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Official websites use. Share sensitive information only on official, secure websites. This work is published and licensed by Dove Medical Press Limited. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4. Background: Self-medication of drugs to alleviate symptoms is a common global behavior, helping relieve burdens on health services, but many drugs eg, antibiotics are prescription-only. Self-medication of antibiotics SMA is an irrational use of drugs, contributing to microbial resistance increasing health care costs and higher mortality and morbidity. This study aimed to assess SMA among university students. Methods: This was a cross-sectional study conducted among medical and non-medical students of the National Defence University of Malaysia. A validated instrument was used to gather data. Ethics approval was obtained. Random and universal sampling was adopted, and SPSS 21 was used for data analysis. Results: A total of students participated in the study: Penicillin, doxycycline, clarithromycin were the antibiotics most used with the majority reporting no adverse drug reactions. Cost savings and convenience were the principal reasons for SMA which were mainly obtained from local retail pharmacies. Conclusion: SMA is common amongst Malaysian students and, despite understanding why SMA is unwise, even medical students self-medicate. Keywords: antibiotics, self-medication, antibiotic resistance, university students, medical students, non-medical students. Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:. Globally, AMR is developing at great speed, threatening the efficacy of antibiotics, and endangering millions with life-threatening infectious diseases including pneumonia, tuberculosis, malaria, gonorrhea, and foodborne diseases that were once easily treatable. These threats are found in both low and high resource settings. The CDC line of action is customized based on the epidemiology of the infectious microbial diseases, finding loopholes that might promote resistance and preventing resistance. Although increasing numbers of microbial infections are resistant to antimicrobial drugs, 49 prior to , no different types of antibiotics had been released for public sale for over 25 years and since then, only three new types of antibiotics for human treatment purpose have been made available for public purchase 50 , 51 This lack of new antibiotics has come about because of increasing competition between pharmaceutical companies, lowering profit margins, and stringent policy issues. One recent systematic review reported that SMA was common among people in the Middle East and contributed to using antibiotics wrongly. A study in Saudi Arabia found a Whilst the practice of SMA and other drugs is more common among the public than more educated people and health professionals, it is still common among health care professionals and university students from Malaysia and other countries. Whilst this was an opportunistic sample as the lead researcher works at the University, no research had been carried out on military students before. UPNM is a military University, most students are cadet officers, although there are some territorial and civil students. Students are extensively occupied with mandatory military training included within each program and access to students for research is difficult, The researchers used random sampling for the non-medical students from the faculties of i. Engineering FE , iii. Language Center LC. In the — academic year, there was a total of 1, student in these faculties and center. The Raosoft Sample Size Calculator was used to calculate the sample size. Data were collected using a previously validated instrument regarding antibiotic use with permission Appendix I. The self-administered questionnaire comprised three sections:. These students did not participate in the subsequent primary study. The questionnaire sections demonstrated acceptable values, with a range between 0. The study pretested result corresponds with earlier studies. The socio-demographic characteristics of the participants were described using frequency and percentages, since they are categorical variables, and compared between medical and non-medical students using the Chi-square test. The use and frequencies of SMA; reasons, diseases, basis and when to stop antibiotics during SMA and the practices and use of antibiotics during SMA were also described using frequency and percentages and compared between medical and non-medical students using Chi-square test. In the logistic regression, forward and backward LR test were used to select the variables to be included in the final model of multiple logistic regression. Each variable was also entered back into the model one by one and removed again if it was not significant, until the final model was achieved. The final model was checked to ensure that the model fitness is good. Some missing values were noted during data analysis as not all participants answered all questions fully. These were automatically excluded from the analysis as per the default setting of analysis using SPSS. The study population was informed about the objectives and process of the study that the data gathered would be anonymized and used for publication, and that study participation was entirely