PUBLIC KNOWLEDGE ATTITUDE AND BEHAVIOUR REGARDING ... · PUBLIC KNOWLEDGE ATTITUDE AND BEHAVIOUR REGARDING ANTIBIOTICS USE IN ANIMALS IN KHARTOUM STATE By MOHAMMED SAHNOON HAJ AHMED

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



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.



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



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………….................................................................................



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


in animals in Khartoum State (b)……………...………………………...…29


in animals in Khartoum State (c)………………………………………...…29


in animals in Khartoum State (d)...……………………………………...…29


in animals in Khartoum State (e).…...…………………………………...…30


in animals in Khartoum State (f)………………………………………...…30


in animals in Khartoum State (g)...……………………………………...…31


in animals in Khartoum State (h)...……………………………………...…32


in animals in Khartoum State (i)………………………………………...…32


in animals in Khartoum State (j)………………………………………...…33



VI


in animals in Khartoum State (k)...……………………………………...…33


in animals in Khartoum State (l)………………………………………...…33


in animals in Khartoum State (m)..……………………………………...…34


in animals in Khartoum State (n)…...…………………………………...…34


in animals in Khartoum State (o)…...…………………………………...…35


in animals in Khartoum State (p)...……………………………………...…35


in animals in Khartoum State (q)...……………………………………...…35


in animals in Khartoum State (r)………………………………………...…36


in animals in Khartoum State (s)………………………………………...…36


in animals in Khartoum State (t)………………………………………...…36


in animals in Khartoum State (u)…...…………………………………...…37


in animals in Khartoum State (v)…...…………………………………...…37


in animals in Khartoum State (w)…..…………………………………...…38



VII

LIST OF FIGURES

FIGURE……………………………………………………………….Page

Fig. 1 Age of respondents …………………...........……………………….25

Fig. 2 Education level of respondents ……………………………………..26



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.



IX

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1

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.



2

CHAPTER ONE

LITERATURE REVIEW

1.1 Definition of antibiotics

An antibiotic is derived from the Greek words a�?�t�?� - anti, "against"

and ß�?�?�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.



3

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



4

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



5

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



6

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.



7

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



8

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



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



10

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



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



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



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).



14

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).



15

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,



16

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



17

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.



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



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



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



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



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.



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.



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.



25

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



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



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



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.


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



29


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



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



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




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).


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


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).


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




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).


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



32

Most participants (88.8%) were not inclined to use cheap antibiotics at

the expense of quality and efficacy (Table 11).


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��


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).


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��


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



33

(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).


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��



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��



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��




34


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 ��


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).


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��




35


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��



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��


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).


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��




36


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��



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��



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


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,



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).


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��



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��




38

The results show that 90 (72%) of respondents do not benefit from

any programme disseminating knowledge about antibiotics (Table 26).


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��




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



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



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)



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.



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.



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.



45

References

Abdel Sattar, A. (2007). Antibiotic selection power point. National Cancer institute, Cairo University.

Alexander, T. W., Yanke, J. L., Reuter, T., Topp, E., Read, R. R., Selinger, B. L. and McAllister, T. A. (2011). Longitudinal characterization of antimicrobial resistance genes in feces shed from cattle fed different subtherapeutic antibiotics. BMC Microbiology, 11:19-22.

Alisky, J., Iczkowski, K., Rapoport, A., and Troitsky, N. (1998). Bacteriophages show promise as antimicrobial agents. J. Infection 36: 5–15.

Anthony, E., Bogaard, V. and Stobberingh, E. (2000). Epidemiology of resistance to antibiotics links between animals and humans. Int. J. Antimicro. Agents, 14: 327–335

Antibiotic. (2011). In: MEDICINAL CHEMISTRY, Chapter 18, pp 335-340.

Barton, M. D. (2000). Antibiotic use in animal feed and its impact on human health. Nutr. Res. Rev., 13:279–299.

Barton, M. D. and Hart, W. S. (2001). Public health risks: Antibiotic resistance - Review. Asian Austral. J. Anim., 14: 414–422.

Bennett, J. W. and Chung, K. T. (2001). Alexander Fleming and the discovery of penicillin. Adv. Appl. Microbiol., 49: 163–184.

Bergen, W. G. and Bates, D. B. (1984). Ionophores: their effect on production efficiency and mode of action. J. Anim. Sci., 58:1465–1483.

Bosch, F. and Rosich, L. (2008). The contributions of Paul Ehrlich to pharmacology: a tribute on the occasion of the centenary of his Nobel Prize. Pharmacology, 82 (3): 171–179.

