Communication interventions to promote the public's awareness of antibiotics: a systematic review

Testing Different Message Styles about Unnecessary Antibiotics Using an Online Platform

Patients' expectations are a major contributor to the unnecessary prescribing of antibiotics, yet limited research has examined how physicians can calibrate these expectations. The studies we conducted tested how varying messages could impact patients' expectations for antibiotics and their experience of medical appointments. All the participants read a short scenario about an appointment for mild sinusitis symptoms, with the patient's expectation of antibiotics. In Study 1, the participants (n = 1069) were randomly assigned to read a positively framed, neutral, or negatively framed message regarding unnecessary antibiotics. In Study 2, the participants (n = 1073) read a message emphasizing either the societal or personal harms of unnecessary antibiotics, or a message without additional rationale. None of our pre-registered hypotheses were supported, but our exploratory analyses indicated that the societal message increased concern about antibiotic resistance. The participants who were more concerned about resistance were less likely to ask for antibiotics, more satisfied when the physician did not prescribe them, and more likely to recommend the physician to a friend. Discussing the consequences of the different courses of action did not appear to negatively impact physician-patient rapport. These studies demonstrate an inexpensive method with which to pre-test various messages about antibiotic consumption, and suggest that such messages are not negatively received by patients.

A survey of patient practices regarding leftover antibiotics reveals a potential source of antibiotic overuse

Taking leftover prescribed antibiotics without consulting a healthcare professional is problematic for the efficacy, safety, and antibiotic stewardship. We conducted a cross-sectional survey of adult patients in English and Spanish between January 2020 and June 2021 in six safety-net primary care clinics and two private emergency departments. We assessed the reasons for stopping prescribed antibiotics early and what was done with the leftover antibiotics. Additionally, we determined 1) prior leftover antibiotic use, 2) intention for future use of leftover antibiotics, and 3) sociodemographic factors. Of 564 survey respondents (median age of 51), 45% (251/564) reported a history of stopping antibiotics early, with 171/409 (42%) from safety net and 80/155 (52%) from the private clinics. The most common reason for stopping prescribed antibiotics early was "because you felt better" (194/251, 77%). Among survey participants, prior use of leftover antibiotics was reported by 149/564 (26%) and intention for future use of leftover antibiotics was reported by 284/564 (51%). In addition, higher education was associated with a higher likelihood of prior leftover use. Intention for future use of leftover antibiotics was more likely for those with transportation or language barriers to medical care and less likely for respondents with private insurance. Stopping prescribed antibiotics early was mostly ascribed to feeling better, and saving remaining antibiotics for future use was commonly reported. To curb nonprescription antibiotic use, all facets of the leftover antibiotic use continuum, from overprescribing to hoarding, need to be addressed.

Exploring the Influence of Family Attitudes and Individual Psychological Factors on Antibiotic Utilization: A Pilot Study

The inappropriate use of antibiotics gives rise to detrimental consequences, both physical and emotional, with a decreased quality of life and higher levels of anxiety and depression. The current observational study aimed to investigate the association between awareness, beliefs, and behaviors toward antibiotics, highlighting the modulating role of individual and psychological factors in response to illness and medication. Through an online questionnaire, several psychological indexes, as well as knowledge of, attitude toward, and experiences with antibiotics, both individual and family-related, were assessed in a sample of 100 responders (74 females, mean age 33.37 ± 11.36). A positive association between intake behavior, awareness, and individual attitude emerged. Familial approach to antibiotics appears as a predictor of individual attitude and behavior toward these drugs, and awareness about antibiotic risks mediate the relationship between the tendency to be more compliant with prescriptions (R2 = 0.300; MSE = 1.541; F(2, 98) = 20.737; p < 0.0001). Moreover, individuals with a personality characterized by higher conscientiousness are more aware of antibiotic risks (p < 0.01), whereas individuals with a lower awareness are those with higher indexes of psychophysical discomfort (i.e., anxiety, perceived stress, somatization) and levels of emotional rebound (p < 0.05). Anxiety (F(3, 96) = 3.874; p = 0.012; R2 = 0.108) and somatization (F(2, 97) = 3.114; p = 0.030; R2 = 0.089) also significatively moderated the intake behavior, despite the family approach. Overall, the current study provides preliminary findings regarding the way in which family experiences and individual psychological aspects may be influencing factors in the behavior and attitude towards antibiotics and can be used to plan patient-centered therapeutic communication and education.

