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PUBLIC KNOWLEDGE ATTITUDE AND BEHAVIOUR REGARDING
ANTIBIOTICS USE IN ANIMALS IN KHARTOUM STATE
By
MOHAMMED SAHNOON HAJ AHMED
(B.V. Sc., University of Khartoum, 1995)
Supervisor
PROF. AHMED ABDEL RAHIM GAMEEL
Dissertation Submitted to the University of Khartoum in Partial Fulfilment
of the Requirements for the Degree of Master of Tropical Animal Heath
(M.T.A.H)
Department of Preventive Medicine and Veterinary Public Health
Faculty of Veterinary Medicine
University of Khartoum
May 2012
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I
Dedication
To the soul of my father
Skheikh Sahnoon Haj Ahmed
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II
ACKNOWLEDGEMENT
Firstly, I am grateful to Allah for providing me with the strength and
health to conduct the present study. I would like to express my deeply
grateful thanks to my supervisor, Prof. Ahmed Abdel Rahim Gameel for his
execution guidance, endless help, and encouragement and follow up
throughout the execution of research work and preparation of the thesis.
I would like to express my thanks and appreciation to the staff of
Department of Preventive Medicine and Public Health, Faculty of
Veterinary Medicine, University of Khartoum for their cooperation.
Also I would like to thank the respondents, in particular animal
breeders, veterinarians and those who were interested in animal production
for their cooperation and patience.
I gratefully, thank my colleague and wife Dr. Nawal M. Elkhair for
her endless help. Finally I extended my deeply thanks to my family for their
support.
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III
CONTENTS Subject ..........................................................................................................Page Dedication............................................................................................................I ACKNOWLEDGEMENT................................................................................II CONTENTS......................................................................................................III LIST OF TABLES.............................................................................................V LIST OF FIGURES....................................................................................... VII ABSTRACT...................................................................................................VIII ARABIC ABSTRACT.................................................................................... IX INTRODUCTION..............................................................................................1
CHAPTER ONE LITERATURE REVIEW
1.1 Definition of antibiotics ............................................................................ 2 1.2 History of antibiotics ................................................................................. 3 1.3 Chemistry of antibiotics ............................................................................ 5 1.4 Origin, types and classification of antibiotics ........................................... 9 1.5 Production of antibiotics ........................................................................ 11 1.6 Indication, uses and misuses of antibiotics ............................................. 12 1.7 Advantages, disadvantages and benefits ................................................. 16 1.8 Mode of action and pharmacodynamics ................................................. 17 1.9 Selection, administration and dosage ...................................................... 18 1.10 Resistance to antibiotics .......................................................................... 19 1.11 Side effects .............................................................................................. 21 1.12 Contraindication of antibiotics ................................................................ 21
CHAPTER TWO MATERIALS AND METHODS
2.1 Curriculum of the study ........................................................................... 23 2.2 Population of the study ............................................................................ 23 2.3 Samples of the study ............................................................................... 23 2.4 Discription of tool of the study ................................................................ 23 2.5 Questionnaire design .............................................................................. .24 2.5.1 Build ways of questionnaire words ......................................................... 24
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IV
2.5.2 Application and distribution of questionnaire ......................................... 24 2.6 Statistical analysis .................................................................................. 24
CHAPTER THREE RESULTS
3. Particulars of the study population .......................................................... 25 3.1 Gender and Age ....................................................................................... 25 3.2 Education ................................................................................................. 25 3.3 Occupation ............................................................................................... 26 3.4 Knowledge and attitude towards antibiotics use in animals ................... 28 3.5 Source, storage and handling of antibiotics ............................................ 30 3.6 Antibiotics administration for treatment and as growth promoters…….32 3.7 General knowledge of microbes .............................................................. 35 3.8 Education and rationl use of antibiotics .................................................. 36
CHAPTER FOUR DICUSSION
................................................................................................................. 39 CONCLUSIONS AND RECOMMENDATIONS………………..….…43 REFERENCES……….............................................................................45
APPENDIX………….................................................................................
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V
LIST OF TABLES
TABLE………………………………………………………………….Page
Table 1. Age of respondents …………………...........…………………… 25
Table 2. Education level of respondents …………………………………..26
Table 3. Occupation of the respondents …………………………………..27
Table 4. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (a).…………………...……………….……..28
Table 5. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (b)……………...………………………...…29
Table 6. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (c)………………………………………...…29
Table 7. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (d)...……………………………………...…29
Table 8. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (e).…...…………………………………...…30
Table 9. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (f)………………………………………...…30
Table 10. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (g)...……………………………………...…31
Table 11. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (h)...……………………………………...…32
Table 12. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (i)………………………………………...…32
Table 13. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (j)………………………………………...…33
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VI
Table 14. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (k)...……………………………………...…33
Table 15. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (l)………………………………………...…33
Table 16. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (m)..……………………………………...…34
Table 17. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (n)…...…………………………………...…34
Table 18. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (o)…...…………………………………...…35
Table 19. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (p)...……………………………………...…35
Table 20. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (q)...……………………………………...…35
Table 21. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (r)………………………………………...…36
Table 22. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (s)………………………………………...…36
Table 23. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (t)………………………………………...…36
Table 24. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (u)…...…………………………………...…37
Table 25. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (v)…...…………………………………...…37
Table 26. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (w)…..…………………………………...…38
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VII
LIST OF FIGURES
FIGURE……………………………………………………………….Page
Fig. 1 Age of respondents …………………...........……………………….25
Fig. 2 Education level of respondents ……………………………………..26
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VIII
ABSTRACT
The objective of this study was to assess the public knowledge,
attitude and behaviour regarding antibiotic use in animals in Khartoum State.
A questionnaire composed of 33 questions of Yes – No style was used
to collect the data. One hundred twenty-five genuinely answered
questionnaires were considered. The data were statistically analyzed and
presented as frequencies and percentages.
All interviewed individuals had contact with animals. Their ages
ranged from 20 to over 50 years; 70% of them were males who had different
education levels and 48.8% were employed in different careers. The results
indicated that 70%–94.4% of the respondents showed positive understanding
of the nature, types, storage, therapeutic use and side effects of antibiotics in
addition to their association with microbes and antimicrobial resistance.
Ninety–two percent of the respondents obtained antibiotics through proper
channels and 60.2% of them would give antibiotics as growth promoters to
animals and poultry; 61.6% of those realized the importance of withdrawal
period before using milk and meat of treated animals. Thus, a high concern
about food safety and human health was indicated. Seventy-two percent of
the respondents pointed out to the missing role of veterinary extension in
educating the public.
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IX
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INTRODUCTION
Antibiotics are now a days among the commonly used drugs in human
and veterinary medicine. They are used mainly for prevention and treatment
of diseases in man and animals and as growth promotors and feed additives
in animals (Levy, 2002). Misuse of antibiotics due to faulty prescription or
improper use would help in development of resistance and spread of
resistant bacterial strains (Turnidge, 2004). Resistance may be generated in
animals receiving antibiotics as prophylaxis and for promoting production
and this may be passed to humans (Chambers, 2006).
The rational use of antibiotics is always associated with level of
education and implementing laws and by-laws concerned with dealing and
dispensing of antibiotics. Therefore, positive public knowledge and attitude
towards antibiotics use is important for safe use of these medications and
reduction of antibiotics bacterial resistance. In many countries studies have
been conducted to assess the awareness of people about antibiotic use and
improve their understanding by appropriate means; one of these would be
veterinary extension.
In Sudan there is scarcity of information about awareness of
antibiotics, their uses and public health hazards. Therefore, the following
study was conducted using a questionnaire with the following objectives:
a. To assess the general public knowledge about antibiotic storage, uses
and side effects in human and animals.
b. To evaluate public awareness about antibiotic bacterial resistance.
c. Understanding of people about antibiotics residues and growth
promotors and their possible public health hazards.
d. To uncover problems associated with antibiotics use.
