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Year : 2019  |  Volume : 16  |  Issue : 3  |  Page : 137-140

Use of social media as a tool for antibiotics awareness

Department of Section of Microbiology and Serology, Central Laboratory, St. Martha's Hospital, Bengaluru, Karnataka, India

Date of Submission03-Aug-2019
Date of Acceptance05-Aug-2019
Date of Web Publication11-Sep-2019

Correspondence Address:
K Raksha
Central Laboratory, St. Martha's Hospital, Nrupathunga Road, Bengaluru - 560 001, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/am.am_51_19

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Objective: Antimicrobial resistance (AMR) is a global health threat; public perception about AMR is a huge lacuna which many researchers, doctors, and policymakers fail to pay attention to. Infection control is often limited to diagnosis and treatment in hospitals, presentations, and panel discussions. On the other side of the fence, usage of social media to spread information about health care is a common practice among the public today. Twitter is one such online platform.Materials and Methods: This was a cross-sectional tweet-based poll titled “antibiotic awareness survey” for 7 days with five simple yet pertinent questions asked to the participants in the Twitter poll and also to retweet (RT) the questions to their followers. The questions were designed keeping in mind the limitation of tweets on the timeline and the necessity of addressal to the issue among the random group. Results: Seventy-two percent responded saying they procure antibiotics based on doctor's prescription. The most common reason to stop antibiotics for 35% of the participants was symptomatic relief and the perception that it is okay to stop, but 56% said they always complete the course. 52% of the participants said that the treating doctor does not explain to them about the antibiotics while prescribing, but 81% said that the doctor advises them on completing the course. 75% of the participants said that antibiotics are in danger and require regulation, 22% said maybe to an extent. Conclusion: Social media plays a critical role in dissemination of AMR-related information; the unrestricted and unregulated access to knowledge shapes the views and opinions of society. The perception and practices were thus reflected through this weeklong discourse about antibiotics on Twitter, and we doctors of today have a responsible role to play.

Keywords: Antibiotic stewardship, community infection control, social media, Twitter

How to cite this article:
Raksha K. Use of social media as a tool for antibiotics awareness. Apollo Med 2019;16:137-40

How to cite this URL:
Raksha K. Use of social media as a tool for antibiotics awareness. Apollo Med [serial online] 2019 [cited 2020 Feb 22];16:137-40. Available from: http://www.apollomedicine.org/text.asp?2019/16/3/137/266786

  Introduction Top

Antimicrobial resistance (AMR) has been identified as a global health threat, with serious health, political, and economic implications; the Ministry of Health and Family Welfare has also identified AMR as one of the top 10 priorities for the Ministry's collaborative work with World Health Organization (WHO) for 2018–2019.[1],[2] Public perception about AMR is a huge lacuna which many researchers, doctors, and policymakers fail to pay attention to. While addressing these issues, infection control and tackling AMR are often limited to diagnosis and treatment in hospitals, paper presentations, and panel discussions in conferences.[3],[4],[5]

This study is a clinical microbiologist's attempt beyond the hospital, as one of my revered teachers once said in an AMR workshop “Microbiologists need to go out beyond the four walls of the laboratory, go to the wards, see the patients, interact with clinicians.” In India, as clinical microbiologists we often forget that patients come from the society where multitude of factors – social, cultural, behavioral, educational, and financial factors – contribute to infections and AMR per se which is most often not assessed, rather “cannot” be assessed with dilutions or minimum inhibitory concentrations for antibiotics and microbes like we routinely do in microbiology laboratory.

Modern lives are going digital, and healthcare is no exception. Social networks have become an important health resource. Twitter (https://twitter.com) is one of the most popular social networks developed over the last decade.[6] This platform allows mass submission of messages called as “Tweets” of up to 140 characters, pictures, and links. These messages are time-stamped and if enabled pinpoint the geographical location of the user at the time of posting. Users can be “followed,” which means that their messages will be delivered automatically to all their “followers.” Followers can endorse messages by favoriting them with “Likes” or disseminating them as “RTs” to their own followers. It is estimated that there will be about 34.4 million Twitter users in India by 2019. However, not all demographic groups are equally represented. Generally, the population using this platform is young, middle-class users who post about themselves to share information or use it as a news source depending on their level of interest in using this platform. Some users can have large numbers of followers, such as celebrities and news organizations. This direct access helps to explain the popularity of the platform.[3]

Taking advantage of this premise and forum, this pilot study was designed to study the immediate response of this online population to questions related to antibiotics. The questions were designed keeping in mind the limitation of tweets on the participant's timeline and the necessity of addressal to the issue related to antibiotic perception and practices among this group. The study also helps us contribute to the nascent yet urgently needed research on influences of social media to tackle an important component of public health education on AMR.