Impact of a public commitment charter, a non-prescription pad and an antibiotic information leaflet to improve antibiotic prescription among general practitioners: A randomised controlled study

BACKGROUND

This study evaluated the effect of a multifaceted antibiotic stewardship intervention on the overall prescription of systemic antibiotics in primary care. Secondary objectives evaluated the effect on the prescription of broad-spectrum antibiotics and the seasonal variation of both total antibiotic and quinolone prescriptions, as a proxy for unnecessary prescribing.

METHODS

This pragmatic, randomised, controlled, before-after intervention study was conducted among general practitioners (GPs) who over prescribe antibiotics in Lorraine, France (Intervention group, n = 109; Control group, n = 236; Before period, 01/10/2017-30/09/2018; After period, 01/10/2018-30/09/2019). The intervention included a public commitment charter, a patient information leaflet and a non-prescription pad. Health Insurance data was obtained to calculate overall and broad-spectrum prescription rate (defined daily doses/1000 consultations) and the seasonal variation of prescriptions (%), by period. The intervention effect was measured with general linear mixed models including three independent variables (group, period and group x period interaction).

RESULTS

Overall, compared to the Before period, GPs in both groups prescribed significantly fewer systemic antibiotics (p < 0.001) and broad-spectrum antibiotics (p < 0.001) after the intervention was implemented. However, the group x period interaction did not show any evidence that the intervention had an effect on these outcomes. Nevertheless, the intervention did result in a trend towards less seasonal variation in total systemic antibiotic prescription (p = 0.052).

CONCLUSIONS

A tendency towards an effect of the intervention to reduce unnecessary antibiotic prescribing during winter months was observed. No effect was observed on the overall volume of systemic antibiotic prescription. This study invites discussion about the challenges faced when evaluating non-pharmacological interventions in primary care.

Exploring factors for antibiotic over-prescription in children with acute upper respiratory tract infections in Assiut, Egypt: a qualitative study

BACKGROUND

Over-prescription of antibiotics contributes to antibiotic resistance, which is a global health threat. Egypt has alarmingly high rates of antibiotic over-prescription for acute upper respiratory tract infections (URIs) in children. To effectively address this issue, it is important to understand the various factors that influence prescription behaviors. The Teixeira antibiotic prescription behavioral model (TAPBM) offers a comprehensive framework through which these factors can be explored. This qualitative study sought to investigate the perspectives of key stakeholders involved in pediatric healthcare in Egypt, with the primary goal of identifying the underlying determinants that contributed to this problem.

METHODS

This qualitative study was conducted in Assiut City, Egypt, between January and March 2023. Purposive sampling was used to select participants, including consultant pediatricians, supervisors of pediatric training programs, and specialists in infection prevention and control. Thirteen semi-structured in-depth interviews (IDIs) were conducted, audio-recorded, and transcribed. Thematic analysis was performed using MAXQDA 2020 software.

RESULTS

Two main themes emerged from the analysis: intrinsic factors related to physicians, extrinsic factors related to patients, and nonphysician factors. Intrinsic factors encompass personal characteristics and attitudes. Prescribing decisions were influenced by factors such as fear of complications, limited follow-up visits, and competition. Knowledge and education also played a significant role. Moreover, diagnostic uncertainty in distinguishing between bacterial and viral infections posed a challenge. Extrinsic factors included patient and caregiver factors, such as parental expectations and demands for antibiotics, driven by the belief that they produced rapid results. Moreover, patients' demographic factors, including socioeconomic status and living conditions, affected their prescribing behavior. Health system-related factors, such as the type of healthcare institution and the absence of formal national guidelines, were identified as influential factors. Additionally, this study highlighted the influence of the pharmaceutical industry. The potential impact of the COVID-19 pandemic on antibiotic prescriptions was addressed.

CONCLUSIONS

The study highlights the intricate interplay between intrinsic and extrinsic factors that shape antibiotic prescription decisions, underscoring the significance of addressing these factors in mitigating overprescribing.

Signalling need for care: a neglected functional role of medical treatment

Background and Objectives

While the primary goals of medical treatment are typically to shorten illness or relieve symptoms, we explore the idea that an important additional goal for some patients is to communicate their needs. Drawing on signalling theory, we argue that undergoing treatments can help patients legitimize their illness and thereby enable access to crucial support during convalescence.

Methods and Results

Four pre-registered within-subjects experiments (n = 874) show that participants are more inclined to provide care to people who undergo treatment, especially when that treatment is painful. Results show this incentivizes the use of antibiotic treatments for viral infections as well as drug treatments for mental illness. A cross-sectional study of 194 chronic pain patients shows that those who experience stigma and doubt over the legitimacy of their illness are more likely to accept aversive treatments. Furthermore, two experiments (n = 653) indicate that subtle manipulations of one's sense of social support may increase willingness to accept treatment.

