Overall results of this study show that most participants had moderate to adequate knowledge regarding antibiotic use. They were aware with the risks of antibiotic use; for example, regarding antimicrobial resistance, allergic and possible side effects. Most of them knew that antibiotics are effective for bacterial infections, but had inappropriate knowledge regarding antibiotics’ effectiveness for viral infections. In terms of beliefs about antibiotic use, overall they expressed beliefs that antibiotics can prevent any symptoms/diseases from becoming worse. Only a few believed that antibiotics have no side effects; that antibiotics can cure any diseases; and that antibiotics can be used effectively to cure skin injuries by pouring the powders onto the wounds. Furthermore, the relationships between knowledge and beliefs suggest that the more appropriate their knowledge about the use of antibiotics; the fewer misconceptions they will have regarding the effectiveness of antibiotics.
There are some limitations in this study, in particular regarding the methods used. Firstly, given that the study involved the population of an urban area of Indonesia, results of this study would apply more to urban people who are mostly literate, are able to easily get access to the mass media, and possibly have received more information about antibiotics than those in rural areas. Secondly, a recognized source of error in studies of antibiotic use involving lay people is whether the participants are able to differentiate antibiotics from other types of medicines
. However, participants who were not familiar with antibiotics were excluded from this study, to minimize bias. Given that nearly half of the cases were excluded, checking was done to assess bias due to these missing values. As mentioned earlier there are no significant differences in any of the socio-demographic characteristics between those who were included and those who were excluded.
Generally, lay people in both developed and developing countries are aware that antibiotics are effective for bacterial infections
[6, 11, 26]. Interestingly, there is inconsistency in the literature regarding the appropriate knowledge among the community members about the effectiveness of antibiotics in treating viral infections
[3, 6, 26, 27]. Furthermore, inconsistent information also exists in terms of people’s knowledge about other therapeutic effects of antibiotics; for example the immediate use of antibiotics for treating a fever or treating skin injuries by pouring antibiotics powders onto them
[6, 11, 28]. Evidence mentioned earlier demonstrates that such misconceptions regarding therapeutic effects of antibiotics do exist among the general public. These facts give evidence to confirm that people are not able to differentiate the types of causal agents of infectious disease, (e.g.: bacteria, viruses, fungal) and they have very limited knowledge regarding the basic mechanism of how the antibiotics work.
In contrast to those misconceptions, people in this study had a sufficient knowledge regarding the risks of using antibiotics, such as antibiotic resistance and allergies. These findings are in line with most other studies from elsewhere
[6, 11, 27–31], but in contrast to what was reported by the European study
. People in this study were familiar with the term “resistance” although information on resistance is not usually provided when purchasing antibiotics
. However, it should be noted that when lay people talk about “resistance”, this term could mean human resists to antibiotics rather than microorganisms to antibiotics. Another possibility is that they might perceive the term of resistance as “something dangerous”. Although people may have inappropriate understanding regarding the meaning of resistance, these findings, somehow, indicate their awareness regarding the risks of antibiotic use.
In this present study, association between beliefs and knowledge is negative and moderate. This means that the more appropriate knowledge people have, the less misconceptions they have. This correlation is likely to be held by the population and is higher for male, for younger, for those with higher education, and for those with higher income level. This finding suggests that women, older people, and those with lower formal education and income levels could be prioritized in any efforts for reducing misconceptions about antibiotic use.
Inappropriate use of antibiotics exists among Indonesians, as is indicated by the previous studies
[17, 23]. Appropriate beliefs regarding antibiotic use may lead people becoming more aware of the disadvantages of using antibiotics inappropriately. Based on the findings of this present study, further studies are suggested. Firstly, a similar study needs to be conducted in rural areas of Indonesia, as this present study represents the urban people. Secondly, a better understanding is needed on the extent to which beliefs can influence people using antibiotics in inappropriate ways; for example using antibiotics without medical consultation. Thirdly, it is imperative to develop a sustainable intervention program to reduce misconceptions of antibiotic use and to increase public’s awareness about the risks of inappropriate use of antibiotics.