A recent study published in The Annals of Family Medicine examined patient expectations for antibiotics when experiencing common symptoms and illnesses. Researchers found that over 93% of patients expected antibiotics for one or more common ailments, with expectations notably higher among those attending public clinics.
Key Findings
The study revealed several factors contributing to increased antibiotic expectations, including lower educational attainment, inadequate health literacy, and a lack of understanding regarding antibiotic risks. Despite clinical guidelines recommending against prescribing antibiotics for common viral infections, such as respiratory illnesses, colds, and diarrhea, many patients still receive these prescriptions. Current estimates suggest that up to 28% of antibiotic prescriptions in the United States are unnecessary.
The inappropriate use of antibiotics significantly contributes to antimicrobial resistance (AMR), a major public health threat. Reducing unnecessary antibiotic prescriptions is complex due to various factors, including patient beliefs and expectations. Few studies have examined the effects of sociodemographic factors and awareness of antibiotic risks on patient expectations.
About the Study
The researchers aimed to determine how often patients expect antibiotics for conditions such as acute diarrhea, colds, sore throats, sinus infections, and bronchitis. They compared expectations between patients in private and public healthcare settings and identified factors that might influence these expectations.
Conducted between January 2020 and June 2021, the survey included participants from six public clinics and two private emergency departments in Harris County, Texas. The study engaged a diverse group of patients, who were recruited through flyers. Surveys were administered in person or virtually due to COVID-19 restrictions. Individuals under 18 or unable to complete the survey were excluded.
The survey assessed patient expectations regarding antibiotics using a Likert scale, which categorized responses into expectations or no expectations. The study also evaluated participants’ knowledge of antibiotic risks, sociodemographic characteristics, and health literacy. Responses indicating awareness of antibiotic risks defined knowledge levels, while health literacy was measured with a validated screening tool.
Statistical comparisons between patient characteristics and antibiotic expectations were conducted using chi-square tests, with multivariable logistic regression analysis assessing the effects of education, risk awareness, healthcare system, and health literacy.
Results
Among surveyed patients, 84% believed antibiotics would help treat bronchitis. Expectations for antibiotic prescriptions were also high for sinus infections (72%), colds/flu (64%), sore throats (66%), and diarrhea (36%). Patients at public clinics were nearly twice as likely to expect antibiotics for diarrhea, sore throat, and colds compared to those in private clinics, with odds ratios (ORs) of 1.8, 2.2, and 1.5, respectively.
The study found that lower education levels predicted higher antibiotic expectations for diarrhea. Patients without a high school diploma were twice as likely to expect antibiotics compared to those with a college education.
Approximately 37% of patients lacked knowledge about antibiotic risks, which significantly influenced their expectations, particularly for diarrhea (OR of 1.6) and cold/flu (OR of 2.9). Expectations for sore throat symptoms were also affected, though to a lesser degree.
Limitations
The study acknowledges several limitations, including limited generalizability to less diverse urban areas, the potential complexity of patients at public clinics, social desirability bias, and the impact of the COVID-19 pandemic on antibiotic expectations.
Conclusion
Differences in education, health literacy, knowledge of antibiotic risks, and healthcare systems contribute to unrealistic expectations for antibiotic treatment of common symptoms. Future interventions should focus on educating patients about the appropriate use of antibiotics and the associated risks. Researchers aim to develop an educational tool to promote responsible antibiotic use and facilitate discussions about non-antibiotic treatment options.
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