Calderon, C. B. and Sabundayo, B. P. (2007). Antimicrobial Classifications: Drugs for Bugs. In Schwalbe R, Steele-Moore L, Goodwin AC. Antimicrobial Susceptibility Testing Protocols. CRC Press. Taylor & Frances group.

Casewell, M., Friis, C., Marco, E., McMullin, P. and Phillips, I. (2003). The European ban on growth-promoting antibiotics and emerging consequences for human and animal health. J. Antimicrob. Chemother., 52:159–161.

Chambers, H. (2006). General principles of antimicrobial therapy. In: Goodman and Gilmans: The pharmacological Basis of therapeutics. 11th ed: Editors: Brunton, L., Parker, K., Blumenthal, D. Buxton, I. New York. USA. Pp1095-1110.



46

Consumer Alert: Antibiotic Resistance Is Growing!" People's Medical Society Newsletter 16 (August 1997): 1.

Cunha, B. A. (2009). Antibiotic Essentials. Jones & Bartlett Learning, p. 180. Science Diction: The Origin Of 'Antibiotic': NPR. www.npr.org, News. Science, (2011).

Dubuc, J., Duffield, T. F., Leslie, K. E., Walton, J. S. and LeBlanc, S. J. (2011). Randomized clinical trial of antibiotic and prostaglandin treatments for uterine health and reproductive performance in dairy cows. J. Dairy Sci., 94: 1325–1338.

Emsile, M. J. and Bond, C. M. (2003). Public knowledge attitudes and behaviour regarding antibiotics. A survey of patients in general practice. Eur. J. Gen. Pract., 9(3): 84–90.

Hawkey, P. M. (2008). The growing burden of antimicrobial resistance. J. Antimicrob. Chemother., 62(1): i1–9.

Finberg, R. W, Moellering, R. C., Tally, F. P., Craig W. A., Pankey G. A., Dellinger E. P., West M. A., Joshi M., Linden P. K., Rolston K. V., Rotschafer J. C. and Rybak M. J. (2004). The importance of bactericidal drugs: future directions in infectious disease.

Clin. Infect. Dis., 39 (9): 1314–1320. Fleming, A. (1980). Classics in infectious diseases: on the antibacterial

action of cultures of a penicillium, with special reference to their use in the isolation of B. influenzae by Alexander Fleming. Rev. Infect. Dis., 2 (1): 129–139.

Florey, H. W. (1945). Use of Micro-organisms for therapeutic purposes. Brit. Med. J., 2 (4427): 635–642.

Forrest, R D. (1982). Early history of wound treatment. J. R. Soc. Med., 75 (3): 198–205.

Foster, W. and Raoult, A. (1974). Early descriptions of antibiosis. J. R. Coll. Gen. Pract., 24 (149): 889–894.

Frydendahl, J. K., Gerner-Smidt, P., Peterson, A. M. and Wegener, H. C. (1999). An outbreak of multidrug-resistant, quinolone-resistant Salmonella enterica serotype Typhimurium DT104. N. Engl. J. Med., 341:1420–1425.

Gaynes, R. (1997). The impact of antimicrobial use on the emergence of antimicrobial resistant bacteria in hospitals. Infect. Dis. Clin. North Am., 11: 757–765.

Gillor, O., Kirkup, B. C. and Riley, M. A. (2004). Colicins and Microcins: The next generation antimicrobials. Adv. Appl. Mircol., 54: 129-142.



http://www.npr.org

47

Goforth, R. and Goforth, C. (2000). A appropriate regulation of antibiotics in livestock of feed. Boston College Environmental Affairs Law Review, 28(1): 39.

Gov Track.us. S. 742--109th Congress (2005). Preservation of Antibiotics for Medical Treatment Act of 2005, GovTrack.us (database of federal legislation). http//govtrack.us/congress/bill.xpd?bill=s109-742.

Joerger, R. D. (2003). Alternatives to antibiotics: Bacteriocins, antimicrobial peptides, and bacteriophages. Poult. Sci., 82: 640–647.

Khachatourians, G. G. (1998). Agricultural use of antibiotics and the evolution and transfer of antibiotic-resistant bacteria. Can. Med. Assoc. J., 159: 1129–1136.

Kingston, W. (2008). Irish contributions to the origins of antibiotics. Irish. J. Med. Sci., 177 (2): 87–92.

Knowles, D. J. C. (1997). New strategies for antibacterial drug design. Trends Microbiol., 5: 379–383.

Landsberg, H. (1949). Prelude to the discovery of penicillin. Isis, 40 (3): 225–227.

Larson, E. (2007). Community factors in the development of antibiotic resistance. Annu. Rev. Public Health, 28: 435–447.