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CHAPTER ONE
LITERATURE REVIEW
1.1 Definition of antibiotics
An antibiotic is derived from the Greek words a�?�t�?� - anti, "against"
and �?�?�t�?�?�?�?� - biotikos, which means "fit for life", is a chemotherapeutic
agent that inhibits or abolishes the growth of micro-organisms, such as
bacteria, fungi, or protozoa (Dorland’s Medical Dictionary, 2010). The term
originally referred to any agent with biological activity against living
organisms; however, recently, antibiotic now refers to substances with anti-
bacterial, anti-fungal, or anti-parasitical activity (Dorland’s Medical
Dictionary, 2010).
The term antibiosis, meaning "against life," was introduced by the
French bacteriologist Vuillemin as a descriptive name of the phenomenon
exhibited by these early antibacterial drugs (Foster and Raoult, 1974;
Calderon and Sabundayo, 2007). Antibiosis was first described in 1877 in
bacteria when Louis Pasteur and Robert Koch observed that an airborne
bacillus could inhibit the growth of Bacillus anthracis (Landsberg, 1949).
The drugs were later renamed antibiotics by Selman Waksman in 1942 to
describe any substance produced by a microorganism that is antagonistic to
the growth of other microorganisms in high dilution (Waksman, 1947;
Landsberg, 1949).
The definition excluded substances that kill bacteria, but are not
produced by microorganisms such as gastric juices and hydrogen peroxide.
The term also excluded synthetic antibacterial compounds such as the
sulfonamides. Many antibacterial compounds are relatively small molecules
with a molecular weight of less than 2000 atomic mass units.
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1.2 History of antibiotics
The discovery of penicillin by Fleming in 1928 and the later
purification and synthesis of this compound were historic milestones in the
fight against infectious disease (Bennett and Chung, 2001). Subsequently,
pharmaceutical companies discovered or developed numerous antibiotics
effective against a wide range of human pathogens. Through a combination
of administering antibiotics, improved sanitation and vaccination, rates of
bacterial diseases rapidly fell. By 1975 the prevailing opinion was that the
fight against infectious diseases, at least in developed countries, had been
won. Based on this trend, many pharmaceutical companies abandoned their
antimicrobial drug development programs, as there seemed to be little need
for new compounds (Knowles, 1997).
Before the early 20th century, treatments for infections were based
primarily on medicinal folklore. Mixtures with antimicrobial properties that
were used in treatments of infections were described over 2000 years ago
(Lindblad, 2008). Many ancient cultures, including the ancient Egyptians
and ancient Greeks, used specially selected mold and plant materials and
extracts to treat infections (Forrest, 1982; Wainwright, 1989). More
observations made in the laboratory of antibiosis between micro-organisms
led to the discovery of natural antibacterial agents produced by
microorganisms. Louis Pasteur observed, "If we could intervene in the
antagonism observed between some bacteria, it would offer perhaps the
greatest hopes for therapeutics" (Kingston, 2008).
Antagonistic activities by fungi against bacteria were first described in
England by John Tyndall in 1875 (Kingston, 2008). Synthetic antibiotic
chemotherapy as a science and development of antibacterials began in
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Germany with Paul Ehrlich in the late 1880s (Calderon and Sabundayo,
2007). Ehrlich noted that certain dyes would colour human, animal, or
bacterial cells, while others did not. He then proposed the idea that it might
be possible to create chemicals that would act as a selective drug that would
bind to and kill bacteria without harming the human host. After screening
hundreds of dyes against various organisms, he discovered a medicinally
useful drug, the synthetic antibacterial Salvarsan (Calderon and Sabundayo,
2007; Limbird, 2004; Bosch and Rosich, 2008) now called Arsphenamine.
After this initial chemotherapeutic compound proved effective, others
pursued similar lines of inquiry but it was not until 1928 that Alexander
Fleming observed antibiosis against bacteria by a fungus of the genus
Penicillium. Fleming postulated that the effect was mediated by antibacterial
compound named penicillin, and that its antibacterial properties could be
exploited for chemotherapy. He initially characterized some of its biological
properties, but he did not pursue its further development (Fleming, 1980;
Sykes, 2001).
The first sulfonamide and first commercially available antibacterial
antibiotic, Prontosil, was developed by a research team led by Gerhard
Domagk in 1932 at the Bayer Laboratories of the IG Farben conglomerate in
Germany (Bosch and Rosich, 2008). Domagk received the 1939 Nobel Prize
for Medicine for his efforts. Prontosil had a relatively broad effect against
Gram-positive cocci, but not against enterobacteria. Research was stimulated
apace by its success. The discovery and development of this sulfonamide
drug opened the era of antibacterial antibiotics. In 1939, coinciding with the
start of World War II, Rene Dubos reported discovery of the first naturally
derived antibiotic, gramicidin from Bacillus brevis. It was one of the first
commercially manufactured antibiotics universally and very effectively used
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to treat wounds and ulcers during World War II (Van Epps, 2006). Research
results obtained during that period were not shared between the Axis and
Allied powers during the war.
Florey and Chain succeeded in purifying the first penicillin, penicillin
G procaine, in 1942, which was not widely available outside the Allied
military's needs before 1945. Purified penicillin displayed potent
antibacterial activity against a wide range of bacteria and had low toxicity in
humans. Furthermore, its activity was not inhibited by biological
constituents such as pus, unlike the synthetic sulfonamides. The discovery of
such a powerful antibiotic was unprecedented, and the development of
penicillin led to renewed interest in the search for antibiotic compounds with
similar efficacy and safety (Florey, 1945). For their discovery and
development of penicillin as a therapeutic drug, Ernst Chain, Howard
Florey, and Alexander Fleming shared the 1945 Nobel Prize in Medicine.
Florey credited Dubos with pioneering the approach of deliberately and
systematically searching for antibacterial compounds, which had led to the
discovery of gramicidin and had revived Florey's research in penicillin (Van
Epps, 2006).
1.3 Chemistry of antibiotics
Modern therapy by chemicals, chemotherapy, is attributed to Paul
Ehrlich (Germany, Nobel Prize in 1908) who synthesized the first antibiotic,
an arsenic compound patterned after an azo dye that he found to stain a
microorganism selectively. The compound first called compound 606 was
introduced commercially in 1910 as a treatment of syphilis under the name
of Salvarsan. Many compounds were investigated over the next 50 years as
antibacterial agents. Some structures are very complex and necessitated the
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development of new synthetic organic reactions in order to prove their
structures.
Arsphenamine (Salvarsan)
An intense effort to develop medicinal agents against malaria was
required because many soldiers were afflicted with the disease. Quinine,
discovered active against malaria in 1820, was reasonably toxic, and other
agents were required. Chloroquine (1934) was synthesized and found to be
highly effective against malaria.
Quinine Chloroquine
Careful studies of the antibacterial compound known as Prontosil (G.
Domagk, Nobel Prize, 1939), a dye that strongly stains proteins, showed that
it was metabolized to sulfanilamide, a more effective antibiotic. Prontosil is
therefore termed a prodrug as it is not the substance responsible for the
biological effect but it does produce the effective drug.
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Prontosil Sulfonamide
These studies led to the investigation of compounds containing the
sulfonamide function as potential antibiotics, and led to a number of very
effective antibiotic agents. Many of these compounds are sulfanilamides that
have an organic group in place of one of the hydrogens of the sulfonamide.
Sulfathiazole proved to be a highly effective antibiotic.
As the search for better antibiotics continued, a revolutionary drug
was developed by Florey and Chain, (1938) who isolated and purified
penicillin. Penicillin was produced by microorganisms of mold and was
found to inhibit the growth of other microorganisms. Penicillin was so
important in the treatment of bacterial infections that many research groups
from all over the world combined their research efforts in the isolation,
purification, testing and synthesis of penicillin drugs. The structurally related
cephalosporin antibiotics were also discovered during this time.
