misinformed about the role of antibiotics in URTI. Agreeing with the statement that antibiotics cure URTI faster was most strongly associated with wanting antibiotics. Those with higher educational levels were less likely to want antibiotics, while those with lower educational levels more likely to have incorrect knowledge.
Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore.
Darius Shaw Teng
DS
Pan
Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore.
Joyce Huixin
JH
Huang
Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore.
Magdalene Hui Min
MH
Lee
Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore.
Yue
Y
Yu
Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore. mark.chen.ic@gmail.com.|Institute of Infectious Diseases & Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, 308433, Singapore, Singapore. mark.chen.ic@gmail.com.
Mark I-Cheng
MI
Chen
Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.
Ee Hui
EH
Goh
Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.
Lili
L
Jiang
Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.
Joash Wen Chen
JW
Chong
Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore.|Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.|Institute of Infectious Diseases & Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, 308433, Singapore, Singapore.|Lee Kong Chian School of Medicine, Nan Yang Technological University, 308232, Singapore, Singapore.
Yee Sin
YS
Leo
Institute of Infectious Diseases & Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, 308433, Singapore, Singapore.
Tau Hong
TH
Lee
Institute of Infectious Diseases & Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, 308433, Singapore, Singapore.
Chia Siong
CS
Wong
Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, 119228, Singapore, Singapore.
Victor Weng Keong
VW
Loh
Frontier Healthcare group, 400305, Singapore, Singapore.
Adrian Zhongxian
AZ
Poh
Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore.|Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, 119228, Singapore, Singapore.|Frontier Healthcare group, 400305, Singapore, Singapore.
Tat Yean
TY
Tham
Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, 119228, Singapore, Singapore.|Division of Primary Care, Raffles Medical Group, 188770, Singapore, Singapore.|Duke NUS Graduate Medical School, National University of Singapore, 169857, Singapore, Singapore.
Wei Mon
WM
Wong
Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore.|Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, 119228, Singapore, Singapore.
Fong Seng
FS
Lim
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005334:Fever / Q000821:virology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D010612:Pharyngitis / Q000821:virology; D011320:Primary Health Care; D012111:Residence Characteristics; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D012846:Singapore; D011795:Surveys and Questionnaires; D055815:Young Adult
D000900:Anti-Bacterial Agents
Antibiotic use; Educational level; Primary healthcare; Singapore; Upper Respiratory Tract Infections (URTIs)