Comparison of knowledge and attitudes about antibiotics and resistance, and antibiotics self-practicing between Bachelor of Pharmacy and Doctor of Pharmacy students in Southern India

  • Akram Ahmad
  • Muhammad U. Khan
  • Jagadeesan Moorthy
  • Shazia Q. Jamshed
  • Isha Patel
Keywords: Students, Pharmacy, Health Knowledge, Attitudes, Practice, Anti-Bacterial Agents, Drug Resistance, Bacterial, India


Background: There is limited research on pharmacy specialization based differences with regards to usage of antibiotics.

Objective: To compare the knowledge, attitude and practice of Bachelor of Pharmacy (BPharm) and Doctor of Pharmacy (PharmD) students about usage and resistance of antibiotics in Southern India.

Methods: This was a cross sectional study involving final year BPharm and PharmD students studying in two private institutions located in Andra Pradesh, India. The study was conducted for the period of 3 months. The questionnaire was divided into 5 components: demographics, knowledge about antibiotic use, attitude towards antibiotic use and resistance, self-antibiotic usage, and possible causes of antibiotic resistance. The study questionnaire was assessed for reliability. Data were analysed by employing Mann Whitney and chi square tests using SPSS version 19.

Results: The sample size comprised of 137 students. The response rate was 76.11% for the study. There was a significant difference in the knowledge of antibiotic use in BPharm and PharmD students (Mean score: 5.09 vs 6.18, p<0.001). The overall attitude of PharmD students about antibiotic use and resistance was positive compared to BPharm students (Mean score: 3.05 vs 2.23, p<0.05). The self-antibiotic practices was higher in BPharm students than PharmD students (36.4% vs 20%, p<0.05). A significantly high number of PharmD students believed that empirical antibiotic therapy led to antibiotic resistance (19.5% versus 48%, P<0.05).

Conclusion: PharmD students were more knowledgeable about antibiotic usage and resistance compared to BPharm students who did not have accurate and the much needed information about the same. Future interventions should be targeted towards educating the BPharm students so that they can implement the acquired knowledge in their practice.


Download data is not yet available.


1. WHO. The Evolving Threat of Antimicrobial Resistance: Options for Action.2012. Available at: (Accessed August 25, 2014).

2. US Department of Human and Health Services, Centre for Disease Control and prevention. Antibiotic Resistance Threats in the United States, 2013. Available at: (Accessed August 25, 2014).

3. Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, Chaudhary U, Doumith M, Giske CG, Irfan S, Krishnan P, Kumar AV, Maharjan S, Mushtaq S, Noorie T, Paterson DL, Pearson A, Perry C, Pike R, Rao B, Ray U, Sarma JB, Sharma M, Sheridan E, Thirunarayan MA, Turton J, Upadhyay S, Warner M, Welfare W, Livermore DM, Woodford N. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010;10(9):597-602. doi: 10.1016/S1473-3099(10)70143-2

4. Ganguly NK, Arora NK, Chandy SJ, Fairoze MN, Gill JP, Gupta U, Hossain S, Joglekar S, Joshi PC, Kakkar M, Kotwani A, Rattan A, Sudarshan H, Thomas K, Wattal C, Easton A, Laxminarayan R; Global Antibiotic Resistance Partnership (GARP) - India Working Group. Rationalizing antibiotic use to limit antibiotic resistance in India. Indian J Med Res. 2011;134:281-294.

5. Ahmad A, Patel I. Schedule H1: Is it a Solution to Curve Antimicrobial Misuse in India? Ann Med Health Sci Res. 2013;3(Suppl 1):S55-S56. doi: 10.4103/2141-9248.121228

6. Chen C, Chen YM, Hwang KL, Lin SJ, Yang CC, Tsay RW, Liu CE, Young TG. Behaviour, attitudes and knowledge about antibiotic usage among residents of Changhua, Taiwan. J Microbiol Immunol Infect. 2005;38(1):53-59.

7. Alanis AJ. Resistance to antibiotics: are we in the post-antibiotic era?. Arch Med Res. 2005;36(6):697-705.

8. Grundmann H, Klugman KP, Walsh T, Ramon-Pardo P, Sigauque B, Khan W, Laxminarayan R, Heddini A, Stelling J. A framework for global surveillance of antibiotic resistance. Drug Resist Updat. 2011;14(2):79-87. doi: 10.1016/j.drup.2011.02.007

9. Wright EP, Jain P. Survey of antibiotic knowledge amongst final year medical students. J Antimicrob Chemother. 2004;53(3):550-551.

