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Surveys highlight gaps in antibiotic awareness among the public
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The majority of survey respondents representing the general public in Australia agreed that antibiotics are less effective when they are used unnecessarily; however, recent data showed that nearly 20% still expected an antibiotic prescription for a cold or influenza-like illness.
The findings highlight the public’s misconception about antibiotics and underscore the need for public health campaigns promoting awareness of antibiotic resistance, according to Christina Gaarslev, of Oslo kommune Helseetaten, Norway, and colleagues.
“It has been estimated that 20% to 50% of all antimicrobial use is inappropriate, and Australia contributes to the problem by being one of the largest antibiotic consumers in the world,” they wrote in Antimicrobial Resistance and Infection Control. “One of the contributing factors is the inappropriate prescribing of antibiotics for nonspecific upper respiratory tract infections (URTIs). Patient/carer expectations have been identified as one of the main drivers for inappropriate antibiotic-prescribing by primary care physicians.”
“Considerable gaps” in antibiotic knowledge
Using a sequential mixed methods approach, the researchers set out to characterize patients who are more likely to expect an antibiotic for a URTI and why. The analysis included data from a random sample of 1,509 survey respondents in Australia aged 16 years and older who participated in the 2014 NPS MedicineWise National Consumer Survey, as well as 21 focus group participants.
Of the survey respondents, only 36.5% reported that antibiotics are effective against bacteria and not viruses. Although 84.1% said that bacteria can become resistant to antibiotics and 73.7% said antibiotics were less likely to work in the future when they are unnecessarily used, 19.5% expected an antibiotic for a cold or influenza-like illness. In addition, 16.9% said they would request antibiotics for these conditions. Respondents aged younger than 65 years, those who did not attend college and those who speak a language other than English at home were more likely to expect or request an antibiotic. In contrast, those who knew antibiotics do not kill viruses and that unnecessary use reduces efficacy were less likely to expect or demand them.
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The researchers interviewed several populations who they believed were more likely to request antibiotics. The populations were divided into four focus groups — people with low socioeconomic status, long-term migrants who speak Arabic at home, long-term migrants who speak Chinese at home, and mothers of young children. Each group consisted of five to six participants who were prescribed antibiotics for themselves or their children in the past 6 months.
According to the researchers, there were “considerable gaps” among most focus group participants in their knowledge of antibiotics and resistance. All participants indicated that antibiotic prescriptions served as compensation for visiting their general practitioner and viewed their personal risk for antibiotic resistance as low or negligible.
In the low socioeconomic group, participants said antibiotics were more effective and less expensive than over-the-counter cold medication and believed that physicians withheld antibiotic prescriptions because they “disliked antibiotics or wanted to save the government money,” Gaarslev and colleagues wrote. In the Arabic-speaking group, participants believed that antibiotics could be used for general illnesses and that they could switch to stronger medications if they developed resistance. In the Chinese-speaking group, participants said they requested antibiotics because they believed the drugs could prevent them from developing an additional infection. The common belief among mothers with young children was that antibiotic use could shorten the duration of illness and prevent their other children from becoming ill.
“There is an urgent need for the core message of future public health campaigns to be focused on the personal consequences of taking antibiotics inappropriately and the implications of antibiotic resistance for the general public,” Gaarslev and colleagues concluded. “Key messages should focus on the immediate and dire repercussions of antibiotic resistance for individuals and their families in the short term.”
U.S. survey results further demonstrate public’s misconception
Similarly, a survey conducted among adults in the United States also demonstrated a lack of antibiotic knowledge.
Rebecca R. Carter, a PhD student in epidemiology and biostatistics at Case Western Reserve University, and colleagues used an online crowdsourcing platform to survey a sample of 215 participants on antibiotics and resistance. They found that only 30% considered antibiotic resistance to be a significant issue. Furthermore, 29% of respondents said antibiotics are capable of killing viruses, roughly one-quarter of respondents believed that antibiotics can treat “most coughs and colds,” and nearly 90% believed that the body could become immune to antibiotics over time.
In addition, while 71% of respondents agreed that antibiotics are overprescribed by doctors and nurses, and 45% considered these providers to not be adequately educated on antibiotic resistance, 72% said they trusted their own doctor or nurse’s judgment on antibiotic prescription.
“Specific knowledge gaps are that antibiotics are effective against bacteria, not viruses, and that antibiotic resistance is a property developed by bacteria, not people,” the researchers wrote. “Given that most of our participants indicated that they trust their doctor or nurse, these professionals may be the most effective at teaching patients about prudent antimicrobial use.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Abimbola Farinde, PhD
Over the last several years, the use of antibiotics among the American population and worldwide has grown. With this has come misuse and overuse of this valuable class of drugs, which has led to the development of significant antibiotic resistance. The CDC has also observed the critical nature of antibiotic resistance with at least 2 million Americans being infected with bacteria that is resistant to antibiotics and at least 23,000 annual deaths as a result of these resistant infections.
With the presence of antibiotic resistance, it is becoming increasingly challenging for prescribers to treat common infections. This is being recognized as a public health concern around the world. When an individual has an antibiotic-resistant infection, treatment becomes more difficult, the illness can last longer and more deaths can result from the lack of adequate treatment. An important factor that has been identified as contributing to antibiotic resistance is patient or caregiver expectations for treatment, which can yield inappropriate antibiotic prescribing. A recent study conducted by Gaarslev and colleagues and released in Antimicrobial Resistance & Infection Control sought to exam which patients are more likely to expect antibiotics for the treatment of an URTI as well as the reasons for this particular occurrence. When patients present to their primary care physician with an ailment such as an URTI, the desire to be prescribed an antibiotic that is proven to be effective and can immediately address their infection is great. There can be instances when the patient’s presentation or complaint may not warrant the initiation of an antibiotic, but at times there can be pressure as well as an expectation to do so.
The researchers performed a nationally representative cross sectional survey and looked at the results of four focus groups to analyze expectations for an antibiotic when presenting with influenza or a cold. They noted that 19.5% of those who were surveyed did expect the doctor to prescribe an antibiotic for a cold or influenza. Individuals who were older than 65 years, did not speak English, or never attended university were found to demand an antibiotic. The underlying reasons why patients demanded an antibiotic were related to the belief that it could shorten duration of illness, that antibiotics are a more effective treatment for the cold or influenza, or that patients are getting a return on their investment from visiting the doctor. However, those respondents who were aware of the indication and limitations of antibiotics were less likely to expect or demand antibiotics.
The key elements that can be identified from this study are the ongoing promotion of education, practice of antibiotic stewardship, and raising awareness to the public on appropriate antibiotic use. To effectively curtail antibiotic resistance will require a concerted effort by doctors to educate their patients. With this information, patients can be actively involved in their own care.
References:
CDC. Antibiotic/Antimicrobial resistance. http://www.cdc.gov/drugresistance/index.html. Accessed November 15, 2016.
FDA. Combating antibiotic resistance. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm092810.htm. Accessed November 15, 2016.
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