  Materials and Methods Top

The study was a cross-sectional, tweet-based poll titled “antibiotic awareness survey” conducted for 7 days from December 1, 2018, to December 7, 2018, on the social media platform Twitter.

The participants in this survey were requested to participate in the Twitter poll and RT the questions to their followers during the period. Five pertinent questions were asked as a part of the survey to assess the public perception of the issue [Figure 1].
Figure 1: Questions of antibiotic awareness survey on twitter

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  Results Top

The responses collected for each of the five questions are as described in [Table 1] and [Figure 2].
Table 1: Total number of responses (votes, retweets, and likes) to questions in the antibiotic awareness survey on twitter

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Figure 2: Responses in antibiotic awareness survey-weeklong poll on twitter

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How do you procure antibiotics?

This question was set to analyze the awareness of accessibility and availability of antibiotics for the participants in this survey. 72% responded saying doctor's prescription, 15% responded saying that they do so based on general recommendation, 8 % old prescription and 5 % said chemist's recommendation.

What is the most common reason for you to stop the course of antibiotics?

This question was designed to understand the reason for discontinuing antibiotic therapy. 35% responded saying they felt better and it is ok to discontinue the course. 56% responded saying they always complete the course. 8% responded saying side effects are too many and 1% said antibiotics are costly and they cannot afford.

When you consult a doctor for any illness, does he or she explain to you about why, when, and how to take the antibiotic while giving you the prescription?

This question was designed to assess the level of patient's education that is imparted by doctors during antibiotic prescription. 52% of respondents said no, the treating doctors do not educate them about the need for antibiotics. 48% of respondents said yes, they do.

When you consult a doctor for any illness, does he or she stress on the fact that the course of the antibiotic has to be completed while giving you the prescription?

This question was designed to assess patient education by treating doctors to complete the course. 81% of respondents said yes, their doctors do advise them to complete the course. 19% said no they do not.

Do you think antibiotics are in danger, their prescription and usage require regulation?

This question was designed to assess the group perception on the status of antibiotics as important drugs of health care. 75% of the respondents said yes, 22% said may be to an extent, and 3% said no, not required.

  Discussion Top

The Twitter algorithm for getting responses to the questions in a poll is complex, depending on mainly the interest of the follower to RT and participate [Figure 3] and hence the disparity in the number of votes, RTs, and likes. This crowd behavior is very similar to the eagle effect or paradoxical zone phenomenon, originally referred to the paradoxically reduced antibacterial effect of penicillin at high doses because the effectiveness of an antibiotic generally rises with increasing drug concentration.[7] Similarly, on social media, the response of the crowd also generally tends to taper off despite the question being on the online platform. In other words, people are no different from a population of microbes. One of the tweets from a doctor read: “This is an interesting poll about the manner in which people procure antibiotics. The result will be interesting to see if this gets 1000+ votes. Kindly RT for greater outreach.”
Figure 3: Algorithm of tweets, retweets, and likes on Twitter

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Although 72% of participants in this survey responded saying that they obtain antibiotics based on doctor's prescription, over-the-counter (OTC) sale of antibiotics is a large part of the AMR problem. India's total use of antibiotics has more than doubled from 2000 to 2015, making our country the world's biggest consumer of antibiotics interventions and awareness campaigns should not be only educational but “multipronged” to tackle the serious societal issue of antibiotic resistance.[8],[9] The Government of India has initiated a few to address the problem: Schedule H1 by the Central Drugs Standard Control Organization to prevent OTC sales of important antibiotics, National Centre for Disease Control national treatment guidelines for antimicrobial use, Mission Indradhanush for improving access to vaccines, and “Medicines with the red line” media campaign in February 2016.[1],[10]

With respect to the responsibility of prescribing, it is interesting to note the half-knowledge that is imparted; the what's, how's, and why's of antibiotics are hardly discussed with patients. A multitude of factors affects this scenario in a country facing hundreds of healthcare management issues. This is evident from the few tweets gathered in this pilot survey [Figure 4]. This also emphasizes the role of the doctors in educating the common public during consultations as in this survey, and in a study by Chinnasami et al., 48% and 65.5% participants, respectively, agreed that doctors always take time to explain in detail how antibiotics are to be used.[4] There is room for more efforts.
Figure 4: A few tweets from participants in antibiotic awareness survey

