The results of a survey conducted by English researchers suggest that public information campaigns about unnecessary antibiotic use and antimicrobial resistance (AMR) could, for some, produce an unintended effect: increased demand for antibiotics.
The findings come in a paper today in Eurosurveillance that describes an online survey completed by more than 2,000 adult residents of the United Kingdom in 2015. The survey found that nearly 40% of respondents would ask their doctor for antibiotics if they experienced influenza-like symptoms for 5 days. This attitude was strongly associated with a belief that antibiotics help flu-like symptoms, a lack of awareness about AMR, and having requested antibiotics for similar symptoms within the previous 12 months.
But the survey also found that nearly 40% of a subgroup of respondents with little knowledge of AMR would be more likely to request antibiotics after being presented with information about the dangers of unnecessary antibiotic use. In addition, more than 40% of those with low AMR awareness said they would be more likely to request antibiotics if their child experienced flu-like symptoms for 5 days.
"Although based on hypothetical reported future behavior, the results of this study suggest that public information campaigns to reduce unnecessary antibiotic use may risk a paradoxical consequence of increased, rather than decreased, public demand for antibiotics," the authors of the paper write.
AMR knowledge, hypothetical antibiotic use
The survey presented respondents with a scenario in which they experienced fever, aching muscles, headache, dry cough, sore throat, and tiredness—symptoms indicative of influenza-like-illness, a condition that's typically caused by a virus and doesn't require antibiotics. Participants were also asked to provide information on factors that might be associated with expectations for, and use of, antibiotics—including demographic factors, personality traits, and attitudes toward health risks.
The survey then included a message explaining that antibiotic resistance occurs when an antibiotic loses its ability to control or kill bacteria, that AMR is a serious public health threat that could make routine medical procedures more dangerous, and that resistance is caused by the unnecessary use of antibiotics.
Ensuing questions on the survey asked respondents how surprised they were by this information, how the information would affect the number of times they might visit their general practitioner (GP) after 5 days of flu-like symptoms, and the likelihood of requesting antibiotics for those symptoms. Participants with children were asked how they would act for their youngest child.
About a third of the respondents (34%) found the information on AMR "very/somewhat" surprising; of this group, 40% said they would "probably/definitely" visit their GP more after experiencing flu-like symptoms, and 39% said they would probably/definitely ask for antibiotics more often for those symptoms. Forty-two percent of the low-AMR-awareness respondents said they would probably/definitely ask for antibiotics if their children had experienced flu-like symptoms for 5 days.
Of the 65% of respondents who said they were not surprised by the AMR information, 20% said they would visit their GP less, and 28% said they would be less likely to ask for antibiotics. Only 3% said they would visit their GP more, while 2% said they would be more likely to ask for antibiotics.
The study comes in the wake of recent research by Public Health England that found that at least 20% of all antibiotics prescribed by GPs in the United Kingdom could be classified as inappropriate. The conditions found to contribute most to inappropriate prescribing were respiratory conditions like flu-like illness. While that study focused on the role of GPs, patient expectation is also believed to play an important role in unnecessary antibiotic consumption.
The researchers argue that the association between the lack of AMR awareness, the belief that antibiotics help flu-like symptoms, and the self-reported likelihood of requesting antibiotics suggests that a well-designed public information campaign about inappropriate antibiotic use and AMR could reduce antibiotic requests for respiratory conditions. They note that a multifaceted campaign in France resulted in a substantial decrease in antibiotic prescribing from 2002 through 2007, though it's unclear whether the reduction was the result of changes in physician or patient behavior.
But the finding that those with poor AMR knowledge might hypothetically react to such a campaign by requesting more antibiotics suggests that the messaging around inappropriate antibiotic use needs to be tested on a small scale before being rolled out to the wider public, the authors say. They add that messaging may need to be tailored to different populations, and choosing the right words may be critical for success.
For example, while the message in the survey conveyed that AMR is a serious public health problem, it did not explain that antibiotics are ineffective for respiratory conditions—a message that could have made a difference among those respondents who believed that flu-like symptoms call for antibiotics.
"Information explicitly challenging this belief, perhaps coupled with reassurance that cold and influenza symptoms are easily treated with rest, fluids and paracetamol [acetaminophen], could potentially form the basis for a successful public campaign," they write.
The British government has called for cutting the amount of inappropriate prescribing by GPs in half by 2020.
Jun 21 Eurosurveill research paper
Feb 28 CIDRAP News story "UK study deems 20% of primary care antibiotics inappropriate"