Analysis of family physicians’ knowledge, attitudes, and actions towards antibiotic prescriptions in North Sulawesi

Authors

  • Cyndhi Widya Sari Ruswandi Universitas Sam Ratulangi
  • Henry Malcom Frank Palandeng Sam Ratulangi University
  • Frelly Valentino Kuhon Sam Ratulangi University

Keywords:

antibiotics, family doctors, knowledge, attitudes, actions

Abstract

Background: Irrational antibiotic use remains a global health challenge and is a major driver of increasing antibiotic resistance. North Sulawesi showed an increase in the use of Access category antibiotics in 2021–2022, necessitating an evaluation to ensure clinical practices are in line with guidelines. Family doctors, as the frontline of primary health care, play a very important role in controlling the appropriate use of antibiotics.

Aim: To determine the level of knowledge, attitudes, and actions of family doctors in prescribing antibiotics and to analyze the relationship between the length of practice of family doctors and their knowledge, attitudes, and actions.

Methods: This study used a quantitative cross-sectional design through the distribution of a Google-form questionnaire to 91 family doctors working with BPJS in North Sulawesi. Univariate analysis was used to determine the frequency distribution of the research variables, while bivariate analysis used the Spearman Rank correlation test to assess the relationship between length of practice and knowledge, attitudes, and actions in prescribing antibiotics

Results: The results showed that all respondents had good knowledge (100%) and attitudes (100%) regarding antibiotic administration, and most showed good practices (95.6%) while a small number showed adequate practices (4.4%). The correlation test results showed that there was no significant relationship between length of practice and knowledge (p = 0.556; r = -0.062), attitude (p = 0.714; r = -0.039), or actions (p = 0.801; r = -0.027).

Conclusion: Family doctors in North Sulawesi have good knowledge, attitudes, and practices in prescribing antibiotics, and length of practice is not significantly related to these three variables.

References

1. Spellberg B. Principles of antiinfective therapy - ClinicalKey. In: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 10th ed. Elsevier; 2019:219. Accessed August 7, 2025. https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323934992000177

2. Sulis G, Adam P, Nafade V, et al. Antibiotic prescription practices in primary care in low- and middle-income countries: a systematic review and meta-analysis. Pubmed. Published online 2020. Accessed August 7, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC7297306/

3. Ferdinand A, Coppo M, Howden B, Browning G. Tackling antimicrobial resistance by integrating one health and the sustainable development goals. BMC Global and Public Health. Published online 2023. Accessed August 7, 2025. https://bmcglobalpublichealth.biomedcentral.com/articles/10.1186/s44263-023-00003-8

4. World Health Organization. Antimicrobial Resistance: Accelerating National and Global Responses. WHO; 2023.

5. Wasir R, Sulistiadi W, Wulandari AA, Ilmi PN. Mengurangi penggunaan antimikroba tanpa resep dokter: strategi pemberdayaan masyarakat untuk menangani resistensi antimikroba di Indonesia. Universitas Pembangunan Nasional Veteran Jakarta; 2024.

6. Rahmadi A, Susilowati SI, Pahriyani A. Profil sebaran antibiotik berdasarkan klasifikasi AWaRe dan potensi risiko resistensi di Indonesia. IJPE. 2024;4(2). doi:10.37311/ijpe.v4i2.26944

7. Handayani R, Pertiwi V. Antibiotic stewardship: how it is implemented in primary healthcare facility. IntechOpen. Published online September 4, 2023. doi:10.5772/intechopen.113102

8. Limato R, Lazarus G, Dernison P, et al. Optimizing antibiotic use in Indonesia: A systematic review and evidence synthesis to inform opportunities for intervention. Lancet Reg Health Southeast Asia. 2022;2:100013. doi:10.1016/j.lansea.2022.05.002

9. Zairina E, Dhamanti I, Nurhaida I, Mutia DS, Natesan A. Analysing of drug patterns in primary healthcare centers in Indonesia based on WHO’s prescribing indicators. Clinical Epidemiology and Global Health. 2024;30:101815. doi:10.1016/j.cegh.2024.101815

10. Kusumawardani LA, Andrajati R, Amanda AB, Rahmafitri AS. Rationality of antibiotic prescribing in basic- and intermediate-level accredited primary health centres in Depok, Indonesia. Pharm Educ. 2024;24(2):127-133. doi:10.46542/pe.2024.242.127133

11. Sulis G, Daniels B, Kwan A, et al. Antibiotic overuse in the primary health care setting: a secondary data analysis of standardised patient studies from India, China and Kenya. BMJ Glob Health. 2020;5(9):e003393. doi:10.1136/bmjgh-2020-003393

12. Kmietowicz Z. UK has more female than male doctors for first time. BMJ. 2025;388:r458. doi:10.1136/bmj.r458

13. Tabalujan JA, Palandeng HMF, Ottay RI. Artritis gout dan perilaku dokter keluarga di Kota Manado. J Kedokt Komunitas Trop. 2023;11(2):463-6. Available from URL: https://ejournal.unsrat.ac.id/index.php/JKKT/article/view/52907

14. Wedhani RA. Medical problem in Asia Pacific and ways to solve it: the roles of primary care/family physician (Indonesia xperience). JFMPC. Published online May 8, 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6559075

15. Sirait R, Ottay RI, Kuhon FV. Perilaku dokter keluarga dan asma di Kota Manado. J Kedokt Komunitas Trop. 2023;11(2):467-70. Available from URL: https://ejournal.unsrat.ac.id/v3/index.php/JKKT/article/view/53210

16. Raranta DG, Kuhon FV, Palandeng HMF. Diabetes melitus tipe 2 dan perilaku dokter keluarga di Kota Manado. JKKT UNSRAT. 2023;11(2):483-8. Available from URL: https://ejournal.unsrat.ac.id/v3/index.php/JKKT/article/view/53172

17. Althagafi NS, Othman SS. Knowledge, attitude, and practice of antibiotics use among primary healthcare physicians, Ministry of Health, Jeddah. JFMPC. Published online August 30, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9638599

18. Faradhila A, Tomi, Indawati I, Nurhaini R. Evaluasi penggunaan antibiotik yang rasional pada pasien pneumonia rawat inap di RS X Kota Cirebon. CERATA Jurnal Ilmu Farmasi. 2023;14(2).