10. Steinberg I. Clinical Choices of Antibiotics: Judging Judicious Use. Am J Manag Care. 2000;6(23 Suppl):S1178-S1188.

11. Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM; Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159-177.

12. Ahmad A, Srikanth BA, Patel I. Indian Pharm.D: Should it be pursued? Arch Pharm Pract. 2014;5(2):97-98.

13. Basak SC, Sathyanarayana D. Pharmacy education in India. Am J Pharm Educ. 2010;74(4):68.

14. Khan AKA, Banu G, KKR. Antibiotic Resistance and Usage-A Survey on the Knowledge, Attitude, Perceptions and Practices among the Medical Students of a Southern Indian Teaching Hospital. J Clin Diagn Res. 2013;7(8):1613-1616. doi: 10.7860/JCDR/2013/6290.3230

15. Shehadeh M, Suaifan G, Darwish RM, Wazaify M, Zaru L, Alja'fari S. Knowledge, attitudes and behavior regarding antibiotics use and misuse among adults in the community of Jordan. A pilot study, Saudi Pharm J. 2012;20(2):125-133. doi: 10.1016/j.jsps.2011.11.005

16. Ahmad A, Patel I, Mohanta G, Balkrishnan R. Evaluation of self medication practices in rural area of town Sahaswan at Northern India. Ann Med Health Sci Res. 2014;4(Suppl 2):S73-S78. doi: 10.4103/2141-9248.138012

17. Jamshed SQ, Elkalmi R, Rajiah K, Al-Shami AK, Shamsudin SH, Siddiqui MJ, Abdul Aziz MA, Hanafi MB, Mohammad Shariff NI, Ramlan NH, Jamil NB, Mustapha NH, Hasman Yusri NB, Shahri NA, Ismail RB, Zamri SM. Understanding of antibiotic use and resistance among final-year pharmacy and medical students: a pilot study. J Infect Dev Ctries. 2014;8(6):780-785. doi: 10.3855/jidc.3833

18. Wester CW, Durairaj L, Evans AT, Schwartz DN, Husain S, Martinez E. Antibiotic Resistance - A Survey of Physician Perceptions. Arch Intern Med. 2002;162(19):2210-2216.

19. Davenport LA, Davey PG, Ker JS; BSAC Undergraduate Education Working Party. An outcome-based approach for teaching prudent antimicrobial prescribing to undergraduate medical students: report of a Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother. 2005;56(1):196-203.

20. Chandy SJ, Mathai E, Thomas K, Faruqui AR, Holloway K, Lundborg CS. Antibiotic use and resistance: perceptions and ethical challenges among doctors, pharmacists and the public in Vellore, South India. Indian J Med Ethics. 2013;10(1):20-27.

21. Azevedo MM, Pinheiro C, Yaphe J, Baltazar F. Portuguese students' knowledge of antibiotics: a cross-sectional study of secondary school and university students in Braga. BMC Public Health. 2009 23;9:359. doi: 10.1186/1471-2458-9-359

22. Olayemi OJ, Olayinka BO, Musa AI. Evaluation of antibiotic self-medication pattern amongst undergraduate students of Ahmadu Bello University (Main Campus) Zaria. Res J Applied Sci Eng Tech. 2010;2:35-39.

23. Auta A, Banwat S, Sariem C, Shalkur D, Nasara B, Atuluku M.Medicines in Pharmacy Students' Residence and Self-medication Practices. J Young Pharm. 2012;4(2):119-123. doi: 10.4103/0975-1483.96627

24. Awad AI, Eltayeb IB. Self-medication practices with antibiotics and antimalarials among Sudanese undergraduate university students. Ann Pharmacother. 2007;41(7):1249-1255.

25. James H, Handu SS, Khaja KA, Sequeira RP. Influence of medical training on self-medication by students. Int J Clin Pharmacol Ther. 2008;46(1):23-29.

26. Steinke D, Davey P. Association between antibiotic resistance and community prescribing: a critical review of bias and confounding in published studies. Clin Infect Dis. 2001;33 Suppl 3:S193-S205.

27. Allegranzi B, Luzzati R, Luzzani A, Girardini F, Antozzi L, Raiteri R, Di Perri G, Concia E. Impact of antibiotic changes in empirical therapy on antimicrobial resistance in intensive care unit-acquired infections. J Hosp Infect. 2002;52(2):136-140.

28. Pasquale TP, Komorny KM, Letting-Mangira D, Peshek S. A Pharmacist-physician antibiotic support team.P&T. 2004; 29(1):33-40.
Original Research