Survey of antibiotic knowledge amongst final year medical students

E. P. Wright* and P. Jain

Department of Medical Microbiology, Conquest Hospital, St Leonards on Sea, East Sussex TN37 7RD, UK

Keywords: education, undergraduates, antibiotics, antimicrobial chemotherapy

Sir,

In 1998 the Standing Medical Advisory Committee Sub-Group on Antimicrobial Resistance recommended that a greater emphasis than hitherto should be placed on teaching about antimicrobial prescribing in medical and dental schools.1 This recommendation was later endorsed by the UK Department of Health.2

It is now 10 years since a survey of undergraduate and continuing medical education about antimicrobial chemotherapy in the UK was reported by a Working Party of the British Society for Antimicrobial Chemotherapy.3 We decided to investigate the current knowledge of final year UK medical students about antibiotics.

During November 2002–May 2003 a questionnaire was distributed to three groups of final year medical students attending a district general hospital for clinical work experience. The questionnaires were circulated and returned before one of us (E.P.W.) gave the students any teaching on antibiotics. All 52 questionnaires were returned although not all questions were answered by each respondent. Those surveyed were asked to give the generic or approved name for six antibiotics listed by their proprietary name. Ciproxin and ciprofloxacin was given as an example. Sixty percent (31/52) knew the generic name for both Augmentin and Fucidin, 40% were correct for Flagyl, 10% for Zinacef but none knew the correct generic name for either Targocid or Magnapen. Secondly, respondents were asked to list three bacteria for which there is increasing evidence of antibiotic resistance. Staphylococcus aureus was named by 94%, Mycobacterium tuberculosis by 48%, Streptococcus pneumoniae by 23%, enterococci by 13%, Enterobacteriaceae by 10% and campylobacter by 4%. Thirdly, students were asked to list three reasons why a patient with a bacterial infection identified and reported by the microbiology laboratory as being ‘sensitive’ to the antibiotic the patient had been prescribed, may not be responding to that treatment. The wrong dose was offered as the commonest reason for treatment failure (52%), followed by poor penetration at the site of infection (27%), inadequate length of treatment (25%), resistance developing while on treatment (23%), errors associated with specimen labelling (13%), bacterium isolated not being the true pathogen (10%), laboratory error (4%) and disease too far advanced (2%). Finally, respondents were asked to estimate the percentage of all hospital in-patients of an average district general hospital who receive an antibiotic either for treatment or prophylaxis, on a daily basis. Forty percent thought between 71%–100% of patients each day were given an antibiotic, 35% thought it was 41%–70% of patients and 23% thought it was 0–40%. The commonest reply (16/51) was 71%–80% of patients. There was one non-response to this question.

The results of this small survey must be interpreted with caution. However, we consider it does show some interesting findings. Although the use of generic names is always encouraged, proprietary names are often used in everyday practice. It is of note that less than half these students knew that metronidazole was the same antibiotic as Flagyl. Their knowledge about antibiotic resistance amongst frequently isolated bacteria was good. Not surprisingly, methicillin-resistant Staphylococcus aureus was the most commonly quoted bacterium demonstrating increased antibiotic resistance. Neisseria gonorrhoeae was not mentioned by any respondent. The question regarding poor response to therapy by the ‘correct’ antibiotic was well answered and overall showed a good understanding of many of the problems associated with antibiotic prescribing. Finally, many students overestimated the number of patients in a district general hospital receiving an antibiotic on a daily basis. Two studies of antibiotic usage within our district general hospital have identified about 33% of all in-patients receiving an antibiotic daily for either treatment or prophylaxis.

We have been unable to identify any other studies of medical student’s knowledge of antibiotics within the literature. Teaching about antimicrobial chemotherapy remains a vital part of both the undergraduate and postgraduate medical curriculum, considering the frequency with which these agents are prescribed and continuing concerns about antibiotic resistance. Antibiotics, antimycotics, antiviral agents as well as antimalaria drugs are considered among the essential drugs of a core curriculum in clinical pharmacology for undergraduate medical students in Europe.4 We believe that there is an important role here for the medical microbiologist who should be involved in the teaching of medical students. One of us (E.P.W.) undertakes two 1 h tutorials about antibiotics and prescribing for frequently diagnosed infections with each new group of medical students. The factual content of such teaching should reflect the nature of the student’s imminent work as junior medical staff dealing with the common infections that require hospital treatment. The results of our small survey should help to guide and stimulate that teaching.

Acknowledgements

We wish to thank Lesley Rudling, Medical Undergraduate Office, and Dr Richard Wray, District General Hospital Sub-Dean, for their assistance with this survey.

Footnotes

* Corresponding author. Tel: +44-1424-755255; Fax: +44-1424-758022; E-mail: paul.wright{at}esht.nhs.uk Back

References

1 . Standing Medical Advisory Committee Sub-Group on Antimicrobial Resistance. (1998). The Path of Least Resistance. Department of Health, London, UK.

2 . Department of Health. (2000). UK Antimicrobial Resistance Strategy and Action Plan. Department of Health, London, UK.

3 . Davey, P., Hudson, S., Ridgway, G. et al. (1993). A survey of undergraduate and continuing medical education about antimicrobial chemotherapy in the United Kingdom. British Journal of Clinical Pharmacology 36, 511–9.[ISI][Medline]

4 . Orme, M., Frolich, J. & Vrhovac, B. (2002). Towards a core curriculum in clinical pharmacology for undergraduate medical students in Europe. European Journal of Clinical Pharmacology 58, 635–40.[CrossRef][ISI][Medline]





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