p–ISSN: 2723 - 6609 e-ISSN: 2745-5254
Vol. 5, No. 6 June 2024 http://jist.publikasiindonesia.id/
Jurnal Indonesia Sosial Teknologi, Vol. 5, No. 6 June 2024 2994
Knowledge, Attitudes, and Behaviors of Pharmacists Towards
the Use of Antibiotics: Literature Review
Rosi Hayyu Anjani
1*
, Hidayah Karuniawati
2
Universitas Muhammadiyah Surakarta, Indonesia
Email: [email protected]
*Correspondence
ABSTRACT
Pharmacists have an important role to play in the safe use
of antibiotics and there appears to be no research evaluating
pharmacists' knowledge, attitudes, and practices towards
antibiotics and antibiotic resistance in Indonesia. An
assessment of pharmacists' knowledge, practices and
attitudes about antibiotics and their resistance will be useful
to identify problems to create effective interventions. The
databases used in the literature search are Google Scholar,
Pubmed, and ScienceDirect, with inclusion criteria
including the year of journal publication from 2010 to
2024, full text, the research sample is pharmacist, the
research uses questionnaires, and the method used is cross-
sectional, focusing on pharmaceutical knowledge, attitudes,
and behaviours on the use of antibiotics. The exclusion
criteria include duplication, not full text, inappropriate
titles, samples taken that are not pharmacists or included
other than pharmacists, only including 1 or 2 of the 3 bound
variables, namely knowledge, attitudes, and behaviours, the
methods used are not cross-sectional, do not use
questionnaires, and files cannot be opened. (n=769) 10
literature met the inclusion criteria, and 8 out of 10
literature stated that sociodemographic factors, namely age,
gender, place of residence, employment status, length of
work, level of education, and the number of antibiotics
administered, affected the knowledge, attitude, and
behaviour of pharmacists towards the use of antibiotics
without a prescription. 8 out of 10 literature is declared to
be of good quality. The results of these 10 kinds of
literature for the percentage of pharmacists who have good
knowledge are 40%-90% of the sample, the percentage of a
good attitude is 50%-90%, and the percentage of good
behaviour is 20%-60%. Sociodemographic factors
influence the knowledge, attitudes, and behaviours of
pharmacists towards the use of antibiotics without
prescriptions.
Keywords: Knowledge;
attitude; community;
pharmacy; use of
antibiotics.
Knowledge, Attitudes, and Behaviors of Pharmacists Towards the Use of Antibiotics: Literature
Review
Jurnal Indonesia Sosial Teknologi, Vol. 5, No. 6 June 2024 2995
Introduction
The impacts of antibiotic resistance include increased resource use, clinical or
economic burden, as well as increased use of broad-spectrum antibiotics, morbidity, and
mortality (Mudenda et al., 2022). Nearly one in six deaths worldwide is caused by
infectious diseases, with few new antimicrobials in the development stage, antimicrobial
resistance continues to grow to be the biggest threat to public health globally (Hadi et
al., 2016).
The use of antibiotics without a prescription is an important factor related to this
irrational use, as more than 50% of antibiotics worldwide are purchased without a
prescription (Hamdani, Nuari, & Rahayu, 2021). Due to the growing problem of
antibiotic resistance, many researchers have studied the contribution of healthcare
providers to this problem Pharmacists, as the main antibiotic providers, can be a major
contributor to antibiotic resistance in Palestine and the world (Al-Halawa, Seir, &
Qasrawi, 2023).
Therefore, pharmacists need to be ready to take on their role in educating patients
about the correct use of medications. Few studies have looked at the role of pharmacists
in terms of antibiotic resistance. In this role, good knowledge related to the use of
antibiotics is needed and balanced with good attitudes and practices related to the
administration of antibiotics to patients (Meinitasari, Yuliastuti, & Santoso, 2021). The
use of inappropriate antibiotics, such as antibiotics given to patients with the flu, can be
the cause of antibiotic resistance.
