Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics and Knowledge, Tan Tock Seng Hospital, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Int J Antimicrob Agents. 2023 Jun;61(6):106796. doi: 10.1016/j.ijantimicag.2023.106796. Epub 2023 Mar 24.
Inappropriate antibiotic use drives antimicrobial resistance (AMR). Complementary and alternative medicine (CAM) is often used alongside Western medicine in multi-cultural Singapore. This study aimed to assess the influence of CAM use on antibiotic usage practices.
A nationally representative cross-sectional population survey was conducted in Singapore from November 2020 to January 2021. CAM use was defined as the use of traditional Chinese medicine, acupuncture, Jamu, Ayurvedic medicine or herbal remedies. Multi-variable logistic regression analysis was conducted to assess the association between CAM use and good antibiotic usage practices, as defined by six proxy statements adapted from guidance from the US Centers for Disease Control and Prevention. Sociodemographic characteristics, motivations for CAM use, and knowledge of antibiotic use and AMR were analysed.
Thirty-four percent of 2004 respondents used CAM. The majority of CAM users were female (CAM users 57% vs non-CAM users 50%; P=0.004), Chinese (82% vs 66%; P<0.001), had a higher level of education (68% vs 64%; P=0.036), lived in the highest tier of public housing apartments or private housing (45% vs 36%; P<0.001), and had good knowledge of antibiotic use (63% vs 58%; P=0.036). After adjusting for potential confounding, CAM use (adjusted odds ratio 1.23, 95% confidence interval 1.00-1.52; P=0.048) was associated with 23% increased odds of good antibiotic usage practices. The top reasons for CAM use included recommendations from family and friends (65%), and concern about the side effects of Western medicine (44%).
CAM use is positively associated with good antibiotic usage practices. Further studies assessing educational interventions utilizing social networks and highlighting the side effects of antibiotics may be useful in improving antibiotic usage practices in communities.
抗生素的不恰当使用导致了抗菌药物耐药性（AMR）的出现。在多元文化的新加坡，补充和替代医学（CAM）常常与西药一起使用。本研究旨在评估 CAM 使用对抗生素使用实践的影响。
2020 年 11 月至 2021 年 1 月，在新加坡进行了一项全国代表性的横断面人群调查。CAM 使用被定义为使用中药、针灸、Jamu、阿育吠陀医学或草药。采用多变量逻辑回归分析，评估了 CAM 使用与根据美国疾病控制与预防中心（CDC）指南改编的六个代理陈述所定义的良好抗生素使用实践之间的关联。分析了社会人口特征、CAM 使用动机、抗生素使用和 AMR 知识。
2004 名受访者中有 34%使用了 CAM。大多数 CAM 用户为女性（CAM 用户 57%，非 CAM 用户 50%；P=0.004），华人（82%，66%；P<0.001），受教育程度较高（68%，64%；P=0.036），居住在公共住房公寓或私人住房的最高层级（45%，36%；P<0.001），并且对抗生素使用有较好的了解（63%，58%；P=0.036）。在调整潜在混杂因素后，CAM 使用（调整后的优势比 1.23，95%置信区间 1.00-1.52；P=0.048）与良好抗生素使用实践的几率增加 23%相关。CAM 使用的主要原因包括来自家人和朋友的推荐（65%）和对西药副作用的担忧（44%）。
CAM 使用与良好的抗生素使用实践呈正相关。进一步评估利用社交网络进行教育干预并强调抗生素副作用的研究，可能有助于改善社区中的抗生素使用实践。