voluntary with no penalty should they choose not to participate. Written consent was obtained before the questionnaires were distributed. The Principal Investigator works in the National Defence University of Malaysia and therefore had access to the study participants, which are a unique group in Malaysia. This leads to some limitations of the study as it is an opportunistic sample but it was not possible to carry out a multi-center study within the resource constraints. Most participants described themselves as Malay in terms of race , The median age of the participants was 21 years old with an inter-quartile range of 2. Medical students had a higher percentage of participants with family members working in health care services; were in Year 4 and 5 of their studies; had obtained Grades B and C in their examinations; were admitted as Cadet Officers; had a higher allowance and free medical care compared to those from non-medical faculties. Antimicrobials were principally consumed for a runny nose, nasal congestion, cough, sore throat, fever, aches and pains, vomiting, diarrhea, and skin wounds Table 2. The other details regarding SMA are shown in Tables 2 — 4. Notes: a With some missing values. Table 2 shows the significant differences regarding reasons for SMA between medical and non-medical students. No medical students cited a lack of trust in prescribing doctors, whereas 16 8. There was no significant difference between medical and non-medical students regarding the dosage and the maximum number of antibiotics taken during an illness. However, significant differences were observed between the two groups regarding the consideration for SMA and where they obtained the antibiotics for SMA. A higher percentage of medical students gave either multiple answers or the brand and price of the antibiotics as their main consideration compared to non-medical students, who were more concerned about the type or an adverse reaction from the antibiotics. The practices regarding the use of antibiotics during SMA are shown in Table 4. Scores from the knowledge section were collated to calculate total knowledge scores, which were then compared between the medical and non-medical students. The mean total scores of the participants were 5. The mean total scores of knowledge about antibiotics among medical and non-medical students. Simple logistic regression was carried out, followed by multiple logistic regression to identify the independently associated factors for SMA. After finalizing the multiple logistic regression, only three variables were found to be independently significantly associated with SMA: year of study, medical faculty, and total knowledge scores. Students reporting lower SMA were in Year 5 compared to Year 1 , a medical student rather than a non-medical student and having a higher total score of knowledge regarding antibiotics. The full results of the multiple logistic regression are shown in Table 5. Prescription-only drugs including antibiotics are often self-administered as patients feel that they will save money and time, but this can lead to substantial adverse drug reactions, antibiotic resistance, treatment failure, and drug-related toxicity: all of which lead to costs for both individuals and health services 18 , With the development of MDR and extremely drug-resistance microbial-strains, treatment options are increasingly limited, and this leads to more visits to doctors; prolonged hospital stays; more expensive proprietary drugs; higher health care costs; poorer quality of life for individuals; increased mortality, and loss of potential work hours. Respondents in the study had similarities with those in other studies involving students. Earlier studies at UPNM reported more male respondents than female. Most of the current study respondents were unmarried reflecting that cadet officers cannot marry whilst a student, but also that most Malaysian university students are unmarried with the average age of marriage being 26—28 years. The current study also found that medical students had a lower rate of SMA per year than non-medical students. This could have been anticipated and explained because medical students learn about the correct use of antibiotics and the dangers of misuse during their degree program. Moreover, many of the medical students had family members who were health professionals. A similar positive awareness regarding SMA among medical students was also observed in an earlier study. Multiple studies report that the high rate of SMA can be explained by poor or lacking drug control measures, regulatory policy, and planning and, whilst antimicrobials are generally prescription-only drugs, patients can buy them over the counter because of the poor practice of regulatory agencies and individuals acquiring antibiotics to sell on the black market. Whilst this is a positive finding, almost half of the respondents changed the dosage of antimicrobials as in another study 99 or changed to another antibiotic because they felt they were not improving, their stock had run out, or they wanted a cheaper alternative. These attitudes reflect an irrational use of antimicrobials which has the potential to promote AMR. Multiple studies also report that penicillin is the most commonly abused antibiotic for SMA. These relatively privileged students cite cost-saving