Conclusions and Implications

These results indicate that people make decisions to provide care in part based on the presence or absence of treatment and furthermore that patients' treatment decision-making is informed by the social consequences of their choices. Signalling theory may help explain the surprising longevity of some ineffective and costly medical procedures.

Knowledge, attitudes and behaviour of Egyptians towards antibiotic use in the community: can we do better?

BACKGROUND

Infectious diseases are among the leading causes of death worldwide. This is concerning because of the increasing capacity of the pathogens to develop antibiotic resistance. Antibiotic overuse and misuse remain the main drivers of resistance development. In the USA and Europe, annual campaigns raise awareness of antibiotic misuse hazards and promote their judicial use. Similar efforts are lacking in Egypt. This study assessed the knowledge of the public in Alexandria, Egypt of antibiotic misuse risks and their habits towards antibiotic use, in addition to conducting a campaign to increase awareness of the safe use of antibiotics.

METHODS

A questionnaire assessing knowledge, attitudes and behaviour towards antibiotics was used to collect responses from study participants at various sports clubs in Alexandria in 2019. An awareness campaign to correct misconceptions and a post awareness survey followed.

RESULTS

Most of the participants were well-educated (85%), in their middle age (51%) and took antibiotics last year (80%). 22% would take an antibiotic for common cold. This dropped to 7% following the awareness. There was a 1.6 time increase in participants who would start an antibiotic on a healthcare professional's advice following the campaign. A 1.3 time increase in participants who would finish an antibiotic regimen was also observed. The campaign made all participants recognize that unwise antibiotic use is harmful to them or others; and 1.5 more participants would spread the word about antibiotic resistance. Despite learning of the risks of antibiotic use, there was no change in how often participants thought they should take antibiotics.

CONCLUSIONS

Although awareness of antibiotic resistance is rising, some wrong perceptions hold fast. This highlights the need for patient and healthcare-tailored awareness sessions as part of a structured and national public health program directed to the Egyptian population.

Awareness of antibiotic resistance: a tool for measurement among human and animal health care professionals in LMICs and UMICs

BACKGROUND

Raising awareness of antimicrobial resistance is a cornerstone of action plans to tackle this global One Health challenge. Tools that can reliably assess levels of awareness of antibiotic resistance (ABR) among human or animal healthcare professionals (HCPs) are required to guide and evaluate interventions.

METHODS

We designed and tested an ABR awareness scale, a self-administered questionnaire completed by human and animal HCPs trained to prescribe and dispense antibiotics in six countries-Ghana, Nigeria, Tanzania, Vietnam, Thailand and Peru. Questionnaires also elicited demographic, practice, and contextual information. Psychometric analysis for the scale followed Rasch Measurement Theory. Bivariate analysis was carried out to identify factors associated with awareness scores.

RESULTS

Overall, 941 HCPs (625 human and 316 animal) from Ghana, Nigeria, Tanzania, Vietnam, Thailand and Peru were included in the study. The 23-item ABR awareness scale had high-reliability coefficients (0.88 for human and 0.90 for animal HCPs) but performed better within countries than across countries. Median ABR awareness scores were 54.6-63.5 for human HCPs and 55.2-63.8 for animal HCPs (scale of 0-100). Physicians and veterinarians scored higher than other HCPs in every country tested. HCPs in this study reported working in contexts with limited laboratory infrastructures. More than 95% of HCPs were interested in receiving information or training on ABR and antimicrobial stewardship.

CONCLUSION

HCPs' awareness of ABR can be reliably assessed with this validated 23-item scale within the countries tested. Using the scale alongside context questions and objective measurement of practices is recommended to inform interventions to improve antibiotic use.

Implementation fidelity in a multifaceted program to foster rational antibiotics use in primary care: an observational study

BACKGROUND

The ARena study (Sustainable Reduction of Antimicrobial Resistance in German Ambulatory Care) is a three-arm, cluster randomized trial to evaluate a multifaceted implementation program in a German primary care setting. In the context of a prospective process evaluation conducted alongside ARena, this study aimed to document and explore fidelity of the implementation program.

METHODS

This observational study is based on data generated in a three-wave survey of 312 participating physicians in the ARena program and attendance documentation. Measures concerned persistence of participation in the ARena program and adherence to intervention components (thematic quality circles, e-learning, basic expenditure reimbursements, additional bonus payments and a computerized decision support system). Participants' views on five domains of the implementation were also measured. Binary logistic and multiple linear regression analyses were used to explore which views on the implementation were associated with participants' adherence to quality circles and use of additional bonus compensation.