Research Methods
Literature Search and Selection Criteria
The databases used in literature searches are Google Scholar, Pubmed, and
ScienceDirect. The search was carried out on each database using keywords
(knowledge) AND (attitude) AND (practice) AND (antibiotic stewardship) OR
(antibiotic resistance) AND (pharmacist) OR (community pharmacist) OR (pharmacy),
with inclusion criteria including the year of journal publication from 2010 to 2024, full
text, the research sample was pharmacist, the research used questionnaires, and the
method used was cross-sectional, focusing on knowledge, attitudes, and behaviours of
pharmacists on the use of antibiotics (Kurniasari & Ichsan, 2023). The exclusion criteria
include duplication, not full text, inappropriate titles, samples taken that are not
pharmacists or included other than pharmacists, only including 1 or 2 of the 3 bound
variables, namely knowledge, attitudes, and behaviours, the methods used are not cross-
sectional, do not use questionnaires, and files cannot be opened.
Study Options
Titles and abstracts are filtered according to the inclusion criteria that have been
determined, to obtain the literature that is desired. Then the selected literature is re-
screened and the feasibility of the analysis is determined.
Rosi Hayyu Anjani, Hidayah Karuniawati
Jurnal Indonesia Sosial Teknologi, Vol. 5, No. 6 June 2024 2996
Results and Discussion
From the search results with the 2010-2024 limit, 769 literatures were obtained.
After duplication screening, 723 results were obtained, with a total of 46 duplicate
literature. Then 723 kinds of literature were screened for titles, filtering literature that
could not be opened and not the full text was obtained from 23 literature with
appropriate titles. Then a full-text literature screening is carried out to find literature that
meets the inclusion criteria of this review literature. The inclusion criteria include the
year of publication of the literature from 2010 to 2024, full text, the research sample is
pharmacists, the research uses questionnaires, and the method used is cross-sectional,
focusing on the knowledge, attitudes, and behaviours of pharmacists on the use of
antibiotics. After screening, 10 kinds of literature that met the inclusion criteria were
obtained, and 13 kinds of literature were excluded because there was one of the
exclusion criteria. In Table 1, the results of these 10 kinds of literature for the
percentage of pharmacists who have good knowledge are 40%-90% of the sample, the
percentage of a good attitude is 50%-90%, and the percentage of good behaviour is
20%-60%. Only 2 out of 10 studies did not provide the results of the conclusions
obtained at the level of knowledge, attitudes, and behaviours of the pharmacists who
were sampled.
Knowledge, Attitudes, and Behaviors of Pharmacists Towards the Use of Antibiotics: Literature
Review
Jurnal Indonesia Sosial Teknologi, Vol. 5, No. 6 June 2024 2997
Table 1
Characteristics and Validity of Research
Autho
r and
Year
Coun
try
Met
hod
Sam
ple
Validati
on and
Number
of
Question
naires
Reli
abili
ty
Knowl
edge
Attit
ude
Behavio
ur
Socio-
demog
raphic
factors
Knowled
ge-
Attitude-
Behavior
Correlatio
n
M
Sudhi
r., et
al,
2020
India
Cro
ss-
sect
ion
al
30
Validate
d, 22
+
Height:
47%
Low:
53%
Heig
ht:
60%
Low:
40%
Height:
66%
Low:
34%
-
-
Mude
nda
S., et
al,
2022
Zam
bia
Cro
ss-
sect
ion
al
178
Validate
d, 24
+
Keep
Good
Keep
Length
of
work
and
reside
nce
affect
attitud
e
There is a
correlatio
n between
knowledg
e-
attitude-
behavior
(Mud
enda
et al.,
2020)
Lusa
ka
Cro
ss-
sect
ion
al
144
Validate
d, 18
-
Height:
93.8%
High
:
67.4
%
Height:
25%
Low:
75%
Age
affects
attitud
es and
behavi
ours,
and
length
of
work
affects
knowl
edge
and
behavi
our.
