American Journal of Epidemiology and Infectious Disease
ISSN (Print): 2333-116X ISSN (Online): 2333-1275 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Epidemiology and Infectious Disease. 2017, 5(2), 35-41
DOI: 10.12691/ajeid-5-2-3
Open AccessArticle

Public Knowledge and Attitude towards Antibiotic Use in Lebanon

Malak Khalifeh1, 2, , Nicholas Moore1 and Pascale Salameh2

1INSERM U 1219 - Pharmaco-¨¦pid¨¦miologie et ¨¦valuation de l'impact des produits de sant¨¦ sur les populations, University de Bordeaux, Bordeaux, France

2Clinical & Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon

Pub. Date: July 04, 2017

Cite this paper:
Malak Khalifeh, Nicholas Moore and Pascale Salameh. Public Knowledge and Attitude towards Antibiotic Use in Lebanon. American Journal of Epidemiology and Infectious Disease. 2017; 5(2):35-41. doi: 10.12691/ajeid-5-2-3


Introduction: Antibiotic resistance is a major threat in global public health. This study aims to assess the public knowledge, attitude and practice towards antibiotic use among general public in Lebanon. Method: It was a cross sectional study in a community-based pharmacy setting in Lebanon. It used a structured random interview to patients visiting community pharmacy seeking for antibiotics. Descriptive statistics were presented and multivariate logistic regressions were performed in data analysis. Results: A total of 495 participated in the study. The study sample had in general low knowledge (average = 6) and attitude score (average=3.16). High proportion of Lebanese participants believed that antibiotics were used for treatment of common cough cold and sore throat symptoms (59%) or viral infections (53%). 42% preferred to take antibiotics from the pharmacy without physician prescription. In the multivariable logistic regression analysis, females showed better knowledge toward antibiotic use compared to males (ORa=1.59, 95%CI=1.01-2.53). Compared to participants aged >50 years old, the level of adequate knowledge was higher in those aged 25-50 years old (ORa=3.66, 95%CI=1.79-7.49). Conclusion: This study identified important knowledge and attitude gaps among general public in Lebanon. Future antibiotic awareness campaigns and patient counselling should be implemented to reduce the risk of antibiotic resistance.