RESULTS

The analysis of fidelity showed overall high persistence of participation in the intervention components across the three intervention arms (90,1%; 97,9%; 92,9%). 96.4% of planned quality circles were delivered to study participants and, across waves, 30.4% to 93% of practices participated; 56.1% of physicians attended the maximum of four quality circles. 84% of the practices (n = 158) with a minimum of one index patient received a performance-based additional bonus payment at least once. In total, bonus compensation was triggered for 51.8% of affected patients. Participation rate for e-learning (a prerequisite for reimbursement of project-related expenditure) covered 90.8% of practices across all intervention arms, with the highest rate in arm II (96.5%). Uptake of expenditure reimbursement was heterogeneous across study arms, with a mean rate of 86.5% (89.1% in arm I, 96.4% in arm II and 74.1% in arm III). Participants' views regarding participant responsiveness (OR = 2.298) 95% CI [1.598, 3.305] and Context (OR = 2.146) 95% CI [1.135, 4.055] affected additional bonus payment. Participants' views on participant responsiveness (Beta = 0.718) 95% CI [0.479, 0.957], Context (Beta = 0.323) 95% CI [0.055, 0.590] and Culture of shared decision-making (Beta = -0.334) 95% CI [-0.614, -0.053] affected quality circle attendance.

CONCLUSION

This study showed an overall high fidelity to the implementation program. Participants' views on the implementation were associated with degree of intervention fidelity.

TRIAL REGISTRATION

ISRCTN, ISRCTN58150046.

"I don't hesitate to use the left-over antibiotics for my child" practices and experiences with antibiotic use among caregivers of paediatric patients at Zomba central hospital in Malawi

Background

Inappropriate use of antibiotics is among the major causes of the global emergency of antibiotic resistance among children. The problem of inappropriate use of antibiotics among children is of special concern because they are still developing immunological systems, hence they are susceptible to many infectious diseases. As such, they receive a considerable disproportional amount of antibiotics which exposes them to antibiotic resistance. This study explored the lived experiences of caregivers of children under the age of five years on the use of antibiotics at Zomba central hospital.

Objective

The main aim of this study was to explore the lived experiences of caregivers of children under the age of five years on antibiotic usage at Zomba Central Hospital, Zomba-Malawi.

Methodology

This was a descriptive qualitative study with a phenomenological approach to explore the lived experience of caregivers of paediatric patients on antibiotic usage from May 2019 to July 2020. The study used interview guides to conduct in-depth interviews with 16 caregivers and purposive sampling was used to select the participants from the children’s ward. All interviews were audio-recorded and qualitative data was transcribed verbatim and thematically analysed manually to extract major themes and concepts on the subject matter.

Results

Caregivers had little knowledge about antibiotic use and its resistance. most caregivers use the antibiotics inappropriately through self-medication, use of left-over antibiotics, buying antibiotics without prescription, and sharing of antibiotics.

Conclusion

Based on the findings of this study, investment in public awareness and organising community-led interventions in antibiotic use related information is key to improve the quality use of antibiotics. The Government should focus on promoting interventions that lessen the indiscriminate use of antibiotics among the caregivers. Stringent laws need to be enforced by the government to restrict the access of antibiotics to parents without a prescription.

Antibiotic Knowledge, Beliefs, and Behaviors: Testing Competing Hypotheses Using an Urban Community Sample

Antibiotic use and misuse continue to be a worldwide concern with the increasing rate of antimicrobial resistance, lack of new antibiotics in the pipeline, and rising health care costs. Despite studies that attempt to distinguish between factors associated with antibiotic use and misuse (e.g., knowledge and beliefs and provider-patient communication), few studies have tested comparative hypotheses related to antibiotic use behavior. This study 1) compares two theoretical models (health belief and patient-centered communication) to learn which best represents the pathways associated with antibiotic use; and 2) describes urban consumers' knowledge, beliefs, and behaviors regarding antibiotic use. Interviewers completed 505 intercept surveys across six clinic- and community-based sites in Southeast Michigan. Structural equation modeling was utilized to compare two competing theoretical models predicting antibiotic behavior. Findings support the assertion that a patient-provider communication model fits the data better than the null model. Descriptive statistical analysis explicated participant knowledge was mixed. While many participants knew correct general facts about antibiotics, 35% of the sample put forth that they believed that antibiotics cure colds and flu and over half (57%) endorsed the belief that antibiotics are good for treating infections caused by viruses. The implications for theory and practice are discussed including the need for clinicians to target communication strategies for the populations that they serve.

Effectiveness of educational interventions in knowledge, attitude, and practice for preventing respiratory infections: a systematic review and meta-analysis

OBJECTIVES

to demonstrate the effectiveness of educational interventions in knowledge, attitude and practice for preventing respiratory infections in adults and older adults.

