Analysis of Profile and Contributing Factors to Non-adherence towards Antibiotics Utilization Among Caregivers of Paediatric Patients

I Komang Agus Bayu Krisnanta(1), Nani Parfati(2), Bobby Presley(3), Eko Setiawan(4*)

(1) Departemen Farmasi Klinis dan Komunitas, Faculty of Pharmacy, University of Surabaya
(2) Department of Pharmaceutics, Faculty of Pharmacy, University of Surabaya
(3) 1) Departemen Farmasi Klinis dan Komunitas, Faculty of Pharmacy, University of Surabaya 2) Pusat Informasi Obat dan Layanan Kefarmasian (PIOLK), Faculty of Pharmacy, University of Surabaya
(4) 1) Departemen Farmasi Klinis dan Komunitas, Faculty of Pharmacy, University of Surabaya 2) Pusat Informasi Obat dan Layanan Kefarmasian (PIOLK), Faculty of Pharmacy, University of Surabaya
(*) Corresponding Author


Non-adherence to antibiotic is considered as one of causes of antibiotic resistance. Caregiver plays a vital role to ensure that the paediatric patients adhere to the antibiotic treatment prescribed by physician. This study aimed to analyze the profile and factors contributing to non-adherence behavior among caregivers of pediatric patients. Caregivers of pediatric patients were recruited from one of private clinic in Surabaya. The percentage ratio of medication used to total prescribed medication was calculated to measure adherence, cut-off of 80% was used in this study to categorize adherence and non-adherence. Factors contributing to the non-adherence behavior was identified by intervewing the caregivers and the results was analysed based on Theory of planned behavior as a guide for mapping factors contributing to non-adherence. Twenty-seven out of a total of 38 caregivers (71.05%) categorized as non-adherence to the therapy. Several factors hindered adherence behavior identified in this study were: caregivers’ belief on adverse drug reaction, false belief on the health prognostic, false knowledge about antibiotic, time commitment of caregivers, forgetfulness, sharing medication among family member phenomenon, and type of medicine preparation. Prevalence of non-adherence behavior to antibiotic among community in Surabaya is relatively high and lack of knowledge does not always be the only reason behind it. Other factors that might influence medication non-adherence need to be considered to get better result, instead of only focusing on increasing patient’s knowledge. Further study is needed to identify the best and more effective intervention to improve adherence as preliminary mapping before establishing local or national scale policy.


Adherence, Antibiotic, Pediatric

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  1. World Health Organization. Global status report on noncommunicable doseases 2014. World Health Organization. Dipublikasikan 2014. Diakses 19 Mei 2015
  2. Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proc Biol Sci. 2015;282(1821):20143085.
  3. Gervassi AL, Horton H. Is Infant Immunity Actively Suppressed or Immature?. Virology. 2014;2014(5):1–9.
  4. Morris SK, Bassani DG, Awasthi S, Kumar R, Shet A, Suraweera W, et al. Diarrhea, pneumonia, and infectious disease mortality in children aged 5 to 14 years in India. Plos One. 2011;6(5):e20119.
  5. Thomson M, Vodicka TA, Buckley DI, Heneghan C, Hay AD. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ. 2013;347:f7027.
  6. Kementerian Kesehatan Republik Indonesia. Riset Kesehatan Dasar (RISKESDAS) 2013. Kememterian Kesehatan Republik Indonesia Bada nPenelitian dan Pengembangan Kesehatan. /riset-badan-litbangkes/menu-riskesnas/menu-riskesdas/374-rkd-2013. Dipublikasikan 2013. Diakses 19 Mei 2015.
  7. Hersh AL, Jackson MA, Hicks LA. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics. 2013;132(6):1146-54.
  8. Teng CL. Antibiotic prescribing for upper respiratory tract infections in the Asia-Pacific region: A brief review. Malays Fam Physician. 2014;9(2):18–25.
  9. Pan AJ, Mei Q, Ye Y, Li HR, Liu B, Li JB. Validation of the mutant selection window hypothesis with fosfomycin against Eschericia coli and Pseudomonas aeruginosa: an in vitro and in vivo comparative study. J Antibiot. 2017;70:166-173.

10. Woolhouse M, Waugh C, Perry MR, Nair H. Global disease burden due to antibiotic resistance-state of the evidence. J Glob Health. 2016;6(1):010306.

11. Gandra S, Barter DM, Laxminarayan R. Economic burden of antibiotic resistance: how much do we really know?. Clin Microbiol Infect. 2014;20(10):973-980.

12. Ciorba V, Odone A, Veronesi L, Pasquarella C, Signorelli C. Antibiotic resistance as a major public health concern: epidemiology and economic impact. Ann Ig. 2015;27(3):562-579.

13. Fernandes M, Leite A, Basto M, Nobre MA, Vieira N, Fernandes R, et al. Non-adherence to antibiotic therapy in patients visiting community pharmacies. Int J Clin Pharm. 2014;36(1):86-91.

14. Axelsson M. Report on personality and adherence to antibiotic therapy: a population-based study. BMC Psychol. 2013;1(1):24.

15. Eells SJ, Nguyen M, Jung J, Macias-Gil R, May L, Miller LG. Relationship between adherence to oral antibiotics and postdischarge clinical outcomes among patients hospitalized with Staphylococcus aureus skin infections. Antimicrob Agents Chemother. 2016;60(5):2941-2948.

16. Francis NA, Gillespie D, Nuttall J, Hood K, Little P, Verheij T, et al. Antibiotics for acute cough: an international observational study of patient adherence in primary care. Br J Gen Pract. 2012;62(599):e429-e437.