Levin, B. R., Antia, R., Berliner, E., Bloland, P., Bonhoeffer, S., Cohen, M., DeRouin, T., Fields, P. I., Jafari, H., Jernigan, D., Lipsitch, M., McGowan, J. E., Mead, P., Nowak, M., Porco, T., Sykora, P., Simonsen, L., Spitznagel, J., Tauxe, R. and Tenover, F. (1998). Resistance to antimicrobial chemotherapy: A prescription for research and action. Am. J. Med. Sci., 315: 87–94.

Levy, S. (2002). The antibiotic paradox. Cambridge, M. A: Perseus Publishing.

Limbird, L. E. (2004). The receptor concept: a continuing evolution. Mol. Interv., 4 (6): 326–36.

Lindblad, W.J. (2008). Considerations for Determining if a Natural Product Is an Effective Wound-Healing Agent. Inter. J. Lower Ext. Wounds, 7 (2): 75–81.

Lowenthal, J. W., Lambrecht, B., van den Berg, T. P., Andrew, M. E., Strom, A. D. G. and Bean, A. G. D. (2000). Avian cytokines- The natural approach to therapeutics. Dev. Comp. Immunol., 24: 355–365.

Lu, H-Z., Weng, X-H., Li, H., Yin, Y-K., Pang, M-Y. and Tang, Y.W. (2002). Enterococcus faecium-related outbreak with molecular



48

evidence of transmission from pigs to humans. J Clin Microbiol 40:913– 917.

Macfarlane, G. T., and Cummings, J. H. (2002). Probiotics, infection and immunity. Curr. Opin. Infect. Dis., 15: 501–506.

Mascio, C.T., Alder J.D. and Silverman J. A. (2007). Bactericidal action of daptomycin against stationary-phase and nondividing Staphylococcus aureus cells. Antimicrob. Agents Chemother., 51 (12): 4255–60

McAllister, T. A., Moustafa, S. M. S. Cheng, K.-J., Newbold, C. J., McKain, N. and Wallace, R. J. (1994). Effect of salinomycin on fermentation and nitrogen metabolism in the artificial rumen. Can. J. Anim. Sci., 74:575–578.

McDermott, P., Zhao, S., Wagner, D., Simjee, S., Walker, R. and White, D. (2002). The food safety perspective of antibiotics resistance Anim. Biotech., 13(1):71–84.

McNulty, C. A. M., Boyle, P., K.-J., Nicols, T., Clapplson, P. and Davey, P. (2007). Don't wear me out-the public knowledge of attitudes to antibiotics. J. Antimicrobe. Chemother., 59:727–738.

Melander, E., Ekdahl, K., Jonsson, G. and Molstad, S. (2000). Frequency of penicillinresistant pneumococci in children is correlated to community utilization of antibiotics. Pediatr. Infect. Dis. J., 19: 1172–1177.

Mellon, M et al. (2001) Hogging It!: Estimates of Antimicrobial Abuse in Livestock, 1st ed. Cambridge, MA: Union of Concerned Scientists.

Metlay, J. P., Camargo, C. A., MacKenzie, T., McCulloch, C., Maselli, J., Levin, S. K., Kersey, A. and Gonzales, R. (2007). Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments. Ann. Emerg. Med., 50 (3): 221–30.

Michalova, E., Novotna, P. and Schlegelova, J. (2004). Tetracyclines in veterinary medicine and bacterial resistance to them. Vet. Med. Czech, 49 (3): 79–100.

Ong, S, Nakase, J., Moran, G. J., Karras, D. J, Kuehnert, M.J. and Talan, D.A. (2007). Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction. Ann. Emerg. Med., 50 (3): 213–20.

Osborne, D. and Sinclair, H. (2006). Public knowledge attitudes and behaviour regarding antibiotics: Does five years make a difference. Int. J. Pharm. Pract., 14: 227–230.



49

Pakpour, S., Jabaji, S. and Chénier, M. R. (2012). Frequency of Antibiotic Resistance in a Swine Facility 2.5 Years after a Ban on Antibiotics. Microb. Ecol., 63(1):41-50.

Pankey, G. A. and Sabath, L. D. (2004). Clinical relevance of bacteriostatic versus bactericidal mechanisms of action in the treatment of Gram-positive bacterial infections. Clin. Infect. Dis., 38 (6): 864–870.

Parimi, N., Pereira, L. M. P. and Prabhaker, P. (2002). The general publics perceptions and use of antimicrobial in Trinidad and Tabago. Pan. Am. J. Public Health, 12: 11–17.