METHODS

this is a systematic review carried out in 11 databases. Primary studies, without language and time restrictions, of the randomized, non-randomized and before-and-after clinical trial type, were selected. The risk of bias was assessed by two independent researchers, and the methodological quality was generated by the Grading of Recommendations, Assessment, Development and Evaluation.

RESULTS

the intervention effectiveness was evidenced in seven studies. The results of the random effects meta-analysis show that there is a statistically significant difference between knowledge about preventing respiratory diseases, with an OR of 2.82 (95%CI 1.70 to 4.69) for the occurrence of events represented by improved knowledge.

CONCLUSIONS

most studies show the effectiveness of educational interventions, which was determined through the Knowledge, Attitude and Practice survey.

Antibiotic prescribing knowledge: A brief survey of providers and staff at an ambulatory cancer center during Antibiotic Awareness Week 2019

We surveyed healthcare professionals at a cancer center regarding their knowledge and perceptions of antibiotic use. Most knew the term “antimicrobial stewardship.” Nurses and other staff were less likely than pharmacists or providers to answer knowledge-based questions correctly. Opportunities exist to improve antibiotic knowledge among cancer center staff.

Community pharmacies, drug stores, and antibiotic dispensing in Indonesia: a qualitative study

BACKGROUND

Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Thus, a better understanding of dispensing practices is crucial to inform national, regional, and global responses to AMR. This requires careful examination of the interactions between vendors and clients, sensitive to the context in which these interactions take place.

METHODS

In 2019, we conducted a qualitative study to examine antibiotic dispensing practices and associated drivers in Indonesia, where self-medication with antibiotics purchased at community pharmacies and drug stores is widespread. Data collection involved 59 in-depth interviews with staff at pharmacies and drug stores (n = 31) and their clients (n = 28), conducted in an urban (Bekasi) and a semi-rural location (Tabalong) to capture different markets and different contexts of access to medicines. Interview transcripts were analysed using thematic content analysis.

RESULTS

A common dispensing pattern was the direct request of antibiotics by clients, who walked into pharmacies or drug stores and asked for antibiotics without prescription, either by their generic/brand name or by showing an empty package or sample. A less common pattern was recommendation to use antibiotics by the vendor after the patient presented with symptoms. Drivers of inappropriate antibiotic dispensing included poor knowledge of antibiotics and AMR, financial incentives to maximise medicine sales in an increasingly competitive market, the unintended effects of health policy reforms to make antibiotics and other essential medicines freely available to all, and weak regulatory enforcement.

CONCLUSIONS

Inappropriate dispensing of antibiotics in community pharmacies and drug stores is the outcome of complex interactions between vendors and clients, shaped by wider and changing socio-economic processes. In Indonesia, as in many other LMICs with large and informal private sectors, concerted action should be taken to engage such providers in plans to reduce AMR. This would help avert unintended effects of market competition and adverse policy outcomes, as observed in this study.

Problems associated with the use of the term "antibiotics"

The term “antibiotics” is a broadly used misnomer to designate antibacterial drugs. In a recent article, we have proposed to replace, e.g., the term “antibiotics” by “antibacterial drugs”, “antibiosis” by “antibacterial therapy”, “antibiogram” by “antibacteriogram”, and “antibiotic stewardship” by “antibacterial stewardship” (Seifert and Schirmer Trends Microbiol, 2021). In the present article, we show that many traditional terms related to antibiotics are used much more widely in the biomedical literature than the respective scientifically precise terms. This practice should be stopped. Moreover, we provide arguments to end the use of other broadly used terms in the biomedical literature such as “narrow-spectrum antibiotics” and “reserve antibiotics”, “chemotherapeutics”, and “tuberculostatics”. Finally, we provide several examples showing that antibacterial drugs are used for non-antibacterial indications and that some non-antibacterial drugs are used for antibacterial indications now. Thus, the increasing importance of drug repurposing renders it important to drop short designations of drug classes such as “antibiotics”. Rather, the term “drug” should be explicitly used, facilitating the inclusion of newly emerging indications such as antipsychotic and anti-inflammatory. This article is part of an effort to implement a new rational nomenclature of drug classes across the entire field of pharmacology.