antibiotic knowledge attitude Lebanon

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Va¡§a¡§na¡§nen, M.H., K. Pietila, and M. Airaksinen, Self-medication with antibiotics¨C does it really happen in Europe? . Health Policy 2006. 77: p. 166-171.
[2]  World Health Organization. WHO Global Strategy for Containment of Antimicrobial Resistance. 2001 [cited 2014 11 July]; Available from:
[3]  Kandakai, T.L., et al., Knowledge, beliefs, and use of prescribed antibiotic medications among low-socioeconomic African Americans. J Natl Med Assoc, 1996. 88(5): p. 289-94.
[4]  Curry, M., et al., Public views and use of antibiotics for the common cold before and after an education campaign in New Zealand. N Z Med J, 2006. 119(1233): p. U1957.
[5]  Prakasam, K.C., N. Kumar, and J. Ramesh, Student's knowledge of antibiotics: A cross- sectional study of students in Tamil Nadu. International Journal of Pharmacy and Pharmaceutical Science 2011. 3(1): p. 232-233.
[6]  International Pharmaceutical Federation. FIP. Statement of Policy Control of Antimicrobial Medicines Resistance (AMR). The Hague: International Pharmaceutical Federation; 2008. 2008 [cited 2012 15 Jan]; Available from:
[7]  World Health Organization. Regional Strategy on Prevention and Containment of Antimicrobial Resistance 2010 ¨C 2015. 2010 [cited 2012 15 Jan]; Available from:
[8]  Cheaito, L., et al., Assessment of self-medication in population buying antibiotics in pharmacies: a pilot study from Beirut and its suburbs. Int J Public Health, 2014. 59(2): p. 319-27.
[9]  Suaifan, G., et al., A cross sectional study on knowledge, attitude, and Behaviour related to antibiotic use and resistanc among medical and non-medical university students in Jordan. Afr. J. Pharm. Pharmacol., 2012. 10(6): p. 763-770.
[10]  Awad, A., et al., Self-medication with antibiotics and antimalarials in the community of Khartoum State, Sudan. J Pharm Pharm Sci, 2005. 8(2): p. 326-31.
[11]  Alzoubi, K., et al., An audit on the knowledge, beliefs and attitudes about the uses and side-effects of antibiotics among outpatients attending 2 teaching hospitals in Jordan. East Mediterr Health J, 2013. 19(5): p. 478-84.
[12]  McNulty, C.A., et al., Don't wear me out--the public's knowledge of and attitudes to antibiotic use. J Antimicrob Chemother, 2007. 59(4): p. 727-38.
[13]  Andre, M., et al., A survey of public knowledge and awareness related to antibiotic use and resistance in Sweden. J Antimicrob Chemother, 2010. 65(6): p. 1292-6.
[14]  Kim, S.S., S. Moon, and E.J. Kim, Public knowledge and attitudes regarding antibiotic use in South Korea. J Korean Acad Nurs, 2011. 41(6): p. 742-9.
[15]  Napolitano, F., et al., Public knowledge, attitudes, and experience regarding the use of antibiotics in Italy. PLoS One, 2013. 8(12): p. e84177.
[16]  Filipetto, F.A., et al., Patient knowledge and perception of upper respiratory infections, antibiotic indications and resistance. Patient Prefer Adherence, 2008. 2: p. 35-9.
[17]  Shehadeh, M., et al., Knowledge, attitudes and behavior regarding antibiotics use and misuse among adults in the community of Jordan. A pilot study. Saudi Pharm J, 2012. 20(2): p. 125-33.
[18]  Abasaeed, A., et al., Self-medication with antibiotics by the community of Abu Dhabi Emirate, United Arab Emirates. J Infect Dev Ctries, 2009. 3(7): p. 491-7.
[19]  Jassim, A.M., In-home Drug Storage and Self-medication with Antimicrobial Drugs in Basrah, Iraq. Oman Med J, 2010. 25(2): p. 79-87.
[20]  Awad, A.I. and E.A. Aboud, Knowledge, attitude and practice towards antibiotic use among the public in Kuwait. PLoS One, 2015. 10(2): p. e0117910.
[21]  Lim, K.K. and C.C. Teh, A Cross Sectional Study of Public Knowledge and Attitude towards Antibiotics in Putrajaya, Malaysia. South Med Rev, 2012. 5(2): p. 26-33.
[22]  Norris, P., et al., Knowledge and reported use of antibiotics amongst immigrant ethnic groups in New Zealand. J Immigr Minor Health, 2010. 12(1): p. 107-12.
[23]  You, J.H., et al., Public knowledge, attitudes and behavior on antibiotic use: a telephone survey in Hong Kong. Infection, 2008. 36(2): p. 153-7.
[24]  European Commission. Antimicrobial Resistance. Brussels, Belgium: European Commission. 2013 [cited 2014 12 December]; Available from:
[25]  Franco, B.E., et al., The determinants of the antibiotic resistance process. Infect Drug Resist, 2009. 2: p. 1-11.
[26]  Kumar, S., P. Little, and N. Britten, Why do general practitioners prescribe antibiotics for sore throat? Grounded theory interview study. BMJ, 2003. 326(7381): p. 138.
[27]  Butler, C.C., et al., Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. BMJ, 1998. 317(7159): p. 637-42.
[28]  Van den Eng, J., et al., Consumer attitudes and use of antibiotics. Emerging Infectious Diseases, 2003. 9(1128-1135).
[29]  Belkina, T., et al., Antibiotic use and knowledge in the community of Yemen, Saudi Arabia, and Uzbekistan. J Infect Dev Ctries, 2014. 8(4): p. 424-9.
[30]  Jafari, F., A. Khatony, and E. Rahmani, Prevalence of self-medication among the elderly in Kermanshah-Iran. Glob J Health Sci, 2015. 7(2): p. 360-5.
[31]  Belongia, E.A., et al., Antibiotic use and upper respiratory infections: a survey of knowledge, attitudes, and experience in Wisconsin and Minnesota. Prev Med, 2002. 34(3): p. 346-52.