-
Moha
med
A., et
al,
2023
Mog
adish
u
Cro
ss-
sect
ion
al
410
Validate
d, 36
-
Height:
47.6%
High
:
52.4
%
Low:
48%
Gende
r
influen
ces
behavi
our
-
Al-
Hala
wa
A., et
Pales
tine
Cro
ss-
sect
ion
152
Validate
d, 38
+
Tall
Good
Low
Reside
nce
affects
knowl
-
Rosi Hayyu Anjani, Hidayah Karuniawati
Jurnal Indonesia Sosial Teknologi, Vol. 5, No. 6 June 2024 2998
al,
2022
al
edge,
attitud
es, and
behavi
ours,
educat
ion
level
affects
attitud
es and
behavi
ours,
where
as
gender
only
affects
knowl
edge.
Mtho
mbeni
C., et
al,
2024
Limp
opo
Cro
ss-
sect
ion
al
35
Develop
ed from
review
literature
, 43
-
Height:
82.4%
Good
Low
Gende
r
affects
knowl
edge
There is a
correlatio
n between
knowledg
e and
attitudes
(Khan
et al.,
2021)
Pakis
tan
Cro
ss-
sect
ion
al
180
Validate
d, 27
+
High:
65.6%
Heig
ht:
90%
Keep
Length
of
work
and
gender
affect
knowl
edge
-
Hadi
A., et
al,
2016
Saud
i
Arab
ia
Cro
ss-
sect
ion
al
189
Validate
d, 28
-
-
-
-
The
amoun
t of
antibio
tics
given
and
the
place
of
origin
affect
behavi
our.
-
Haile
T., et
al,
2022
Ethio
pia
Cro
ss-
sect
ion
158
Validate
d, 23
+
-
-
-
Length
of
emplo
yment,
-
Knowledge, Attitudes, and Behaviors of Pharmacists Towards the Use of Antibiotics: Literature
Review
Jurnal Indonesia Sosial Teknologi, Vol. 5, No. 6 June 2024 2999
al
emplo
yment
status,
and
educat
ion
level
affect
behavi
our.
Hussa
in A.,
et al,
2020
Suda
n
Cro
ss-
sect
ion
al
1.21
7
Validate
d, 28
-
Mediu
m:
61.7%
Good
:
98.9
%
Good:
51.2%
Length
of
work
affects
knowl
edge
-
Table 2
Quality of Literature
N
Kriter
ia
M
Sudhir.
, et al,
2020
Mud
enda
S.,
et
al,
202
2
Mude
nda
S., et
al,
2020
Moha
med
A., et
al,
2023
Al-
Hala
wa
A., et
al,
2022
Mthomb
eni C., et
al, 2024
Khan
U., et
al,
2021
Hadi
A., et
al,
2016
Hail
e T.,
et
al,
202
2
Hussai
n A., et
al,
2020
1
Was
there a
clearly
defined
researc
h
questio
n?
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
2
Did the
authors
select
sample
s that
well
represe
nt the
populat
ion to
be
studied
?
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Rosi Hayyu Anjani, Hidayah Karuniawati
Jurnal Indonesia Sosial Teknologi, Vol. 5, No. 6 June 2024 3000
N
Kriter
ia
M
Sudhir.
, et al,
2020
Mud
enda
S.,
et
al,
202
2
Mude
nda
S., et
al,
2020
Moha
med
A., et
al,
2023
Al-
Hala
wa
A., et
al,
2022
Mthomb
eni C., et
al, 2024
Khan
U., et
al,
2021
Hadi
A., et
al,
2016
Hail
e T.,
et
al,
202
2
Hussai
n A., et
al,
2020
3
Did
the
author
s use
design
s that
balanc
e costs
with
errors?
?
?
?
?
?
?
?
?
?
?
4
Did the
authors
describe
the
research
instrum
ent?
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
5
Was
the
instru
ment
pretest
ed?