Penicillin Cephalosporin
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The search for antibiotics continued to be successful with the isolation
and structure determination of the complex antibiotics streptomycin and
tetracycline.
Streptomycin Tetracycline
Chloramphenicol, isolated in 1947, possesses a relatively simple
structure. With its two chiral carbons, it has four stereoisomers. Studies at
Parke, Davis and Co. showed that only the R, R stereoisomer is active
against microorganisms. This finding began the study of stereoisomers as
medicinal agents. Antibiotic agents with large ring systems were also
isolated.
Chloramphinacol
Erythromycin, a macrocyclic compound, is effective against penicillin
resistant bacteria. Another large ring system that contains only amino acids
is Tyrocidine A, a component of gramicidin antibacterial agents. Some
cyclic peptides are used in the treatment of other diseases such as Hodgkin's
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9
disease. Search for new antibiotics continues with an emphasis on discovery
of drugs that are effective against drug-resistant bacteria. A b-lactam class of
antibiotics called carbapenems show promise with broad spectrum antibiotic
properties.
Erythromycin Tyrocidine A
1.4 Origin, types and classification of antibiotics
Earlier the antibiotics were natural, generated by good bacteria.
Nowadays there is dealing with synthesized antibiotics. Still, antibiotic
materials are derived from good bacteria that can combat harmful ones.
Mold and soil organisms were grown to accumulate the first coarse
examples of antibiotics (Science dictionary, 2011).
At the highest level, antibiotics can be classified as either bactericidal
or bacteriostatic. Bactericidals kill bacteria directly where bacteriostatics
prevent them from dividing. However, these classifications are based on
laboratory behaviour; in practice, both of these are capable of ending a
bacterial infection (Pelczar et al., 1999)
Antibacterial antibiotics are commonly classified based on their
mechanism of action, chemical structure, or spectrum of activity. Most target
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bacterial functions or growth processes (Calderon and Sabundayo, 2007).
Those that target the bacterial cell wall (penicillins and cephalosporins) or
the cell membrane (polymixins), or interfere with essential bacterial
enzymes (quinolones and sulfonamides) have bactericidal activities. Those
that target protein synthesis (aminoglycosides, macrolides, and tetracyclines)
are usually bacteriostatic (Finberg et al., 2004). Further categorization is
based on their target specificity. "Narrow-spectrum" antibacterial antibiotics
target specific types of bacteria, such as Gram-negative or Gram-positive
bacteria, whereas broad-spectrum antibiotics affect a wide range of bacteria.
Following a 40-year hiatus in discovering new classes of antibacterial
compounds, three new classes of antibacterial antibiotics have been brought
into clinical use: cyclic lipopeptides (such as daptomycin), glycylcyclines
(such as tigecycline), and oxazolidinones (such as linezolid) (Cunha, 2009).
According to the mode of action antibiotics can be classified into
many groups. Aminoglycosides group bind to the bacterial 30S ribosomal
subunit, interfering with protein synthesis. Ribosomes are the protein factory
of the cells. They are composed of two subunits in bacteria, a 30S and a
larger 50S. By binding to the ribosome, aminoglycosides inhibit the
translocation of tRNA during translation and leaving the bacterium unable to
synthesize proteins necessary for growth. Penicillins and cephalosporins
(beta-lactam antibiotics) work by interfering with interpeptide linking of
peptidoglycan, a strong, structural molecule found specifically in bacterial
cell walls. Cell walls without intact peptidoglycan cross-links are
structurally weak, prone to collapse and disintegrate when the bacteria
attempts to divide. Macrolides group exert their bateriostatic effect by
binding irreversibly to the 50S subunit of bacterial ribosomes. By binding to
the ribosome, macrolides inhibit translocation of tRNA during translation
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11
(the production of proteins under the direction of DNA). Although the cells
of humans also have ribosomes, these eukaryotic cellular protein factories
differ in size and structure from the ribosomes of prokaryotes.
Quinolones group is a broad spectrum synthetic antibiotic that inhibits
bacterial DNA replication; these include nalidixic acid, norfloxacin and
ciprofloxacin. Sulfonamides (Sulfa drugs) act by binding irreversibly to a
bacterial enzyme that produces folic acid. Tetracyclines group inhibits
bacterial protein synthesis by preventing tRNA molecules from binding to
the 30S ribosomal subunit. Representatives of this class include tetracycline,
doxycycline and trimocycline.
1.5 Production of antibiotics
The first widely used antibiotic compounds used in modern medicine
were produced and isolated from living organisms, such as the penicillin
class produced by fungi in the genus Penicillium, or streptomycin from
bacteria of the genus Streptomyces. With advances in organic chemistry
many antibiotics are now also obtained by chemical synthesis, such as the
sulfa drugs. Many antibiotics are relatively small molecules with a molecular
weight less than 2000 Da.
Trading companies still grow them for antibiotic production. Making
their first steps in producing antibiotics, researchers used containers of all
sorts and kinds to grow large amounts of bacteria. Later on, beer brewing
equipment was used for those purposes. Nowadays the technologies go
further and large fermentation cells with liquid work are used. The scientists
faced also a number of problems, for example, how to purify antibiotics
from different admixtures. As chambers released antibiotics, they went
through a number of other processes, the result of which was impure
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12
antibiotic examples. It was Rene Dubos who solved this problem brilliantly,
despite all the difficulty of the process. He was the first to isolate gramicidin
(Science dictionary, 2011).
1.6 Indication, uses and misuses of antibiotics
Antibiotics are widely used for the treatment of bacterial and
protozoan infections. Antibiotics are also effective against several parasites
as well as immunomodulation, such as tetracycline which is effective in
periodontal inflammation and dapsone which is effective in autoimmune
diseases (Rogers et al., 1982). Antibiotics are used in prevention of
infection when there is surgical wound and for dental prophylaxis
(Wilson et al., 2007; Zadik et al., 2008). Furthermore, there is use of
antibiotics in conditions of neutropenia, particularly cancer related ones.
Antibiotics have been utilized broadly in the last 50 years in animal’s
food to treat, prevent, or control infectious illness or to enhance efficiency of
feed utilization and weight gain (Pakpour et al., 2011). Approximately 50%
of all antibacterial agents used annually in the EU are given to animals for
therapy, prevention of bacterial infections as well as growth promotors
(Anthony et al., 2000).
Antibiotics have been used in beef cattle production since the 1950s,
for therapy, as prophylactics against bacterial infection, and as antimicrobial
growth promoters (Alexander et al., 2008). Antibiotics used for non-
therapeutic applications are generally administered in the diet, either at
specific times of high disease risk such as upon arrival at the feedlot or on a
continuous basis to improve feed efficiency (Pritchard et al., 1993) and the
efficiency of meat and milk production through alterations in rumen
microbial fermentation (Bergan et al., 1984; McAllister et al., 1994) and
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13
metabolism (Walton, 1983). However, the uses of antibiotics in animal’s
food are under increasing scrutiny due to concerns over potential risk to
human health from increasingly widespread antibiotic resistance (Smith et
al., 2002; Anderson et al., 2003). Moreover, there was strong evidence that
antibiotic-resistant bacteria can be transferred from livestock to humans
(Barton, 2000; Van den Bogaard and Stobberingh, 2000) and consequently,
concern for human health, as well as consumer and political pressure,
prompted the European Union to ban Antibiotics Growth promotor (AGP) in
1999 (Casewell et al., 2003).
In clinical practice, a group of antibiotics was used for the treatment
of intra-amniotic infections to improve pregnancy outcomes and reduce
neonatal morbidity and mortality rates in humans (Romero et al., 1992;
Smorgick et al., 2007). In veterinary medicine, antibiotics were used as a
treatment for preventing postpartum uterine disease among cows at high risk
of uterine disease in cattle (Dubuc et al., 2011).
