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aim: To assess parents' knowledge and attitudes towards the use of antibiotics within the paediatric age range. Methods and Materials: This observational, descriptive and cross-sectional study, with a voluntary and anonymous questionnaire was implemented over three months to a sample of parents of children and teenagers enrolled on two Family Health Units, D. Jordão (rural area) and Sétima Colina (urban area). results: A total of 294 valid questionnaires were obtained. Only 149 (51%) answered that antibiotics treat bacterial infections, 101 (34%) believed that they help in the recovery of a flu and 36 (12%) considered that they should always be used in case of fever. Two hundred twenty-seven (77%), identified misuse of antimicrobials as a cause of bacterial resistance, even so, 31% became concerned if the doctor does not prescribe these drugs. Only 87 (30%) showed high level of knowledge and a statistically significant correlation existed between higher age of parents [Odd’s ratio (OR)=2.37], education (OR=3.42), confidence in doctors (OR=2.06) and level of knowledge of respondents. There was no statistically significant difference between the level of knowledge of users in the rural environment compared to those in the urban environment (p=0.546). conclusion: Most parents are unaware of antibiotics’ function, as well as the difference between viral and bacterial infections. Although they identify that misuse of these drugs may lead to bacterial resistance, parents become reluctant when antibiotics are not prescribed. introduction Antibiotics, whose function allows the prevention and cure of infections of bacterial origin, are considered one of the most relevant inventions of the 20th century.1-3 Prior to their discovery, bacterial infections contributed significantly tzo morbidity and mortality on a global scale.1,4 Thus, antibiotics play an essential role in medical practice,2,5 so their prescription has been increasing.4,6 In 2014, these drugs contributed to 70.5% of the total anti-infectious drugs prescribed at ambulatory care and hospitals in Mainland Portugal.7 However, its widespread use correlates with the development of strains of resistant bacteria.1,8,9 Although this is a natural process resulting from the selective pressure exerted by the use of antibiotics, the selection of resistant strains is enhanced by inappropriate and frequent use of this pharmacological class.8,10,15 Antibiotic resistance is an important threat to the efficacy of these drugs, leading to more expensive antibiotic alternatives with more serious side effects.10-12 This requires a greater number of consultations, complementary diagnostic tests and additional drug prescriptions, culminating in many cases in extended hospital days and,13,15 ultimately, in an increase in mortality.14-16 Antibiotic resistance is thus responsible for serious clinical consequences and represents a heavy economic investment,17 so it is currently assumed as one of the most relevant public health problems worldwide.8,10,12,18 Although the prescription of the antibiotic is the responsibility of the clinician, there are several factors that, directly or indirectly, may influence its decision.13,17,24,25 Parents have a distorted view of the function of these drugs, as well as of the diseases that require their use.13,17,24,25 Among the infectious conditions verified at paediatric age, most are of viral aetiology, self-limited in nature and with a very low risk of complications, and it is sufficient, in most article history Received 20 January 2020 Accepted 8 February 2020 keywords parents, antibiotics, knowledge, attitudes, questionnaire contact: Ana Sofia Esteireiro email: esteireira@gmail.com address for correspondance: Ana Sofia Esteireiro, Rua Diário de Notícias, 2500-176, Caldas da Rainha, Leiria, Portugal. ©2020 Pediatric Oncall 45 PEDiATRiC ONCALL JOURNAL (APRiL-JUNE 2020) 17(2): 44-53 cases, the use of symptomatic control.11,26,27 However, studies show that, at an early stage of the disease, the non-prescription of an antibiotic is associated with parental dissatisfaction regarding the therapeutic attitude adopted by the doctor.25,28 Data from the 2018 Eurobarometer show that Portugal is one of the European countries where there is greater ignorance about the action of this pharmacological class, as 64% of Portuguese consider that antibiotics are effective in the face of viral infection (vs. 48% of European average), 55% believe that its use contributes to the resolution of flu and colds (vs. 28% European average) and only 24% reported having received information in the last 12 months on this issue (vs. 33% of the European average).12 The low level of clarification in antibiotic therapy contributes to the incomplete course of treatment with these drugs, which translates into the suspension of its administration when there is improvement in symptomatology, in non-compliance with the frequency of appropriate administration, dose reduction or use of self-medication.11,24,25 