✓
✓
✓
✓
✓
x
✓
✓
✓
✓
6
Were
qualit
y
contr
ol
meas
ures
descri
bed?
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
7
Was
the
respo
nse
rate
suffic
ient
to
✓
✓
✓
✓
✓
x
✓
✓
✓
x
Knowledge, Attitudes, and Behaviors of Pharmacists Towards the Use of Antibiotics: Literature
Review
Jurnal Indonesia Sosial Teknologi, Vol. 5, No. 6 June 2024 3001
N
Kriter
ia
M
Sudhir.
, et al,
2020
Mud
enda
S.,
et
al,
202
2
Mude
nda
S., et
al,
2020
Moha
med
A., et
al,
2023
Al-
Hala
wa
A., et
al,
2022
Mthomb
eni C., et
al, 2024
Khan
U., et
al,
2021
Hadi
A., et
al,
2016
Hail
e T.,
et
al,
202
2
Hussai
n A., et
al,
2020
enabl
e
gener
alizin
g the
result
s to
the
target
popul
ation
?
8
Were
the
statis
tical,
analy
tic,
and
repor
ting
techn
iques
appr
opria
te to
the
data
colle
cted?
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
9
Was
evid
ence
of
ethic
al
treat
men
t of
hum
an
subj
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Rosi Hayyu Anjani, Hidayah Karuniawati
Jurnal Indonesia Sosial Teknologi, Vol. 5, No. 6 June 2024 3002
N
Kriter
ia
M
Sudhir.
, et al,
2020
Mud
enda
S.,
et
al,
202
2
Mude
nda
S., et
al,
2020
Moha
med
A., et
al,
2023
Al-
Hala
wa
A., et
al,
2022
Mthomb
eni C., et
al, 2024
Khan
U., et
al,
2021
Hadi
A., et
al,
2016
Hail
e T.,
et
al,
202
2
Hussai
n A., et
al,
2020
ects
prov
ided
?
10
Wer
e
the
auth
ors
tran
spar
ent
to
ens
ure
eval
uati
on
and
repl
icati
on?
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Quality of
survey
studies
High
Hig
h
High
High
High
Low
High
High
Hig
h
Mediu
m
Table 2 shows the results of the analysis of whether the literature used in this
review literature is of high quality or vice versa, the results obtained from Table 2 are 1
literature from (Mthombeni, Burger, Lubbe, & Julyan, 2024), and research from
(Abdelrahman Hussain, Osman Mohamed, Sandel Abkar, Siddig Mohamed, & Khider
Elzubair, 2022) has medium quality, while others have high quality.
In the results of the study, only 1 out of 10 studies stated that sociodemographic
factors had no effect on pharmacists' knowledge, attitudes, and behaviours towards
antibiotics, while the other 9 stated that sociodemographic factors affected pharmacists'
knowledge, attitudes and behaviours towards antibiotics. Sociodemographic factors that
influence pharmaceutical knowledge, attitudes, and behaviours include gender, place of
residence, position occupied, number of workers, length of work, and level of
Knowledge, Attitudes, and Behaviors of Pharmacists Towards the Use of Antibiotics: Literature
Review
Jurnal Indonesia Sosial Teknologi, Vol. 5, No. 6 June 2024 3003
education. Only 1 study examined the correlation between knowledge, attitudes, and
behaviours, while the others only focused on the influence of sociodemographic factors
on the knowledge, attitudes, and behaviours of pharmacists.
Conclusion
The results obtained from this study, 8 out of 10 kinds of literature stated that
sociodemographic factors affect the knowledge, attitudes, and behaviours of
pharmacists towards the use of antibiotics. Influential sociodemographic factors include
age, gender, place of residence, employment status, length of employment, level of
education, and the amount of antibiotics given.
Rosi Hayyu Anjani, Hidayah Karuniawati
Jurnal Indonesia Sosial Teknologi, Vol. 5, No. 6 June 2024 3004
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