Some antibiotics such as Monensin are used extensively in the beef
and dairy industries to prevent coccidiosis, increase the production of
propionic acid and prevent bloat. On the other hand, tetracyclines are broad-
spectrum antibiotics active against both gram-positive and gram-negative
organisms. Generally gram-positive species are inhibited by lower
tetracycline concentrations than gram-negatives. The group spectrum of
activity also includes some anaerobic bacteria, Rickettsiae, Chlamydia,
Mycoplasma, spirochaetes and also some protozoa. They lack activity
against fungi and viruses. Secondary fungal infections are often common
following tetracycline therapy as a result of the destruction of the ‘normal’
protective microbial flora (Michalova et al., 2004).
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Inappropriate antibacterial treatment and overuse of antibiotics have
contributed to the emergence of antibacterial-resistant bacteria. Self
prescription of antibacterials and their use as growth promoters in
agriculture are additional examples of misuse (Larson, 2007). Many
antibacterials are frequently prescribed to treat symptoms or diseases that do
not respond to antibacterial therapy or are likely to resolve without
treatment, or incorrect or suboptimal antibacterials are prescribed for certain
bacterial infections (Slama et al., 2005; Larson, 2007). The overuse of
antibacterials, like penicillin and erythromycin, has been associated with
emerging antibacterial resistance since the 1950s (Pearson, 2007; Hawkey,
2008). Widespread usage of antibacterial drugs in hospitals has also been
associated with increases in bacterial strains and species that no longer
respond to treatment with the most common antibacterials (Hawkey, 2008).
Common forms of antibacterial misuse in humans include excessive
use of prophylactic antibiotics in travellers and failure of medical
professionals to prescribe the correct dosage of antibacterials on the basis of
the patient's weight and history of prior use. Other forms of misuse include
failure to take the entire prescribed course of the antibacterial, incorrect
dosage and administration, or failure to rest for sufficient recovery.
Inappropriate antibacterial treatment, for example, is the prescription of
antibacterials to treat viral infections such as the common cold. One study on
respiratory tract infections found "physicians were more likely to prescribe
antibiotics to patients who appeared to expect them" (Ong, 2007).
Multifactorial interventions aimed at both physicians and patients can reduce
inappropriate prescription of antibiotics (Metlay et al., (2007).
Several organizations concerned with antimicrobial resistance are
lobbying to eliminate the unnecessary use of antibacterials (Larson, 2007).
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The issues of misuse and overuse of antibiotics have been addressed by the
formation of the U.S. Interagency Task Force on Antimicrobial Resistance.
This task force aims to actively address antimicrobial resistance, and is
coordinated by the US Centres for Disease Control and Prevention, the Food
and Drug Administration (FDA), and the National Institutes of Health
(NIH), as well as other US agencies (Centres for Disease Control and
Prevention, 2009). An NGO campaign group is (Keep Antibiotics Working,
2010). In France, an "Antibiotics are not automatic" government campaign
started in 2002 and led to a marked reduction of unnecessary antibacterial
prescriptions, especially in children (Sabuncu et al., 2009).
In agriculture, antibacterials are often used to promote weight gain in
livestock. More than 70% of the antibacterials used in U.S. are given to
livestock in the absence of infectious diseases (Mellon et al., 2001). This
practice has been associated with the emergence of antibacterial-resistant
strains of bacteria, including Salmonella spp., Campylobacter spp.,
Escherichia coli, and Enterococcus spp. The emergence of antibacterial
resistance has prompted restrictions on antibacterial use in the UK in 1970
(Swann report 1969), and the EU has banned the use of antibacterials as
growth-promotional agents since 2003. Moreover, several organizations
(e.g., The American Society for Microbiology (ASM), American Public
Health Association (APHA) and the American Medical Association (AMA)
have called for restrictions on antibiotic use in food animal production and
an end to all non-therapeutic uses. However, commonly there are delays in
regulatory and legislative actions to limit the use of antibacterials, partly
attributable to resistance against such regulation by industries using or
selling antibacterials, and to the time required for research to test causal
links between antibacterial use and resistance. Two federal bills (GovTrack,
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2005), endorsed by public health and medical organizations aimed at
phasing out non-therapeutic use of antibacterials in US food animals were
proposed, but have not passed (GovTrack, 2005).
1.7 Advantages, disadvantages and benefits
The advantages of antibiotics have revolutionized the modern medical
arena and saved countless lives. Antibiotics are beneficial for those patients
who are suffering from bacterial diseases; some types only affects and cure
bacterial diseases such as tuberculosis. There are also broad-spectrum types
of antibiotics which work equally well on bacteria and fungi. It is cost,
effective and readily available as compared to others. There are over a 100
of types of antibiotics but the majority of the diseases can be cured by few
types. If the right antibiotic is taken as prescribed, it will cure the disease in
the shortest span of time (Raf, 2009).
There are also many disadvantages of using antibiotics. Excess of
everything is bad. The first and the major demerit of the antibiotics are in the
form of side effect. Some of the most common side effects are: Diarrhoea,
stomach upset, vomiting, soft stools and in serious cases there may be
abdominal cramps, allergic reaction and respiratory symptoms (Raf, 2009).
However, side effects are commonly assured in humans but in animals it is
not usually observed unless drastic or serious effects occur.
The antibiotics were first given only to those patients who had minor
diseases like tummy upset, etc. but is has been proved that the repetition of
the antibiotics is harmful and may cause serious diseases like Cancer. Many
of the medical research centres has declared that the over use of the
antibiotics is harmful for the human body as it affects and disturbs the body
internal ecology and homeostasis (Raf, 2009). Irrational use of broad
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spectrum antibiotics may be harmful because it removes all the bacteria
whether beneficial or harmful. Tetracycline antibiotic in children decreases
the level of iron, calcium and magnesium. Excessive use of antibiotics in
general, can result in depletion of iron (Raf, 2009).
1.8 Mode of action and pharmacodynamics
Antibiotics have different mode of action by which they act as
therapeutic agents. Some of antibiotics are acting as cell wall synthesis
Inhibitors (Go, 2011). Bacteria contain murein or peptidoglycan that is
highly essential in maintaining the cell wall structure. Cell wall synthesis
inhibitors such as beta-lactams, cephalosporins and glycopeptides block the
ability of microorganisms to synthesize their cell wall by inhibiting the
synthesis of peptidoglycan. Other antibiotics are interfering with protein
synthesis. Some examples include tetracyclines, chloramphenicol,
aminoglycosides and macrolides (Go, 2011). Cell membrane inhibitors
antibiotics such as polymyxins disrupt the integrity and structure of cell
membranes, thereby killing them. These set of antibiotics are mostly
effective on gram negative bacteria because these are the bacteria that
contain a definite cell membrane (Go, 2011).
DNA and RNA are extremely essential nucleic acids present in every
living cell. Antibiotics such as quinolones and rifamycins bind to the
proteins that are required for the processing of DNA and RNA, thus
blocking their synthesis and thereby affecting the growth of the cells (Go,
2011). Competitive Inhibitors antibiotics also referred to as anti-metabolites
or growth factor analogues, these are antibiotics that competitively inhibit
the important metabolic pathways occurring inside the bacterial cell.
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18
Important ones in this class are sulphonamides such as Gantrisin and
Trimethoprim (Go, 2011).
The successful outcome of antimicrobial therapy with antibacterial
compounds depends on several factors. These include host defense
mechanisms, the location of infection, and the pharmacokinetic and
pharmacodynamic properties of the antibacterial (Pankey and Sabath, 2004).
