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Physicians' words, actions reinforce antibiotics myths among parents

Clinicians’ words and deeds regarding prescriptions confirm parents’ beliefs that antibiotics are necessary to treat severe illnesses, and addressing physician-patient communication is key to adjusting expectations about antibiotics, according to data published in the Annals of Family Medicine.

“Patient and parent expectation of antibiotic treatment has been identified as a driver of antibiotic prescribing by clinicians,” Christie Cabral, PhD, of the Centre for Academic Primary Care, at the University of Bristol School Social and Community Medicine, in England, and colleagues wrote. “Numerous campaigns have attempted to increase public awareness of appropriate use of antibiotics, many aiming to communicate the message that most [respiratory tract infections (RTI)] are caused by viruses and cannot be treated with antibiotics. Greater public knowledge, however, does not necessarily lead to reduced consumption of antibiotics.”

To better understand the perceptions of physicians and parents regarding communication about RTI in children, and that communication’s effect on those parents’ thoughts on antibiotics, the researchers recorded 60 primary care consultations, including 70 parents, 74 children and 19 clinicians, in six practices in England. Children were aged 3 months to 12 years, and presented with RTI and cough.

The researchers selected 27 parents and 13 clinicians for semi-structured video-elicitation interviews. The videos were used to look into the participants’ thoughts regarding communication during consultation.

According to the researchers, although physicians frequently told parents that antibiotics were ineffective against viruses, this had no effect on their beliefs regarding the need for antibiotics. Specifically, parents believed that antibiotics were needed to treat more severe illness, a preconception that was often confirmed by physicians using problem-minimizing language when making viral diagnoses, and problem-oriented language when issuing antibiotics. A prescription for antibiotics confirmed parents’ belief in the severity of their child’s illness. In addition, parents had a poor understanding of antimicrobial resistance. Nonetheless, most held beliefs that supported a reduction of prescribed antibiotics.

“This study suggests that within-consultation communication aimed at reducing antibiotic expectations would be more effective if it acknowledged that viral illness can be severe (eg, in bronchiolitis or viral pneumonia) and that bacterial infections can be self-limiting,” Cabral and colleagues wrote. “It also suggests that clearer explanations of the symptoms and signs of a child’s illness that indicate when antibiotics are and are not warranted would help reduce misconceptions, as would reducing antibiotic prescribing that is not supported by the evidence (such as prescribing for yellow phlegm).” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.