Pearson, C. (2007). Antibiotic Resistance Fast-Growing Problem Worldwide. Voice of America. http://voanews.com/english/archive/2007-02/2007-02-28- oa33.cfm.

Pechere, J. C. (2002). Patients’ interviews and misuse of antibiotics. Clin. Infect. Dis., 33: S170–173.

Pelczar, M. J., Chan, E. C. S. and Krieg, N. R. (1999). Host-Parasite Interaction; Nonspecific Host Resistance, In: Microbiology Concepts and Applications, 6th ed., McGraw-Hill Inc., New York, U.S.A. pp. 478-479.

Pirotta, M.V. and Garland, S. M. (2006). Genital Candida species detected in samples from women in Melbourne, Australia, before and after treatment with antibiotics. J. Clin. Microbiol., 44 (9): 3213–3217.

Pritchard, R. H., Thomson, J. U., Sai Leela, S. and Hildreth, M. B. (1993). Performance of chlortetracycline-sulfamethazine combinations in feeder calves with coccidiosis. Agri. Practice, 14:24–29.

Raf, D. (2009). Advantages and disadvantages of Medicines: ANTIBIOTICS. Science » Medicine. www.wisdia/articles.com.

Rhee, K.Y. and Gardiner, D.F. (2004). Clinical relevance of bacteriostatic versus bactericidal activity in the treatment of gram-positive bacterial infections. Clin. Infect. Dis., 39 (5): 755–6.

Roberts, M.C. (2002). Resistance to Tetracycline, Macrolide-Lincosamide-Streptogramin, Trimethoprim, and Sulfonamide Drug Classes. Mol. Biotech., 20: 261-283.

Rogers, R. S., Seehafer, J. R., Perry, H. O. (1982). Treatment of cicatricial (benign mucous membrane) pemphigoid with dapsone. J. Am. Acad. Dermatol., 6 (2): 215–223.

Romero, R., Hagay, Z., Jores, J., Sepulveda, W. and Mazor, M. (1992). Eradication of Ureaplasma urealyticum from the amniotic fluid with transplacental antibiotic treatment. Am. J. Obstet. Gynecol., 166:618–622.



http://voanews.com/english/archive/2007-02/2007-02-28-

http://www.wisdia/articles.com

50

Sabuncu, E, David, J., Bernède-Bauduin, C., Pépin, S., Leroy, M., Boëlle, P.Y., Watier. L. and Guillemot, D. (2009). Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002–2007. PloS. Med., 6 (6):e1000084.

Salyers, A. (2002). An overview of genetic basis of antibiotics resistance in bacteria and its implications for agriculture. Anim. Biotech., 13(1):1–5.

Salyers, A. A., Gupta, A. and Wang, Y. (2004). Human intestinal bacteria as reservoirs for antibiotic resistance genes. Trends. Microbiol., 12:412–416.

Shoskes, D. A. (2002). Phytotherapy in chronic prostatitis. Urology, 60: 35–37.

Silbergeld E. K, Graham, J. and Price L. B. (2008). Industrial food animal production, antimicrobial resistance, and human health. Annu. Rev. Public Health 29:151–169.

Simeoni, D., Rizzotti, L., Cocconcelli, P., Gazzola, S., Dellaglio, F. and Torriani, S. (2008) Antibiotic resistance genes and identification of staphylococci collected from the production chain of swine meat commodities. Food Microbiol., 25:196–201.

Slama, T.G., Amin, A., Brunton, S. A., File, T. M Jr., Milkovich. G., Rodvold, K. A., Sahm, D. F., Varon, J. and Weiland. D Jr. (2005). A clinician's guide to the appropriate and accurate use of antibiotics: the Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria. Am. J. Med., 118 (7A): 1S–6S.

Smorgick, N., Frenkel, E., Aaidenstein, R., Lazarovitch, T. and Sherman, D. J. (2007). Antibiotic treatment of intra-amniotic infection with Ureaplasma urealyticum. Fetal Diagn. Ther., 22:90–93.

Solomon, D. H., van Houten, L., Glynn, R. J., Baden, L., Curtis, K., Schrager, H. and Avorn, J. (2001). Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center. Arch. Intern. Med., 161: 1897–1902.

Spanu, T, Santangelo R, Andreotti F, Cascio GL, Velardi G, Fadda G (2004). Antibiotic therapy for severe bacterial infections: correlation between the inhibitory quotient and outcome. Int. J. Antimicrob. Agents, 23 (2): 120–128.

Stavrou, E., Vassiliou, S. and Kamberos, S. (1989). Indications and contraindications of the administration of antibiotics in oral and maxillofacial surgery. Hell Stomatol. Chron., 33(3):185-189.