A bactericidal activity of antibacterials may depend on the bacterial growth
phase, and it often requires ongoing metabolic activity and division of
bacterial cells (Mascio et al, 2007). These findings are based on laboratory
studies, and in clinical settings have also been shown to eliminate bacterial
infection (Pankey and Sabath, 2004; Pelczar et al., 1999). Since the activity
of antibacterials depends frequently on its concentration, (Rhee and
Gardiner, 2004) in vitro characterization of antibacterial activity commonly
includes the determination of the minimum inhibitory concentration and
minimum bactericidal concentration of an antibacterial (Pankey and Sabath,
2004; Wiegand et al., 2008). To predict clinical outcome, the antimicrobial
activity of an antibacterial is usually combined with its pharmacokinetic
profile, and several pharmacological parameters are used as markers of drug
efficacy (Spanu et al., 2004).
1.9 Selection, administration and dosage
The selection of specific antibiotic depends on nature of infection,
presumed site of infection, gram stain results, suspected or known
organisms, microbial flora, patient immune status, allergics, renal and
hepatic dysfunction and antibiotic availability (Abdel Sattar, 2007)
Oral antibacterials are orally ingested, whereas intravenous
administration may be used in more serious cases, such as deep-seated
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19
systemic infections. Antibiotics may also sometimes be administered
topically, as with eye drops or ointments (Wikipedia, the free encyclopedia,
2011).
Dosage varies with drug, route of administration, pathogen, site of
infection, and severity. Additional considerations include renal function, age
of patient, and other factors. Manufacturers' recommendations should be
consulted for dose and route (Consumer Alert, 1997).
1.10 Resistance to antibiotics
Antimicrobial resistance was observed shortly after the start of the
antibiotic era in the early 1950s. Since 1960, studies have been reported
which have shown the development of drug resistance and in vitro resistance
transfer between enteric bacteria, especially for isolates from animals fed
antibiotics (Watanabe, 1963). However, it was not until the 1990s that it
became clear that the rate at which resistance developed was increasing
rapidly (Levin et al., 1998). In 2000, the World Health Organization
cautioned that infectious disease may become untreatable because of the
high levels of resistance of many human pathogens to the available drugs
(World Health Organization, 2000).
The increasing threat of antibiotic resistance is largely the result of the
overuse and misuse of antibiotics in human health as well as in agricultural
and food production settings (Gillor et al., 2004). Approximately one third
of all hospitalized patients receive antibiotics and at least half of these
prescriptions are unnecessary, poorly chosen, and/or incorrectly
administered (Gaynes, 1997; van Houten et al., 1998). In the agricultural
industry, the use of antibiotics for prophylactics and growth promotion has
contributed significantly to the emergence of resistant bacteria in animals
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20
(Barton and Hart, 2001; van den Bogaard and Stobberingh, 1999). In
addition, the almost exclusive reliance on broad-spectrum antibiotic agents
is a contributing factor to the rapid emergence of multidrug resistant
pathogens (Solomon et al., 2001; Wester et al., 2002). As novel mechanisms
of antimicrobial resistance emerge in the pool of microbial pathogens, the
frequencies of resistance have increased, although there is evidence that
reduction in the use of broad spectrum antibiotics may result in improved
microbial susceptibility (Melander et al., 2000; Tan, 2003; Vlahovic-
Palcevski et al., 2001; Witte, 1998).
On the other hand, an investigation derived from different steps of the
production chain of pork meat industries illustrates the wide distribution of
multidrug-resistant staphylococci (Simeoni et al., 2008). Moreover, resistant
bacteria and resistance genes can be transferred from food animals, their
waste, and their meat to humans via the food processing chain or the
environment (Silbergeld et al., 2008). Studies showed that human diseases
and deaths caused by strains of multidrug-resistant pathogenic Salmonella
enterica serotype Typhimurium DT104 in Denmark (Frydendahl et al., 1999)
and Enterococcus faecium in China (Lu et al., 2002) originated from swine
herds. Moreover, numerous studies with enteric bacteria have shown that the
use of antibiotics at sub-therapeutic levels in feeds increases the relative
proportions and prevalence of antibiotic resistance in facultative bacteria in
cattle faeces (Alexander et al., 2011).
A study conducted by Alexander et al., (2008) indicates that sub-
therapeutic administration of tetracycline in combination with
sulfamethazine increased the prevalence of tetracycline- and AMP-resistant.
Moreover, the resistance to antibiotics may be related to additional
environmental factors such as diet. Recently, antimicrobial-resistant
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21
Escherichia coli can be transferred between food-producing animals and
humans through the food chain, and their plasmid-encoded resistant genes
can be transferred to other pathogens, which potentially results in food
poisoning that is more difficult to treat with conventional antimicrobial
agents (Koo and Woo, 2011).
1.11 Side effects
Antibacterials are screened for any negative effects on humans or other
mammals before approval for clinical use, and are usually considered safe
and most are well-tolerated. However, some antibacterials have been
associated with a range of adverse effects (Slama et al., 2005). Side effects
range from mild to very serious dependence on the antibiotics used, the
microbial organisms targeted, and the individual patient. Safety profiles of
newer drugs are often not as well established as for those that have a long
history of use (Slama et al., 2005). Adverse effects range from fever and
nausea to major allergic reactions, including photodermatitis and
anaphylaxis. Diarrhoea may result from disruption of the species
composition in the intestinal flora, resulting in overgrowth of pathogenic
bacteria, such as Clostridium difficile (University of Michigan Health
System, 2006). Antibacterials can also lead to overgrowth of yeast species of
the genus Candida (Pirotta and Garland, 2006). Side effects can also result
from interaction with other drugs.
1.12 Contraindications of antibiotics
It's well known that antibiotics are among the most widely used drugs
in medicine. Antibiotics, as all other drugs, in cases of improper use, can
cause harmful effects on the body and as a result, there has been an increase
in the frequency of their toxic side-effects plus the prevalence of resistant
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22
microorganisms (Stavrou et al., 1989). Therefore, use of antibiotics for
prophylaxis or treatment of diseases or for prevention of post-operative
complications should be carefully guarded. Use of antibiotics as growth
promotors in animals and birds should be prohibited or at least very much
restricted. Milk or meat from animals receiving antibiotic treatment should
not be used or sold before the allowed withdrawal period of the antibiotics.
Ideally, in both human and veterinary medicine, antibiotics should be
prescribed only after identifying the organism and performing antibiograms.
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23
CHAPTER TWO
MATERIALS AND METHODS
2.1 Curriculum of the study
The study followed the descriptive approach which depends on the
examination of the situation to be studied and to identify the problem and
hypothesis.
2.2 Population of the study
The population of the study consisted of veterinarians, those who are
interested in animal production, animal breeders and others dealing in one
way or other with animals in Khartoum State. The total approached was 158
individuals.
2.3 Samples of the study
The samples of the study consisted initially of 158 individuals but the
proportion of individuals ended with 125 individuals. The classification of
the research sample was represented in the following: gender, qualification,
type of work, social environment and its relation to the animals.
2.4 Description of tool of the study
The study required the use of a questionnaire. The description of the
questionnaire is shown in Appendix A1. The questionnaire was designed in
an appropriate way to identify the direction of knowledge and the general
attitude towards the use of antibiotics in animals in Khartoum state. Speech-
questionnaire presentation was built to clarify purpose of the study and ask
the respondents to answer the questions.
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24
2.5 Questionnaire design
The questionnaire was designed in a form of questions. A total of 33
statements, mostly closed with two alternative graduated scale “Yes - No”
style, was developed to meet the requirements to be measured (Appendix
A1). In case of positive answers elaboration is sometimes required. Items for
bio-data (gender, age, etc.) are included in the questionnaire.
2.5.1 Building ways of questionnaire words
The words of questionnaire were built to follow the problem of the
study and to determine the required information on uses of antibiotics and its
impact on animals and microbes.
2.5.2 Application and distribution of questionnaire
The application form of questionnaire was distributed to veterinarians,
herders and farmers in Khartoum State.
2.6 Statistical analysis
The data was analysed using Mc Nemar’s Chi Square Test. The data
was assessed using the method of percentages and ratios analysis. Statistical
data processing was presented as tables and figures.