and convenience as the reasons for SMA. SMA can lead to adverse drug reactions and interactions, mask signs and symptoms which makes it harder to reach the correct diagnosis, and can promote the development of additional infectious diseases. Additionally, the wrong antibiotic or wrong dosage often seen in SMA can lead to microbial resistance, treatment failure, and increased cost. This is confirmed by multiple other studies which also report that when medical students have a good knowledge about SMA, subsequently more responsible self-medication practice was observed. One earlier Ethiopian study utilizing bivariate and multivariable analysis found that multiple factors were independently associated with non-prescribed antimicrobial use. In the current study, simple logistic and multiple logistic regression found SMA was significantly associated with several factors. Regarding year of study, it was lower in Year 5 compared to Year 1 students, probably due to the higher level of knowledge about antibiotics and greater maturity of the Year 5 clinical students than their biomedical science peers. The Territorial Army students had a lower reported SMA than the Cadet Officers, which might be explained by the Cadet Officers having much less time available to attend clinics. The latter can be explained by students with lower incomes looking to save money so buying cheaper over the counter antibiotics than by going to a doctor which costs more. A recent review revealed substantial overuse and misuse of antibiotics among US physicians. There are several limitations to this study. First, the study was carried out in a specific context, a military college in Malaysia and therefore the study participants may not be representative of other university students around the world and the findings may not be generalizable to other contexts eg, where antibiotics cannot be bought over the counter. The students were self-selecting as they could opt out of the study, and they also self-reported on their behaviors, therefore there could be some recall bias leading to respondents either over- or under-reporting SMA. The study sample was also relatively low and therefore more studies in different contexts with larger numbers and measuring actually observed behaviors would help to validate or refute the findings from this study. Furthermore, some participants did not complete all survey questions, hence the missing data in the results presentation. The cross-sectional study design used did not allow for the causal—effect relationship to be inferred or concluded from the results of this study. Finally, it was unclear what and how any educational interventions might have impacted on the findings; therefore, action research studies would also be useful to examine the impact on antibiotic usage of education on antibiotic resistance and appropriate use of antibiotics. Currently, AMR is a global public health crisis which has often been ascribed to the indiscriminate, irrational use of antimicrobials by registered health practitioners and SMA. These study respondents are medical and non-medical military students of the public university, who should be relatively informed and educated about the risks of SMA and will probably be future leaders in the country. Whilst these Malaysian students might not be representative of those in other contexts, the study highlights that more multi-center, well-designed prospective research studies are urgently required to confirm the issue and inform new health care and educational policies and strategies, which must include strict regulation of purchasing antibiotics over the counter. Self-medication of antibiotics SMA is a common problem, especially in low and middle-income countries. It helps contribute to antimicrobial resistance and leads to a range of other health issues for individuals and health economies. Medical students, particularly more senior students, are less likely to practice SMA than non-medical students, reflecting their deeper knowledge of antibiotic use and misuse. Whilst multiple factors contribute to SMA, cost and convenience are common reasons, reflected in the findings from this study. More educational, policy and regulatory interventions are required to increase knowledge about antibiotic use and prevent the purchase of antibiotics without prescription. The authors are very grateful to Dr. Researchers are also grateful to those students who participated in this study. This study obtained no financial support. The authors report no other conflicts of interest in this work. As a library, NLM provides access to scientific literature. Infect Drug Resist. Find articles by Mainul Haque. Find articles by Nor Azlina A Rahman. Find articles by Judy McKimm. Find articles by Golam Mohammad Kibria. Find articles by Md Anwarul Azim Majumder. Find articles by Seraj Zohurul Haque. Find articles by Md Zakirul Islam. Find articles by Shahidah Leong Binti Abdullah. Find articles by Aqil Mohammad Daher. Find articles by Zainal Zulkifli. Find articles by Sayeeda Rahman. Find articles by Russell Kabir. Received Jan 29; Accepted Mar 25; Collection date This article has been corrected. 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Buying Ecstasy online in Rajshahi

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Buying Ecstasy online in Rajshahi