19. Chizimu JY, Mudenda S, Yamba K, et al. Antibiotic use and adherence to the WHO AWaRe guidelines across 16 hospitals in Zambia: a point prevalence survey. JAC-Antimicrobial Resistance. 2024;6(5). doi:10.1093/jacamr/dlae170

20. Júnior B, Patrício J. Social desirability bias in qualitative health research. Rev Saúde Pública. 2022;56:101. doi:https://doi.org/10.11606/s1518-8787.2022056004164

21. Al-homaidan HT, Barrimah IE. Physicians’ knowledge, expectations, and practice regarding antibiotic use in primary health care. IJHS. Published online June 12, 2018. https://pmc.ncbi.nlm.nih.gov/articles/PMC5969788/

22. Liu C, Liu C, Wang D, Zhang X. Knowledge, attitude and intentions to prescribe antibiotics: a structural equation modeling study of primary care institutions in Hubei, China. IJERPH. Published online July 5, 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6651188

23. Molina-Romera G, Vazquez-Cancela O, Vazquez-Lago JM, et al. Knowledge, attitudes and practice regarding antibiotic prescription by Medical Interns: a qualitative study in Spain. Antibiotics. 2023;12(3):457. doi:10.3390/antibiotics12030457

24. Thakolkaran N, Shetty V, D R N, D’Souza, Shetty A. Antibiotic prescribing knowledge, attitudes, and practice among physicians in teaching hospital in South India. JFMPC. Published online September 6, 2017. https://pmc.ncbi.nlm.nih.gov/articles/PMC5787949/

25. Ewoldt TMJ, Abdulla A, Van Den Broek P, et al. Barriers and facilitators for therapeutic drug monitoring of beta-lactams and ciprofloxacin in the ICU: a nationwide cross-sectional study. BMC Infect Dis. 2022;22(1):611. doi:10.1186/s12879-022-07587-w

26. Pogorzelska-Maziarz M, Carter EJ, Manning ML, Larson EL. State health department requirements for reporting of antibiotic-resistant infections by providers, United States, 2013 and 2015. Public Health Reports. Published online December 12, 2016. https://pmc.ncbi.nlm.nih.gov/articles/PMC5298509

27. Bakhit M, Mar CD, Gibson E, Hoffmann T. Exploring patients’ understanding of antibiotic resistance and how this may influence attitudes towards antibiotic use for acute respiratory infections: a qualitative study in Australian general practice. BMJ. Published online March 13, 2019. https://bmjopen.bmj.com/content/9/3/e026735

28. Baillie EJ, Merlo G, Van Driel ML, Magin PJ, Hall L. Early-career general practitioners’ antibiotic prescribing for acute infections: a systematic review. Journal of Antimicrobial Chemotherapy. Published online January 22, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10904722/

29. Eggermon D, Smit MAM, Kwestroo GA, Verheij RA, Hek K, Kunst AE. The influence of gender concordance between general practitioner and patient on antibiotic prescribing for sore throat symptoms: a retrospective study. BMC Family Practice. Published online November 17, 2018. https://pmc.ncbi.nlm.nih.gov/articles/PMC6240216

30. Ho B, Kukan S, McIsaac W. Do family medicine residents optimally prescribe antibiotics for common infectious conditions seen in a primary care setting? JAMMI. Published online November 29, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10697098/

31. Vazquez-Lago JM, Lopez-Vazquez P, Lopez-Duran A, Taracido-Trunk M, Figueiras A. Attitudes of primary care physicians to the prescribing of antibiotics and antimicrobial resistance: a qualitative study from Spain. Family Practice. 2012;29(3):352-360. doi:10.1093/fampra/cmr084

32. Fernandez-Lazaro CI, Brown KA, Langford BJ, Daneman N, Garber G, Schwartz KL. Late-career physicians prescribe longer courses of antibiotics. OXFORD Academic. Published online November 1, 2019. https://academic.oup.com/cid/article/69/9/1467/5275150

33. Karimi G, Kabir K, Farrokhi B, et al. Prescribing pattern of antibiotics by family physicians in primary health care. Pubmed. Published online January 19, 2023. Accessed August 7, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC9854067/

Published

2025-12-31

How to Cite

1.
Ruswandi CWS, Palandeng HMF, Kuhon FV. Analysis of family physicians’ knowledge, attitudes, and actions towards antibiotic prescriptions in North Sulawesi. J Kedokt Komunitas Trop [Internet]. 2025 Dec. 31 [cited 2026 Jan. 10];13(2):751-62. Available from: https://ejournal.unsrat.ac.id/v3/index.php/JKKT/article/view/65666

Issue

Section

Articles

Similar Articles

1 2 3 4 5 6 7 8 9 > >> 

You may also start an advanced similarity search for this article.