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CHAPTER THREE
RESULTS
3 Particulars of the study population
3.1 Gender and Age
One hundred and twenty five individuals were interviewed. Eighty
eight (70%) were males and the rest 37 (29.6%) were females. Their age
ranges from 20 to over 50 years with the majority (29.6%) falling within the
age group 31-40 years (Table 1). One hundred and two (81.6%) of them
were urban population and only 23 (18.4%) live in the neighbouring villages
and come daily to the capital for business.
Table 1. Age of respondents
Percentage Number Age group
26.6 33 Between 20-30
29.6 37 31-40
24.4 31 41-50
19.2 24 Greater than 50
100 125 Total
88 (70%) males; 37 (29.6%) females
102 (81.6%) Urban; 23 (18.4%) villagers
3.2 Education
Of the 125 individuals interviewed 16 (12.8%) did not receive any level
of education. The highest fraction of respondents (37.6%) was university
graduates, and non had postgraduate education (Table 2). It is clear from the
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26
table that individuals with different levels of education were reasonably (and
randomly) represented.
Table 2. Education level of respondents
Percentage Number Level of education
���� �� Illiterates
���� �� Primary
�� �� Secondary
���� �� University
� � Postgraduate
��� ��� Total
0%
100%
12.8%
29.6%20%
37.6%
0
20
40
60
80
100
120
140
Illitera
tesPrim
ary
Second
ary
Univer
sity
Postgr
aduate Tot
al
Level of education
Num
ber o
f res
pond
ents
Fig 1. Education level of respondents
3.3 Occupation
Sixty one (48.8%) of the participants were employed in different careers
(government or private); these included all the females interviewed. Six
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27
(4.8%) of the respondents were students and 58 (46.4%) had no definite
work (Table 3). All those interviewed had contact with animals either as pets
or farm animals (cattle, sheep and goats).
Table 3. Occupation of the respondents
Percentage Number Type of work
��� � Students
���� �� Employees
� � Housewives
46.4 �� Others
��� ��� Total
48.8% 46.4%
0%
100%
4.8%
0
20
40
60
80
100
120
140
Studen
ts
Emplo
yees
Housew
ives
Others Tot
al
Occupation
Num
ber o
f res
poda
nts
Fig. 2 Occupation of the respondents
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28
3.4 Knowledge and attitude towards antibiotics use in animals
One hundred and eighteen (94.4%) of the respondents know about
antibiotics and 115 (92%) of them deal with antibiotics; 110 (88%)
individuals could cite specific antibiotics in use for animals treatment (Table
4). Oxytetracycline and penicillin and to a lesser extent sulfa drugs, were
used by the respondents and 70 (56%) of those knew the advantages of
antibiotics as therapeutic agents (Tables 5 and 6). Table 7 shows that 29
(32.2%) of the respondents believe that antibiotics can cure any disease,
while majority (64.8%) do not think so, and 12% had no idea.
Table 4. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (a).
Statement Yes No Total Mean
±SD
Do you know anything about antibiotics? ��� � ��� ��� ±0.7 ���� ��� ���
What is your definition of an antibiotic? �� �� ��� ���
±0.6 ���� ���� ���
Example of an antibiotic ��� �� ��� ��� ±0.5 �� �� ���
Do you have previous experience or
experience of antibiotics? ��� �� ��� ���
±0.7 �� � ���
Did you use an antibiotic? ��� �� ��� 4 ±0.7 �� �� ���
Mean difference is significant at P<0.01, SD: Standard deviation
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29
Table 5. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (b).
Types of
antibiotics used by
respondents
Oxy-tetracycline Penicillin Sulpha Others Not
remember Do not
use Mean ±SD
51 31 6 14 8 15 ���
±0.8 40.8 24.8 4.8 11.2 6.4 12
Mean difference is significant at P<0.01, SD: Standard deviation
Table 6. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (c).
Why did you use the previous antibiotic?
know Do not know
Do not use Total Mean
±SD
70 40 15 125 ��� ±0.8 56 32 12 100
Mean difference is significant at P<0.01, SD: Standard deviation
Table 7. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (d).
Do you believe that antibiotic treat any
disease?
Yes No Do not know Total Mean
±SD
�� �� 15 125 3.7 ±0.9 ���� ���� 12 100
Mean difference is significant at P<0.05, SD: Standard deviation
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30
3.5 Source, storage and handling of antibiotics
A significantly (P<0.05) higher percentage of the respondents (81.6%)
obtain antibiotics after consulting a veterinarian. A small fraction (10.4%)
gets antibiotics from pharmacies without prescription (Table 8). The
majority 88 (70.4) of the respondents read and follow the veterinarians’
instructions (Table 8).
Table 8. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (e).
From where did
you get an antibiotic?
From a veterinarian
From a pharmacist
From citizens
Do not use Total Mean
±SD 102 13 0 10 125 4
±0.7 81.6 10.4 0 8 100
Do you read the prescription of the antibiotic or just follow the veterinarians’ instructions or both?
Read
Follow instructions Both Total Mean
±SD 5 32 88 125 3.9
±0.7 4 25.6 70.4 100
Mean difference is significant at P<0.05, SD: Standard deviation
The results showed that 56.8% of the participants stored antibiotics at
room temperature, while 31.2% kept them at refrigerator temperature and
12% were not at all concerned about storage. None used freezing for storing
their drugs (Table 9).
Table 9. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (f).
How do you keep the antibiotics?
At room temperature
In the refrigerator
In the freezer
anywhere Total Mean ±SD
71 39 0 15 125 ��� ±0.8 56.8 31.2 0 12 100
Mean difference is significant at P<0.01, SD: Standard deviation
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31
The questions on the administration of antibiotics showed 61.6% of
the respondents did not abide by the exact dose of antibiotics, although 84%
were careful about the time and frequency of administration of antibiotics
(Table 10). A serious malpractice was indicated by this study: 30.4% of the
participants would use antibiotics intended for human use to animals and
21.6% would give antibiotics for veterinary use to human (Table 10).
A significantly finding is that 87 (69.6%) of respondents are aware of the
antibiotics residues in milk and meat and stick by the withdrawal period
allowed for excretion of antibiotics (Table 10).
Table 10. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (g).
Statement Yes No Do not
use Total
Mean
±SD
Are you committed to the exact
dose? �� �� 10�� ��� 4.1*
±0.7 ���� ���� 8�� ��� Are you committed to the dose
time? 105 10 10�� ��� 3.8
±1 84 8 8�� ���
Do you use human antibiotic to the
animal? 38 77 10�� ��� 3.9
±0.9 30.4 61.6 8�� ���
Do you use animal antibiotic to
human?
27 88 10�� ��� � ±1 21.6 70.4 8�� ���
Are you committed to the
withdrawal period and excretion of
the antibiotic in the milk or meat?
87 28 10�� ��� 4
±1 69.6 22.4 8�� ���
Mean difference is significant at P<0.01, SD: Standard deviation. * Not significant
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32
Most participants (88.8%) were not inclined to use cheap antibiotics at
the expense of quality and efficacy (Table 11).
Table 11. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (h).
Are you seeking for the use of cheap
antibiotics even if it is not the best?
Yes No Total Mean
±SD
14�� 111�� �����4
±0.8��11.2�� 88.8�� �����
Mean difference is significant at P<0.01, SD: Standard deviation
3.6 Antibiotics administration for treatment and as growth promoters
The present results show that 60.8% of owners do not use antibiotics
for healthy animals when some animals in the farm get sick, they will treat
only the sick (Table 12).
Table 12. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (i).
Do you use antibiotics for
healthy animals if there is
an infectious disease in the
farm?