Educational Video Improves Knowledge about Outpatients' Usage of Antibiotics in Two Public Hospitals in Indonesia

The inappropriate use or misuse of antibiotics, particularly by outpatients, increases antibiotic resistance. A lack of public knowledge about "Responsible use of antibiotics" and "How to obtain antibiotics" is a major cause of this. This study aimed to assess the effectiveness of an educational video about antibiotics and antibiotic use to increase outpatients' knowledge shown in two public hospitals in East Java, Indonesia. A quasi-experimental research setting was used with a one-group pre-test-post-test design, carried out from November 2018 to January 2019. The study population consisted of outpatients to whom antibiotics were prescribed. Participants were selected using a purposive sampling technique; 98 outpatients at MZ General Hospital in the S regency and 96 at SG General Hospital in the L regency were included. A questionnaire was used to measure the respondents' knowledge, and consisted of five domains, i.e., the definition of infections and antibiotics, obtaining the antibiotics, directions for use, storage instructions, and antibiotic resistance. The knowledge test score was the total score of the Guttman scale (a dichotomous "yes" or "no" answer). To determine the significance of the difference in knowledge before and after providing the educational video and in the knowledge score between hospitals, the (paired) Student's t-test was applied. The educational videos significantly improved outpatients' knowledge, which increased by 41% in MZ General Hospital, and by 42% in SG General Hospital. It was concluded that an educational video provides a useful method to improve the knowledge of the outpatients regarding antibiotics.

The effect of generic market entry on antibiotic prescriptions in the United States

When patented, brand-name antibiotics lose market exclusivity, generics typically enter the market at lower prices, which may increase consumption of the drug. To examine the effect of generic market entry on antibiotic consumption in the United States, we conducted an interrupted time series analysis of the change in the number of prescriptions per month for antibiotics for which at least one generic entered the US market between 2000 and 2012. Data were acquired from the IQVIA Xponent database. Thirteen antibiotics were analyzed. Here, we show that one year after generic entry, the number of prescriptions increased for five antibiotics (5 to 406%)-aztreonam, cefpodoxime, ciprofloxacin, levofloxacin, ofloxacin-and decreased for one drug: cefdinir. These changes were sustained two years after. Cefprozil, cefuroxime axetil and clarithromycin had significant increases in trend, but no significant level changes. No consistent pattern for antibiotic use following generic entry in the United States was observed.

Self-prescribing of antibiotics by patients seeking care in Indian emergency departments

STUDY OBJECTIVE

Antibiotic resistance is a global health threat. India has one of the highest rates of antibiotic use in the world. The objective of this study was to evaluate the prevalence of self-prescribed antibiotic use of patients presenting with febrile and infectious disease-related complaints to Indian emergency departments.

METHODS

This was a prospective observational study conducted at 6 Indian emergency departments (EDs) between January 1, 2019 and December 31, 2019. Adult patients who presented with a chief complaint of febrile illness or infectious disease complaints were included. Our principal outcomes of interest were self-prescribed use of antibiotics within the prior 6 months or for the presenting complaint. We queried respondents about source of antibiotics as well as about demographic characteristics that influenced use.

RESULTS

A total of 1421 patients were enrolled. Sixty percent (n = 856) of respondents reported using antibiotics in the prior 6 months or for their current complaint. Those who reported self-prescribing antibiotics either in the past or currently had at least some college education (P < 0.001), tended to use the pharmacy (P < 0.001) or the ED (P = 0.001) for their care when sick, and were more likely to have some comorbid conditions (P = 0.014) as compared to the group that did not self-prescribe antibiotics. The most common reason respondents reported self-prescribing antibiotics was because they did not want to wait to see their doctor (n = 278, 33%). Thirty-five percent of patients who were self-prescribed antibiotics before presentation did not receive and were not prescribed antibiotics in the ED, at discharge, or both.

CONCLUSIONS

Self-prescribing of antibiotics occurs commonly in India. This use increases the risk for resistance due to inappropriate or unnecessary use. Promotion of antibiotic stewardship is needed to curtail such use.

Antibiotic practices among household members and their domestic animals within rural communities in Cumilla district, Bangladesh: a cross-sectional survey

Background

Antibiotic resistance is a global threat to human health, and inappropriate use of antibiotics in humans and animals is widely considered to be a key driver of antibiotic resistant infections. Antibiotic use in humans and animals is growing rapidly in low- and, particularly, middle-income countries. However, there is little detailed understanding about practices related to the use of antibiotics in humans and animals within community settings in such countries. Here we aimed to understand the antibiotic practices of rural households across Cumilla district, Bangladesh, in relation to household members and their domestic animals.

Methods

In 2018 we conducted a cross-sectional survey using representative cluster sampling methods. We collected self-reported information from 682 female and 620 male household heads, with women also asked about their children’s antibiotic practices.