Sykes, R. (2001). Penicillin: from discovery to product. Bull. World Health Organ., l 79 (8): 778–779.



51

Tan, T. Q. (2003). Antibiotic resistant infections due to Streptococcus pneumoniae: impact on therapeutic options and clinical outcome. Curr. Opin. Infect. Dis., 16: 271–277.

Turnidge, J. (2004). Antibiotics use in animals prejudices, perception and realities. J. Antimicrob. Chemtherp., 53: 26–27.

University of Michigan Health System (2006). Antibiotic-Associated Diarrhea. www.med.umich.edu.

Van den Bogaard, A. E. and Stobberingh, E. E. (1999). Antibiotic usage in animals- Impact on bacterial resistance and public health. Drugs, 58: 589–607.

Van den Bogaard, A. E. and Stobberingh, E. E. (2000). Epidemiology of resistance to antibiotics links between animals and humans. Int. J. Antimicrob. Agents, 14:327–335.

Van Epps, H. L. (2006). René Dubos: unearthing antibiotics. J. Exp. Med., 203 (2): 259.

Van Houten, M. A., Luinge, K., Laseur, M. and Kimpen, J. L. (1998). Antibiotic utilization for hospitalised paediatric patients. Int. J. Antimicrob. Agents, 10: 161–164.

Verschuere, L., Rombaut, G., Sorgeloos, P. and Verstraete, W. (2000). Probiotic bacteria as biological control agents in aquaculture. Microbiol. Mol. Biol. Rev., 64: 655–671.

Vlahovic-Palcevski, V., Morovic, M., Palcevski, G. and Betica-Radic, L. (2001). Antimicrobial utilization and bacterial resistance at three different hospitals. Eur. J. Epidemiol., 17: 375–383.

Wachter, D., Joshi, M. P. and Rimal, B. (1999). Antibiotics dispending by drug retaders in Kathmandu, Nepal. Trop. Med. Int. health, 4:782–788.

Wainwright, M. (1989). Moulds in ancient and more recent medicine. Mycologist, 3 (1): 21–23.

Waksman, S. A. (1947). "What Is an Antibiotic or an Antibiotic Substance?". Mycologia 39 (5): 565–569.

Walton, J. R. (1983). Modes of action of growth promoting agents. Vet. Res. Commun., 7:1–7.

Watanabe, T. (1963). Infective heredity of multiple drug resistance in bacteria. Bacteriol. Rev., 27(1): 87-115.

Wester, C. W., Durairaj, L., Evans, A. T., Schwartz, D. N., Husain, S. and Martinez, E. (2002). Antibiotic resistance- A survey of physician perceptions. Arch. Intern. Med., 162: 2210–2216.



http://www.med.umich.edu

52

Wiegand, I., Hilpert K., Hancock. R. E. W (2008). Agar and broth dilution methods to determine the minimal inhibitory concentration (MIC) of antimicrobial substances. Nat. Protoc., 3 (2): 163–175.

Wilson, M. and Lindow, S. E. (1993). Release of recombinant microorganisms. Annu. Rev. Microbiol., 47: 913–944.

Wilson, W., Taubert, K. A., Gewitz, M., Lockhart, P. B., Baddour, L.M., Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS., Newburger, J. W., Strom, B. L, Tani, L. Y., Gerber, M., Bonow, R. O., Pallasch, T. and Shulman, S. T. (2007). Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation, 116 (15): 1736–1754.

Witte, W. (1998). Medical consequences of antibiotic use in agriculture. Science, 279: 996–997.

World Health Organization (2000). Drug resistance threatens to reverse medical progress: Press Release WHO/41.

You, J. H. S., You, B., Choi, K. C., Chau, C. T. S., Huang, O. R. and Lee. S. S. (2008). Public knowledge, attitude and behaviour on antibiotics use. A telephone Survey in Hong Kong. Infection, 36: 153-157.

Zadik, Y., Findler, M., Livne, S., Levin, L. and Elad. S. (2008). Dentists' knowledge and implementation of the 2007 American Heart Association guidelines for prevention of infective endocarditis. Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. Endod., 106 (6): e16-19.



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 ( )



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 ( )



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 ( )



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 ( )



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 ( )



Documents

PUBLIC KNOWLEDGE ATTITUDE AND BEHAVIOUR REGARDING ... · PUBLIC KNOWLEDGE ATTITUDE AND BEHAVIOUR REGARDING ANTIBIOTICS USE IN ANIMALS IN KHARTOUM STATE By MOHAMMED SAHNOON HAJ AHMED