Yes No Total Mean
±SD
49�� 76�� ����� 4 ±0.8��39.2�� 60.8�� �����
Mean difference is significant at P<0.01, SD: Standard deviation
Table 13 shows that 50.4% of the respondents would give antibiotics
to pregnant animals, while 49.6% would not. Of the latter group 77.4%
know why not to give pregnant animals antibiotics (Table 14). However, 90
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(72%) of participants think that antibiotics are harmful to the foetus (Table
15). 82 (65.6%) believe that their use is not totally safe (Table 16) and 72
(57.6%) are aware of the side effects of antibiotics in human and animals
(Table 16).
Table 13. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (j).
Do you give antibiotics to
pregnant animals if you
have?
Yes No Total Mean
±SD
63�� 62�� ����� 3.8 ±0.9��50.4�� 49.6�� �����
Mean difference is significant at P<0.01, SD: Standard deviation
Table 14. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (k).
If no: Why?
Know Do not
know Total
Mean
±SD
48�� 14�� 62�� 4.2 ±0.8��77.4�� 22.6�� �����
Mean difference is significant at P<0.01, SD: Standard deviation
Table 15. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (l).
Does the antibiotic affect
the foetus?
Yes No Total Mean
±SD
90�� 35�� ����� 3.8 ±0.8��72�� 28�� �����
Mean difference is significant at P<0.01, SD: Standard deviation
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34
Table 16. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (m).
Do you think that antibiotics are
safe to use?
Yes No Total Mean
±SD
43�� 82�� �����3.9
±0.8��34.4�� 65.6�� �����
Do you know the side effects of
antibiotics on animals and human?
72 53 ����� 3.7 ±0.9��57.6 42.4 �����
Mean difference is significant at P<0.01, SD: Standard deviation
The results show that 112 (89.6%) of interviewed individuals would
give antibiotics to sick lactating dairy animals and 79 (60.2%) of
respondents would give antibiotics to animals and birds as growth promotors
(Tables 17 and 18). However, 70 (56%) of those believe that growth
promotors have unwanted side effects (Table 19).
Table 17. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (n).
Do you give antibiotics to
sick dairy animals if you
have?
Yes No Total Mean
±SD
112�� 13�� ����� 3.9 ±0.9��89.6�� 10.4�� �����
Mean difference is significant at P<0.05, SD: Standard deviation
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35
Table 18. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (o).
In which species of
animals do you use
antibiotics as growth
promoters?
Calves Poultry Sheep and
goats All Total
Mean
±SD
12�� 14�� 20�� 79�� ����� 3.8 ±0.9��9.6�� 11.2�� 16�� 60.2�� �����
Mean difference is significant at P<0.05, SD: Standard deviation
Table 19. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (p).
Are there any side effects of growth
promoters?
Yes No Total Mean ±SD
70�� 55�� ����� 4 ±0.8��56�� 44�� �����
Mean difference is significant at P<0.01, SD: Standard deviation
3.7 General knowledge of microbes
Participants were asked about their knowledge of microbes and their
relationship with antibiotics. One hundred and three (82.4%) of respondents
are variably informed about microbes, and 47 (37.6%) have knowledge
about types of microbes (Tables 20 and 21). Ninety six (96.8%) know the
relationship between antibiotics and their effects on microbes and 90 (72%)
are informed about bacterial resistance to antibiotics (Tables 22 and 23).
Table 20. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (q).
Do you know anything about
microbes?
Yes No Total Mean ±SD
103�� 22�� ����� 4.2 ±0.7��82.4�� 17.6�� �����
Mean difference is significant at P<0.01, SD: Standard deviation
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36
Table 21. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (r).
What are types of microbes?
Know Do not
know Total
Mean
±SD
47�� 78�� ����� 3.8 ±0.8��37.6�� 62.4�� �����
Mean difference is significant at P<0.01, SD: Standard deviation
Table 22. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (s).
What is the relationship between
microbes and antibiotics?
Know Do not
know Total
Mean
±SD
96�� 29�� ����� ��� ±0.7��76.8�� 23.2�� �����
Mean difference is significant at P<0.01, SD: Standard deviation
Table 23. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (t).
Can there be a resistance to antibiotics by microbes?
Yes No Do not know Total Mean
±SD
90 17 18 125 3.9 ±1.1 72 13.6 14.4 100
Mean difference is significant at P<0.01, SD: Standard deviation
3.8 Education and rational use of antibiotics
One hundred and seventeen (93.6%) of respondents think that level of
education and culture of people in general and animals owners in particular,
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37
are effective factors in rational use of antibiotics (Table 24). Similarly 121
(96.8%) of the participants believe that working in the field of animal
production is an important factor in understanding the action and side effects
of antibiotics (Table 25).
Table 24. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (u).
Do you think that the
culture of the animal
owners affect the right use
of antibiotics?
Yes No Total Mean
±SD
117�� 8�� ����� 4.2 ±0.7��
93.6�� 6.4�� �����
Mean difference is significant at P<0.01, SD: Standard deviation
Table 25. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (v).
Do you think that the
working in the field of
animal production plays a
role in understanding the
use of antibiotics?
Yes No Total Mean
±SD
121�� 4�� 125��4.2
±0.7��96.8�� 3.2�� 100��
Mean difference is significant at P<0.01, SD: Standard deviation
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38
The results show that 90 (72%) of respondents do not benefit from
any programme disseminating knowledge about antibiotics (Table 26).
Table 26. Public knowledge attitude and behaviour regarding antibiotics use
in animals in Khartoum State (w).
Do you listen or learn any guidance
programmes in how to optimize the
use of antibiotics?
Yes No Total Mean
±SD
35�� 90�� ����� ��� ±0.9��28�� 72�� �����
Mean difference is significant at P<0.05, SD: Standard deviation
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39
CHAPTER FOUR
DISCUSSION
Antibiotics are among the most commonly prescribed medicines in
both human and veterinary medicine. They are used in humans for
prophylaxis and treatment of diseases and for prevention of post – operative
complications. In animals they are used for prevention and treatment of
diseases and as growth promoters (Levy, 2002; Turnidge, 2004). In despite
of the benefits of antibiotics in animals, which have very much reduced the
incidence of disease outbreaks and promoted animal production, they may
have hazardous effects on humans. Misuse of antibiotics may lead to
bacterial resistance and spread of resistant strains to humans and animals
(Chambers, 2006; Goforth and Goforth, 2000). This lead to some calls for
drawing guidelines and regulations for use of antibiotics in agriculture
(Salyers, 2002). It seems that knowledge about antibiotics and antimicrobial
therapy has not been given much concern locally and elsewhere in the world.
So, many studies have been carried out in several countries to assess public
knowledge and attitude to antibiotics and antibiotic bacterial resistance
(Emsile and Bond, 2003; Osborne and Sinclair, 2006; Pechere, 2001).
Therefore, this study was conducted to visualize public awareness and
behavior towards antibiotics.
In this study, different age groups were represented and both genders
were included to give a fair reliable result. All respondents were dealing or
were in contact with animals and most of them were living in Khartoum.
There is growing interest of the urban population to keep pets, psittacine
birds and other ornamental birds. Many people also have small holds of
dairy animals. The results revealed that a high percentage (82.4 - 94.4%) of
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40
the respondents had a good understanding about antibiotics and microbes
and their types, uses of antibiotics, and bacterial antibiotic resistance. They
realize that antibiotics would not treat any disease but many of them do not
know their exact action. However, veterinarians and university graduates are
expected to be better informed.