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Twenty-two percent of participants in this survey thought antibiotics require regulation to an extent and 3% replied in negative when there are already measures in place; this indeed reflects the difficulties in implementation of policies and guidelines. A multidisciplinary approach is the need of the hour; institutional organizations must consider the contribution and impact of social media tools on public health campaigns and against many hurdles within their communications strategy.[3]


The literacy and awareness level of participants can result in favorable responses despite what they practice and hence cannot be extrapolated to the general population. The study was also limited by the number of followers of the author on the social media platform as explained with the algorithm, and there are a variety of other social media and online communities and platforms that may also provide insights about information networks related to AMR and antibiotics.

  Conclusion Top

Several industries from business, marketing to politics have used social media to their advantages. Organizations such as WHO and Centers for Disease Control use social media to spread awareness and gather vital information on people health.[11] The vast quantity of data generated has increasingly been exploited for healthcare and public health analysis. People across the globe talk about antibiotics on social media and free tools can be used rapidly to gain initial insight into discussion topics and trigger for changes in the volume of conversations like this pilot survey.

Therefore, the medical fraternity and associations in India related to infectious diseases, microbiology, pharmacology, medicine, etc., can strongly consider making use of these platforms to spread the right information from the right source for “antibiotics” with official pages and handles. The general population's understanding of antibiotic use is crucial and our responsibility to address to contain AMR.[12]


I would like to thank all the participants and followers on her Twitter timeline who enthusiastically participated and shared their opinions on AMR in this survey.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ministry of Health and Family Welfare, Government of India with support from World Health Organization Country Office for India. National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017 – 2021; April, 2017. Available from: http://www.searo.who.int/india/topics/antimicrobial_resistance/nap_amr.pdf. [Last Accessed on 2019 May 23].  Back to cited text no. 1
Center for Disease Dynamics, Economics & Policy. Access Barriers to Antibiotics; 2019. Available from: https://cddep.org/wp-content/uploads/2019/04/AccessBarrierstoAntibiotics_CDDEP_FINAL.pdf. [Last Accessed on 2019 May 15].  Back to cited text no. 2
Dyar OJ, Castro-Sánchez E, Holmes AH. What makes people talk about antibiotics on social media? A retrospective analysis of Twitter use. J Antimicrob Chemother 2014;69:2568-72.  Back to cited text no. 3
Chinnasami B, Sadasivam K, Ramraj B, Pasupathy S. Knowledge, attitude and practice of parents towards antibiotic usage and its resistance. Int J Contemp Pediatr 2016;1:256-61.  Back to cited text no. 4
Chandy SJ, Mathai E, Thomas K, Faruqui AR, Holloway K, Lundborg CS. Antibiotic use and resistance: Perceptions and ethical challenges among doctors, pharmacists and the public in Vellore, South India. Indian J Med Ethics 2013;10:20-7.  Back to cited text no. 5
Goff DA, Kullar R, Newland JG. Review of Twitter for infectious diseases clinicians: Useful or a waste of time? Clin Infect Dis 2015;60:1533-40.  Back to cited text no. 6
Prasetyoputri A, Jarrad AM, Cooper MA, Blaskovich MA. The eagle effect and antibiotic-induced persistence: Two sides of the same coin? Trends Microbiol 2019;27:339-54.  Back to cited text no. 7
Farooqui HH, Selvaraj S, Mehta A, Heymann DL. Community level antibiotic utilization in India and its comparison vis-à-vis European countries: Evidence from pharmaceutical sales data. PLoS One 2018;13:e0204805.  Back to cited text no. 8
Porter G, Grills N. Medication misuse in India: A major public health issue in India. J Public Health (Oxf) 2016;38:e150-7.  Back to cited text no. 9
Banerjee D, Raghunathan A. Knowledge, attitude and practice of antibiotic use and antimicrobial resistance: A study post the red line initiative. Curr Sci 2018;114:1866-77.  Back to cited text no. 10
Dash N, Aboukhater R, Abuhalimeh B, Amira S. Misuse of antibiotics among social media users. GSTF J Nursing Health Care 2017;5:(1): 1- 4. DOI: 10.5176/2345-718X_5.1.164.  Back to cited text no. 11
Andersen B, Hair L, Groshek J, Krishna A, Walker D. Understanding and diagnosing antimicrobial resistance on social media: A Yearlong overview of data and analytics. Health Commun 2019;34:248-58.  Back to cited text no. 12


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1]


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