Results

Only 48% (95% CI: 40, 56%) of women and men had heard of antibiotics, and among those women and men who were aware of antibiotics and the children of those women 70% (95% CI: 64, 76%) reported having previously taken antibiotics, while among these individuals who reported previously taking antibiotics 21% (95% CI: 18, 25%) said they had done so most recently within the last month. Risky/inappropriate antibiotic practices in humans and animals were often reported. For example, among women and men who were aware of antibiotics and the children of those women 52% (95% CI: 40, 63%) reported previously taking antibiotics for a “cough/cold”, despite antibiotics being typically inappropriate for use against viral upper respiratory tract infections. Among poultry-owning respondents who were aware of antibiotics 11% (95% CI: 8, 15%) reported previously giving healthy poultry antibiotics, mainly for growth/prophylaxis, while among cattle-owning respondents who were aware of antibiotics and reported previously giving their cattle feed 20% (95% CI: 9, 37%) said the feed had contained antibiotics at least sometimes.

Conclusions

Our results highlight the need for context-adapted interventions at both the community level and the health systems level to reduce inappropriate antibiotic use among humans and domestic animals in rural Bangladesh. Successfully reducing inappropriate use of antibiotics among humans and animals is a required and critical step in tackling antimicrobial resistance.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10457-w.

Students' Experiences of Working With a Socio-Scientific Issues-Based Curriculum Unit Using Role-Playing to Negotiate Antibiotic Resistance

The emergence and widespread of antibiotic-resistant pathogenic microorganisms are of great individual and societal relevance. Due to the complex and multilayered nature of the topic, antibiotic resistance (ABR) is the object of concern for several scientific fields, such as microbiology or medicine, and encompasses a broad range of political, economic, and social aspects. Thus, the issue related to antibiotic-resistant bacterial diseases offers an excellent platform for designing and implementing the teaching and learning of socio-scientific issues (SSI). We created a SSI-based curriculum unit for use in secondary science classrooms by developing a collaborative partnership between education researchers and microbiologists. This classroom environment allows students to explore and negotiate ABR as a societal and scientific phenomenon. For this purpose, we leveraged role-playing within the SSI-based unit as a productive context for engaging students in learning opportunities that provide multiple perspectives on ABR and the complex interplay of its accelerators. This case-based paper describes Austrian school students' experiences from their participation in a SSI-embedded role-playing classroom environment and subsequent activities that included a mini congress with a poster presentation and a panel discussion. An open-ended questionnaire-based assessment tool was used to examine the situational characteristics of the students' work. To assess students' contributions, we applied a qualitative content analysis design and identified cognitive and affective outcomes. The students' learning experiences demonstrate that they considered the content - the social complexities of antibiotic-resistant bacteria and associated diseases - exciting and very topical. The students perceived that learning about ABR is relevant for their future and involves both individual and societal responsibility for action. Although the curriculum unit and its assignments were described as labor-intensive, it became apparent that the role-playing setting has the potential to inform students about multiple stakeholder positions concerning ABR. Concerning the promotion of science practices, almost all students claimed that they learned to organize, analyze, evaluate, and present relevant information. Moreover, the students affirmed that they learned to argue from the perspective of their assigned roles. However, the students did not clarify whether they learned more through this SSI-based classroom instruction than through conventional science teaching approaches.

Using evidence-based infographics to increase parents' understanding about antibiotic use and antibiotic resistance: a proof-of-concept study

Background

Communities need to see antibiotic stewardship campaigns as relevant to enhance understanding of antibiotic use and influence health-seeking behaviour. Yet, campaigns have often not sought input from the public in their development.

Objectives

To co-produce evidenced-based infographics (EBIs) about antibiotics for common childhood infections and to evaluate their effectiveness at increasing parents’ understanding of antibiotic use.

Methods

A mixed-methods study with three phases. Phase 1 identified and summarized evidence of antibiotic use for three childhood infections (sore throat, acute cough and otitis media). In phase 2, we co-designed a series of prototype EBIs with parents and a graphic design team (focus groups). Thematic analysis was used to analyse data. Phase 3 assessed the effect of EBIs on parents’ understanding of antibiotic use for the three infections using a national online survey in the UK.

Results

We iteratively co-produced 10 prototype EBIs. Parents found the evidence displayed in the EBIs novel and relevant to their families. Parents did not favour EBIs that were too medically focused. Parents preferred one health message per EBI. We included eight EBIs in a national survey of parents (n = 998). EBIs improved knowledge by more than a third across the board (34%, IQR 20%–46%, P < 0.001). Respondents confirmed that EBIs were novel and potentially useful, corroborating our focus groups findings.

Conclusions

Co-designed EBIs have the potential to succinctly change parents’ perceptions about antibiotics for acute respiratory tract infections in children. Further research should test EBIs in real-world settings to assess their reach as a potential public-facing intervention.