Most respondents (81.6%) explained that they would consult
veterinarians for antibiotic prescription and some said they would consult
the pharmacist. This reflects high awareness of people that drugs should be
prescribed by the concerned persons (medics or vets.). It also reflects high
confidence of respondents in veterinarians. In this respect, pharmacists
should practice their role in disseminating knowledge about antibiotics, their
uses and hazards. Unfortunately, many pharmacists dispense antibiotics, and
other drugs, over-the-counter without authorized prescription and thus
contribute to drug misuse (Parmi et al., 2002; Pechere, 2001; Wachter et al.,
1999; You et al., 2008). On the other hand, antibiotics should be prescribed
after identifying the cause of infection or disease. Bacteriological methods
could be used for isolation and identification of bacteria and testing their
sensitivity to various antibiotics. However, even if antibiotics are correctly
dispensed, education of public on correct use is important for successful
treatment and prevention of resistance. It is good to note in this study that a
large number of respondents would consult a veterinarian and also read the
brochure enclosed with the medicine before use.
The study also shows that the majority of respondents would pay
generously to obtain the suitable effective antibiotic and will not buy cheap
drugs at the expense of efficacy. However, the results indicate that there is a
problem in storing antibiotics, mostly at room temperature. In hot climates,
like in Sudan, this is liable to reduce the efficacy of the drug. Another
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41
problem indicated by this study is that many people do not stick by the right
dose or whole course of antibiotic to be given. This is a common passive
attitude; when animal owners observe any clinical improvement, they tend to
interrupt treatment. One serious issue revealed in this study is that about
third of the respondents informed that they would use antibiotics intended
for animal treatment for humans and vice versa. This is hazardous and
constitutes a serious public health problem.
Respondents in this study also showed great understanding about the
use of antibiotics during pregnancy and the detrimental effect on the fetus.
Knowledge about the use of antibiotics as growth promoters was very
satisfactory and many respondents are informed about the side effects.
Nearly seventy percent of the respondents are well aware of the problem of
antibiotic residues. They are informed and agree with the withdrawal period
for the removal of antibiotics from treated animals before using their milk or
meat. This reflects great understanding regarding animal health and human
food safety.
The present findings show that awareness of respondents about
antibiotic bacterial resistance is quite fair. Respondents with low educational
qualifications seem to be less knowledgeable about bacterial resistance
which is considered as a public health problem (McNulty et al., 2007).
Interviewed individuals in this study think that level of education and
working in the field of animal production would improve awareness of use
of antibiotics. The role of veterinary extension appears to be very weak and
should be activated to disseminate knowledge and raise awareness of public
about various issues related to the veterinary profession, such as the issue of
antibiotic bacterial resistance. Bacterial resistance has been generated in
animals and crops and has spread to humans (Turnidge, 2004). Levy (2002)
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42
states that billions of animals and birds in the United States receive
antibiotics during their life time as growth promoters. Because of the
increasing incidence of bacterial resistance in both man and animals, the
possible correlation between antibiotic use in animals and increased
resistance in humans has been questioned (McDermott et al., 2002).
Because of the importance of the antibiotic issue, a day known as
”European antibiotic awareness day” is held every 18 November each year
to raise awareness about how to use antibiotics, bacterial resistance and
threat to public health.
On conclusion, the results of this limited study indicate a high positive
status of knowledge and awareness of antibiotics, therapeutic uses, bacterial
resistance, their uses as growth promoters, hazards of irrational use and
public health significance.
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43
CONCLUSIONS AND RECOMMENDATIONS
CONCLUSIONS
1. The results of the study indicated a high degree of knowledge and
awareness of the nature, types, therapeutic uses, storage and side effects
of antibiotics and their importance in treating diseases, particularly
bacterial infections.
2. The study showed that people used antibiotics as growth promoters to
ruminants and poultry with high understanding of the importance of
withdrawal period before using meat or milk from treated animals.
3. There is a good awareness of irrational use of antibiotics and
development of antimicrobial resistance and its association with public
health.
4. The study indicated the missing role of veterinary extension in
disseminating knowledge of various veterinary problems.
RECOMMENDATIONS
1. Antibiotics and other veterinary medications should be purchased only
on prescription so as to avoid irrational use of these drugs.
2. Antibiotics should be given after establishing the cause of infection
and after performing sensitivity tests.
3. Suitable antibiotics should be given in the proper doses in complete
courses to avoid development of resistance.
4. Meat and milk from animals or birds treated with antibiotics should
not be used before allowing for a safe withdrawal period.
5. Animals should be protected against various diseases, particularly
bacterial diseases; by vaccination to reduce the chances of such diseases
and use of antibiotics for their treatment.
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44
6. The role of veterinary extension should be activated to educate the
public about various veterinary problems, particularly those of zoonotic
nature and public health significance.
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45
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Appendix 1. A questionnaire on public knowledge attitude and behaviour
regarding antibiotics use in animals in Khartoum State.
1- Number of sample:
2- Age
Less than 20 ( ) Between 20-30 ( ) 31-40 ( ) 41-50 ( ) Greater than 50 ( )
3- Sex
Male ( ) Female ( )
4- Level of education
Illiterates ( ) Primary ( ) Secondary ( ) University ( ) Postgraduate ( )
5- Type of work
Students ( ) Employees ( ) Housewives ( ) Others ( )
6- Social environment
City ( ) Village ( )
7- The relationship between respondents and animals
Yes ( ) No ( )
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1- Do you know anything about antibiotics?
Yes ( ) No ( )
2- What is your definition of antibiotic?
Knows ( ) Do not ( ) Reasonable ( ) Excellent ( )
3- Example of an antibiotic
Knows ( ) Do not ( )
4- Do you have previous experience or experience of antibiotics?
Yes ( ) No ( )
5- Types of antibiotics used by respondents
Oxy-tetracycline ( ) Penicillin ( ) Sulpha ( ) Others ( ) Not remember ( )
6- Why did you use the previous antibiotic?
Knows ( ) Do not ( )
7- Do you believe that antibiotic treat any disease?
Yes ( ) No ( )
8- From where did you get an antibiotic?
From a veterinarian ( ) From a pharmacist ( ) From citizens ( )
9- Are you committed to the exact dose?
Yes ( )
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No ( ) 10- Are you committed to the dose time?
Yes ( ) No ( )
11- Do you use human antibiotic to the animal? Yes ( ) No ( )
12- Do you use animal antibiotic to human? Yes ( ) No ( )
13- Are you committed to the withdrawal period and excretion of the antibiotic in the milk or meat?
Yes ( ) No ( )
14- Do you know the side effects of antibiotics on animals and human? Yes ( ) No ( )
15- Do you know anything about microbes? Yes ( ) No ( )
16- What are species of microbes? Knows ( ) Do not ( )
17- What is the relationship between microbes and antibiotics? Knows ( ) Do not ( )
18- Can there be a resistance to antibiotics by microbes? Knows ( ) Do not ( )
19- How do you keep the antibiotics? At room temperature ( ) In the refrigerator ( ) In the freezer ( ) Anywhere ( )
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20- Are you seeking for the use of cheap antibiotics even if it is not the best? Yes ( ) No ( )
21- Do you read the prescription of the antibiotic or just follow the veterinarians’ instructions or both?
Read ( ) Follow orders ( ) Both of them ( )
22- Do you give antibiotics to sick dairy animals if you have? Yes ( ) No ( )
23- Do you give antibiotics to pregnant animals if you have? Yes ( ) No ( )
24- If not: Why? Knows ( ) Do not ( )
25- Does the antibiotic affect the foetus? Yes ( ) No ( )
26- Do you think that antibiotics are safe to use? Yes ( ) No ( )
27- In which species of animals do you use antibiotics as growth
promoters?
Calves ( ) Poultry ( ) Sheep and goats ( ) All ( )
28- Are there any side effects of growth promoters?
Yes ( ) No ( )
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29- Do you use antibiotics for healthy animals if there is an infectious
disease in the farm?
Yes ( ) No ( )
30- Do you think that the culture of the animal owners affect the right use
of antibiotics?
Yes ( ) No ( )
31- Do you think that working in the field of animal production plays a
role in understanding the use of antibiotics?
Yes ( ) No ( )
32- Do you listen or learn any guidance programmes in how to optimize
the use of antibiotics?
Yes ( ) No ( )
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