Self-medication with antibiotics, in particular the sale of antibiotics without a prescription and the use of surpluses thereof, in the face of a clinical picture similar to what motivated its initial prescription,12,29 is considered one of the factors that leads to inadequate use of this pharmacological class.13 in the European panorama 7% of respondents report that they did not obtain antibiotics with a prescription, and in Portugal this value is even higher, 10%.12 In this sense, studies have been conducted in the national territory in order to evaluate the prevalence of self-medication with antibiotics, one in the Algarve, in 2008, and another in the municipality of Vizela in 2011,14 prevalence of 4% and 18.9% respectively.29 This work aims to characterize the knowledge and attitudes of parents about the use of antibiotics in paediatric age and to verify whether they differ between users of the urban vs. rural environment. it is also intended to investigate the existence of a relationship between gender, age, education, as well as between the number and age of sons, with the parent’s level of knowledge about antibiotic therapy. Methods & Materials Study drawing An investigation protocol was elaborated, which defined the objectives and methodology of the study, with prior approval by the Ethics Committee of the Regional Health Administration of Lisbon and Tagus Valley. This was a descriptive and cross-sectional observational study with an analytical component. The data were collected through the application of a questionnaire to a convenience sample, during the period between June and August 2017. Population and sample The study population consisted of the parents of children and adolescents (under 18 years) enrolled in the Family Health Unit (USF) Sétima Colina and USF D. Jordão. The USF Sétima Colina is located in Lisbon (urban area) and USF D. Jordão in Lourinhã (rural area). A convenience sample was used, consisting of 294 users of the two USF over the age of 18 years, who agreed to participate in the investigation. Although it was a convenience sample, the dimension that would be needed if the sample was random was determined through the OpenEpi® system to a 95% confidence level, with the outcome number used as a reference. Written consent was obtained from the participants, after an oral and written description of the study purpose. inclusion criteria: parents of healthy children and adolescents (without chronic pathology that makes them more vulnerable to repeated infections). Exclusion criteria: parents with illiteracy or inability to understand the written Portuguese language. it is also excluded all caregivers who are not parents of the children. Study instrument The data were obtained through the application of a questionnaire prepared by the researchers (Figure 1), not validated for the Portuguese population, based on studies with similar objectives. This is an anonymous and self-completion paper questionnaire. The questionnaire consists of 15 questions, organized into two distinct parts: part i socio-demographic data of the respondent; part ii knowledge and attitudes about antibiotic therapy. A pilot test was performed (total of 30 parents, 15 of each USF) in order to detect difficulties in interpreting questions or incongruities. The final questionnaire, after rectifications, was delivered by clinical secretaries to parents who agreed to participate in the study. After completing them, the questionnaires were delivered and placed in a closed envelope designated for this purpose. data analysis The data collection was carried out by the researchers and the information was introduced into a computer database (in Microsoft Excel®), created for this purpose. To ensure confidentiality, all data has been encoded with a numeric code. The variables evaluated in the study for parents were age, gender, education, nationality, number of children, the existence of preschool children, knowledge and attitudes about the use of antibiotics, their use without medical prescription, as well as the level of confidence in the attending physician. The level of knowledge about antibiotic therapy was obtained according to the number of correct answers to the 5 questions about function, use and side effects of these drugs (each correct answer corresponds to 1 point, incorrect or unfilled answers correspond to 0 points). A low level of knowledge is considered when obtained from 0 to 2 points, average knowledge between 3 and 4 points and a high level of knowledge when the respondent obtains 5 points. The level of confidence in the doctor was obtained by the answer of parents to the question “do you stay rested when the doctor does not prescribe antibiotics to your child?”, considering that there is confidence when the answer is positive. Descriptive analysis was performed, presenting frequencies and percentages for categorical variables; standard deviations for continuous variables. The ques

Parents Knowledge and Attitudes Towards the use of Antibiotics in Patients within the Paediatric age Range.