Perceptions regarding antimicrobial use and resistance among adult hospital patients in Saudi Arabian Ministry of Health (MOH) hospitals

Background

Education, a key strategy within antimicrobial stewardship programmes (ASPs), has been mainly directed towards healthcare professionals and prescribers more than hospitalised patients.

Aim

To examine patients' knowledge and perceptions of antibiotic use and resistance, while evaluating the institutional role of patient education on antibiotic use in two Saudi Arabian hospitals, one with an implemented ASP and one without an ASP.

Method

A cross-sectional self-administered survey was developed and piloted. A total of 400 surveys were distributed, 200 within the hospital with an ASP and another 200 within the hospital without an ASP. Data were coded and analysed. Ethical approval was obtained before the start of the study.

Findings

176 patients responded to the survey with 150 surveys completed and analysed. 78% of patients agreed that they should only take an antibiotic when prescribed by the doctor, however they still tended to keep left over antibiotics for future use. 84% of patients were unaware 'antibiotic resistance', with 48% believing that antibiotics help them get better quicker when they had a 'cold'. Information on antibiotic use and resistance were provided to patients in the hospital with an ASP in contrast to the hospital without an ASP.

Conclusion

Overall there are poor perceptions regarding antibiotic use and resistance among hospital patients in Saudi Arabia. Patients in the hospital with ASP demonstrated greater knowledge during their hospitalisation. ASPs should not only focus on educating healthcare professionals but should involve the patients and seize the opportunity to educate them while hospitalised.

Knowledge, attitude and practices among consumers toward antibiotics use and antibiotic resistance in Swat, Khyber-Pakhtunkhwa, Pakistan

Objective: Inappropriate use of antibiotics is one of the main causes of antibiotic resistance around the globe. The present study was aimed to assess the knowledge, attitude, and practices toward antibiotics and antibiotic resistance among consumers. Methods: A cross-sectional study was conducted from April 2019 to September 2019. The participants visiting community pharmacies to buy the antibiotics were approached by data collectors. The descriptive analysis, Kruskal Wallis, and Mann-Whitney statistical tests were used for data analysis through SPSS. Results: 399 participants at three pharmacies with male (n = 352, 88.2%), age (years) group between 34 to 41(n = 138, 34.6%), uneducated (n = 128, 32.1%), and higher education (n = 76, 19.0%) level of the participants were noted. Poor to moderate knowledge were observed; participants were unaware of the risk and misuse of antibiotics at all three pharmacies. By some means, a positive attitude noted, but the storage of antibiotics at home (Median = 2, IQR = 2) was preferred to use when needed. Most of the respondents didn't follow the actual dosage regimen as prescribed (n = 266, 66.7%, p < 0.05). Conclusion: A lack of knowledge and malpractices toward antibiotics use among consumers were observed. Education and awareness of the public about antibiotic resistance is the need of the hour.

Antimicrobial Resistance in Humans and Animals: Rapid Review of Psychological and Behavioral Determinants

A rapid review of current evidence examining psychological issues regarding the use of antibiotics and antimicrobials and resistance to these in both human and animal populations was conducted. Specific areas of interest were studies examining psychological determinants of AMR and interventions which attempt to change behavior with regard to AMR in the general population; animals; and fish, in particular. Although there is some evidence of the effectiveness of behavior change in general human populations, there is limited evidence in farmed animals, with a particular dearth in fish farming. We conclude there is an urgent need for more psychological research to identify major barriers and facilitators to change and evaluate the effectiveness of theory-based interventions aimed at reducing AM use in food production animals, including the promotion of alternatives to AMs, such as vaccination.

The second-hand effects of antibiotics: communicating the public health risks of drug resistance

Antimicrobial resistance (AMR) poses a threat to modern medicine, but there are challenges in communicating its urgency and scope and potential solutions to this growing problem. It is recognized that AMR has a 'language problem' and the way in which healthcare professionals communicate about AMR may not always resonate with patients. Many patients are unaware that antibiotics can have detrimental effects to those beyond the recipient, due to transmission of drug-resistant organisms. The overestimation of benefits and underestimation of risks helps to fuel demand for antibiotic use in situations where they may be of little or no benefit. To better communicate risks, clinicians may borrow the term 'second-hand' from efforts to reduce smoking cessation. We present several examples where antibiotics themselves have second-hand effects beyond the individual recipient in hospitals, long-term care homes and the community. Incorporation of the concept of the second-hand effects of antibiotics into patient counselling, mass messaging and future research may help facilitate a more balanced discussion about the benefits and risks of antibiotic use in order to use these agents more appropriately.