17. Llor C, Hernandez S, Bayona C, Moraqas A, Sierra N, Hernandez M, et al. A study of adherence to antibiotic treatment in ambulatory respiratory infections. Int J Infect Dis. 2013;17(3):e168-172.

18. Grosso G, Marventano S, Ferranti R, Mistretta A. Pattern of antibiotic use in the community: non-adherence and self-prescription rates in an Italian urban population. Mol Med Rep. 2012;5:1305-1310.

19. Sari WDM. Studi perbandingan kepatuhan penggunaan antibiotik di apotek Bhumyamca dan Tiara 2. [Bachelor Thesis]. Surabaya: Universitas Katolik Widya Mandala Surabaya; 2015.

20. Pranata R. Kepatuhan penggunaan antibiotik jangka pendek pada pasien dewasa di puskesmas Andalas kota Padang. [Bachelor Thesis]. Padang: Universitas Andalas; 2016.

21. Siwi YR. Evaluasi kerasionalan penggunaan antibiotika untuk infeksi menular seksual (IMS) pada tahun 2006 di kalangan pekerja seks komersial (PSK) di lokasi Pasar Kembang Yogyakarta. [Bachelor Thesis]. Yogyakarta: Universitas Sanata Dharma; 2007.

22. Wibowo R, Soedibyo S. Kepatuhan berobat dengan antibiotik jangka pendek di poliklinik umum departemen ilmu kesehatan anak rumah sakit dr.Cipto Mangunkusumo, Jakarta. Sari Pediatri. 2008;10(3):171-176.

23. Yosmar R, Fitria A, Yuliandra Y, Arifin H. Evaluation of parents’ adherence in giving antibiotics on respiratory tract infections (RTI) and factors associated with adherence. Res J Pharm Biol Chem Sci. 2016;7(1):1662-1665.

24. Peters RM, Templin TN. Theory of planned behavior, self-care motivation, and blood pressure self-care. Res Theory Nurs Pract. 2010;24(3):172-186.

25. Plotnikoff RC, Lippke S, Courneya K, Birkett N, Sigal R. Physical activity and diabetes: an application of the theory of planned behaviour to explain physical activity for Type 1 and Type 2 diabetes in an adult population sample. Psychol Health. 2010;25(1):7-23.

26. Ogden J. Health psychology: a textbook. 4th ed. Open Berkshire, UK: University Press;2007.

27. Zheng L, Zhang L, Hu Z, Ehle EA, Chen Y, Liu L, et al. Systematic review of evidence-based guidelines on medication therapy for upper respiratory tract infection in children with AGREE instrument. Plos One. 2014;9(2):e87711.

28. Le Doare K, Barker CIS, Irwin A, Sharland M. Improving antibiotic prescribing for children in the resource-poor setting. Br J Clin Pharmacol. 2015;79(3):446-455.

29. Loftson T. Essential Pharmacokinetics: a primer for pharmaceutical scientists. Oxford, UK:Academic Press;2015

30. Asín-Prieto E, Rodríguez-Gascón A, Isla A. Applications of the pharmacokinetic/pharmacodynamic (PK/PD) analysis of antimicrobial agents. J Infect Chemother. 2015;21(5):319-329.

31. Fish DN, Kiser TH. Correlation of pharmacokinetic/pharmacodynamic-derived predictions of antibiotic efficacy with clinical outcomes in severely ill patients with Pseudomonas aeruginosa pneumonia. Pharmacotherapy. 2013;33(10):1022-34.

32. Levison ME, Levison JH. Pharmacokinetics and pharmacodynamics of antibacterial agents. Infect Dis Clin North Am. 2009;23(4):791-815.

33. Takemoto CK, Hodding JH, Kraus DM. Pediatric & Neonatal Dosage Handbook. 20 ed. Hudson, Ohio: Lexi-Comp, Inc;2013.

34. Nielsen EI, Cars O, Friberg LE. Pharmacokinetic/pharmacodynamics (PK/PD) indices of antibiotics predicted by semimechanistic PKPD model: a step toward model-based dose optimization. Antimicrob Agents Chemother. 2011;55(10) :4619-4630.

35. MacGowan A. Revisiting beta-lactams-PK/PD improves dosing of old antibiotics. Curr Opin Pharmacol. 2011;11:470-476.

36. Chao J, Nau DP, Aikens JE. Patient-reported perceptions of side-effects of antihyperglycemic medication and adherence to medication regimens in persons with diabetes mellitus. Clin Ther. 2007;29(1):177-180.

37. Okoronkwo I, Okeke U, Chinweuba A, Iheanacho P. Nonadherence factors and sociodemographic characteristics of hiv-infected adults receiving antiretroviral therapy in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. ISRN AIDS. 2013; 2013: 843794.

38. Okuboyejo S. Non-adherence to medication in outpatient setting in nigeria: the effect of employment status. Glob J Health Sci. 2014;6(3):37-44.

39. Lee WP, Lee SSS, Xin X, Thumboo J. Towards a better understanding of reasons for non-adherence to treatment among patients with rheumatoid arthritis: A focus group study. Proceedings of Singapore Healthcare. 2017;26(2):109-113.

40. Chan YH, Fan MM, Fok CM, Lok ZL, Ni M, Sin CF, et al. Antibiotics nonadherence and knowledge in a community with the world's leading prevalence of antibiotics resistance: implications for public health intervention. Am J Infect Control. 2012 Mar;40(2):113-117.

41. Medi RK, Mateti UV, Kanduri KR, Konda SS. Medication adherence and determinants of non-adherence among south Indian diabetes patients. Journal of Social Health and Diabetes. 2015;3:48-51


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