Inappropriate antibiotic use driven by ‘knowledge, beliefs, and expectations’

Key takeaways:

• Most respondents expected to receive antibiotics for at least one of five common symptoms or illnesses.
• Researchers found that 37% of respondents lacked knowledge about antibiotics, which affected expectations.

Despite clinical guidance advising against such use, most individuals said that antibiotics would help treat common symptoms and prevent more serious illness, according to results of a survey of patients seen in primary care and ED clinics.

The findings, published in Annals of Family Medicine, revealed that compared with those seen in private clinics, patients treated at public clinics had significantly greater antibiotic expectations for conditions such as diarrhea, sore throat and cold/influenza symptoms.

A lack of knowledge about antibiotic risks was also tied to increased antibiotic expectations, the researchers found.

Patients frequently receive antibiotic prescriptions for symptoms and illnesses like diarrhea, colds or influenza and respiratory tract infections “despite guidelines recommending against these practices,” according to Lindsey A. Laytner, PhD, MPH, CPT, a postdoctoral research fellow at Baylor College of Medicine, and colleagues.

“Individuals’ knowledge, beliefs, and expectations may contribute to inappropriate antibiotic use,” they wrote.

The researchers conducted a survey at six primary care clinics and two private EDs between January 2020 to June 2021 to determine the prevalence and predictors of antibiotic expectations for several illnesses.

The analysis included 564 respondents, among whom 33% were Black and 47% were Hispanic.

Over 93% of respondents expected to receive an antibiotic for at least one of five symptoms or illnesses.

Among respondents, most believed that antibiotics would improve bronchitis (84%), sinus infections (72%), sore throat (66%) and cold or influenza (64%) but not diarrhea (36%).

Results also showed that a higher proportion of public clinic patients believed that antibiotics would improve sore throat, diarrhea and cold or influenza compared with those seen at private clinics.

Laytner and colleagues found that public clinic patients more often expected to receive antibiotics for diarrhea (OR = 1.8; 95% CI, 1.2-2.8), sore throat (OR = 2.2; 95% CI, 1.5-3.2) or cold or influenza (OR = 1.5; 95% CI, 1-2.3) compared with private clinic patients.

Education level predicted patient antibiotic expectations for diarrhea because patients with less than a high school education expected antibiotics two times more than college-educated patients (95% CI, 1.2-3.5).

Additionally, patients with adequate health literacy were 30% less likely to expect antibiotics for diarrhea.

The researchers noted that 37% of respondents lacked knowledge about antibiotic risks, while results showed a lower proportion of public clinic patients had knowledge about antibiotic side effects compared with those seen at private clinics.

This lack of knowledge corresponded to increased antibiotic expectations for diarrhea (OR = 1.6; 95% CI, 1.1-2.4) and cold or influenza symptoms (OR = 2.9; 95% CI, 2-4.4) and less significantly to sore throat symptoms.

The analysis had some limitations identified by the researchers. Laytner and colleagues pointed out that private clinic patients may be more medically and psychosocially complex — thus affecting their antibiotic expectations — while patient expectations may have been impacted by changes tied to the COVID-19 pandemic.

The researchers concluded that future stewardship interventions aimed at reducing inappropriate patient antibiotic expectations “should inform patients of the symptoms/illnesses that antibiotics treat and emphasize the individual harms/risks (or harms/risks to others close to an individual) of antibiotics.”