Factors affecting caregivers' use of antibiotics available without a prescription in Peru

Area of Science:

• Global Health
• Pediatric Infectious Diseases
• Antimicrobial Stewardship

Background:

• Antibiotic resistance is a growing global health concern, necessitating an understanding of antibiotic use patterns in children.
• Over-the-counter availability of antibiotics in many regions complicates appropriate pediatric use and adherence to medical advice.
• Caregiver decision-making significantly influences antibiotic consumption in young children, particularly in resource-limited settings.

Purpose of the Study:

• To identify key factors influencing caregiver choices regarding antibiotic administration to children.
• To assess caregiver adherence to medical recommendations when antibiotics are not prescribed for common childhood illnesses.
• To explore the impact of education and physician communication on caregiver antibiotic-seeking behavior.

Main Methods:

• A house-to-house survey was conducted with 1200 caregivers in three peri-urban districts of Lima, Peru.
• Data collected included past antibiotic exposure in children and caregiver responses to hypothetical scenarios of common cold and diarrhea.
• Statistical analysis examined associations between caregiver education, physician communication, and antibiotic use patterns.

Main Results:

• A high prevalence of antibiotic exposure was observed: 87.2% of children under 5 had received antibiotics, with 70.3% before age one.
• Caregivers demonstrated high compliance with seeking medical advice (76.4% for colds, 87.1% for diarrhea) and respecting non-prescription decisions (84.6%).
• Higher caregiver education correlated with greater acceptance of non-prescription decisions and reduced use of pharmacist-recommended antibiotics. Physician explanations increased adherence to non-prescription advice fivefold.

Conclusions:

• Prescribed antibiotic use in young children is frequent, but caregivers largely adhere to physician recommendations, even when antibiotics are withheld.
• Physician communication and caregiver education are crucial in reducing inappropriate antibiotic use and preventing future misuse.
• Interventions should focus on improving physician prescribing practices and enhancing patient-physician communication to combat irrational antibiotic use.