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A recent study published in The Annals of Family Medicine highlights a critical issue in healthcare: unrealistic patient expectations for antibiotics in treating common symptoms. The study, conducted between January 2020 and June 2021, reveals that over 93% of patients anticipated being prescribed antibiotics for one or more common symptoms, with the highest expectations among patients visiting public clinics.
Antibiotic Misuse: A Public Health Challenge
Antibiotics are frequently prescribed for conditions like respiratory infections, colds, and diarrhea—ailments typically caused by viruses that do not respond to these medications. Despite clinical guidelines advising against such practices, up to 28% of antibiotic prescriptions in the United States are deemed unnecessary. This overprescription fuels antimicrobial resistance (AMR), which has emerged as a global public health threat, potentially leading to untreatable infections and the collapse of healthcare systems.
However, reducing inappropriate antibiotic prescriptions remains a complex challenge. Patient beliefs, expectations, and knowledge gaps about antibiotic risks are key contributing factors. Until now, few studies have explored how sociodemographic factors and health literacy independently influence antibiotic expectations.
Study Design and Findings
Researchers surveyed patients across six public primary care clinics and two private emergency departments in Harris County, Texas. The survey, conducted in person or virtually due to COVID-19 restrictions, assessed patient expectations for antibiotics for conditions like bronchitis, cold/flu, sore throat, sinus infections, and diarrhea. The survey also examined patients’ knowledge of antibiotic risks, education levels, and health literacy.
The findings revealed that:
- 84% of patients expected antibiotics for bronchitis.
- 72% anticipated antibiotics for sinus infections.
- 64% expected antibiotics for cold/flu.
- 66% believed antibiotics were necessary for sore throat.
- 36% thought antibiotics would help with diarrhea.
Notably, patients attending public clinics were almost twice as likely to expect antibiotics for diarrhea, sore throat, and cold/flu compared to those in private clinics. Lower education levels, particularly among those without a high school diploma, were linked to higher expectations of antibiotic prescriptions, especially for diarrhea.
The study also found that 37% of patients lacked knowledge of antibiotic risks, significantly increasing their expectations for antibiotics in treating conditions like diarrhea and cold/flu.
Implications and Future Directions
The study’s findings underscore the importance of addressing health literacy gaps to curb unrealistic antibiotic expectations. Patients who are unaware of the risks associated with inappropriate antibiotic use are more likely to expect these medications for viral infections. Education plays a pivotal role, as lower education levels are strongly correlated with higher antibiotic expectations.
Lead researcher Dr. Laytner emphasized the need for targeted interventions to improve patient education. “We need to focus on educating patients about which symptoms antibiotics can effectively treat, as well as the risks posed to both individuals and society by antibiotic misuse.”
To address this issue, the researchers are developing an antibiotic education tool for both patients and clinicians. This tool aims to promote appropriate antibiotic use and facilitate discussions about non-antibiotic treatment options, ultimately reducing unnecessary prescriptions and helping to combat AMR.
Conclusion
The study highlights significant gaps in health literacy and knowledge about antibiotic risks, particularly among patients in public clinics and those with lower education levels. These factors contribute to unrealistic expectations for antibiotics in treating common viral symptoms. Future antibiotic stewardship programs must focus on improving patient education to align expectations with evidence-based treatment guidelines, thereby helping to reduce the threat of antimicrobial resistance.
Journal Reference: Laytner, L. A., Trautner, B. W., Nash, S., et al. (2024). Lack of Knowledge of Antibiotic Risks Contributes to Primary Care Patients’ Expectations of Antibiotics for Common Symptoms. The Annals of Family Medicine, 22(5);421-425. DOI: 10.1370/afm.3161.
