Lack of Knowledge of Antibiotic Risks Contributes to Primary Care Patients’ Expectations of Antibiotics for Common Symptoms

Dear Editor,

We were intrigued by the insightful article by Laytner et al., "Lack of Knowledge of Antibiotic Risks Contributes to Primary Care Patients’ Expectations of Antibiotics for Common Symptoms" [1]. The study highlights a pervasive issue that mirrors the challenges we face within the Spanish public health system: the persistent misconception among patients that antibiotics are a cure-all solution.

In Spain, despite extensive public health campaigns, many patients still expect antibiotics for common viral infections such as colds and influenza [2,3]. This expectation not only leads to unnecessary antibiotic prescriptions but also contributes significantly to the development of antimicrobial resistance and the disruption of the intestinal microbiota [4,5]. Alterations in gut flora can result in adverse health outcomes, including increased susceptibility to infections and metabolic disorders [6].

One pressing challenge we encounter is the limited time during consultations to educate patients effectively. However, even brief, targeted communication can make a substantial difference [7]. Incorporating concise educational messages about the ineffectiveness of antibiotics against viruses and the potential harms of misuse can help reshape patient expectations without extending consultation times significantly.

Utilizing the waiting area as an educational space has also proven beneficial. Displaying informative posters and providing brochures that clearly explain when antibiotics are necessary—and when they are not—can preempt misconceptions before the patient enters the consultation room [8]. Interactive digital displays or videos could further engage patients and reinforce key messages.

An innovative approach we have explored is the implementation of group education sessions for patients who frequently request antibiotics. These sessions, led by multidisciplinary teams including physicians, nurses, and pharmacists, provide a forum to discuss the dangers of antibiotic overuse and offer strategies for symptom relief without antibiotics [9]. Engaging patients in this manner not only educates but also empowers them to make informed decisions about their health.

Collaborating with community pharmacists is another effective strategy. Pharmacists, often the first point of contact for patients seeking over-the-counter remedies, can reinforce messages about appropriate antibiotic use and advise on alternative treatments for symptom management. This collaborative approach extends the educational reach beyond the clinic.

We also recognize the potential of leveraging technology to enhance patient education. Initiatives like the European Antibiotic Awareness Day provide digital resources to inform the public about responsible antibiotic use [10]. Developing mobile applications or utilizing social media platforms could further disseminate accurate information and engage a broader audience, particularly among younger patients.

Wee think that the findings by Laytner et al. [1] underscore the universal need for effective patient education on antibiotic use. By adopting multiple educational strategies tailored to our patient populations, we can address misconceptions, reduce inappropriate antibiotic use, and combat the growing threat of antimicrobial resistance.

Sincerely,
Rebeca Tenajas & Dr. David Miraut

REFERENCES:

[1] L.A. Laytner, B.W. Trautner, S. Nash, R. Zoorob, J.O. Okoh, E. Amenta, K. Olmeda, J. Salinas, M.K. Paasche-Orlow, L. Grigoryan, Lack of Knowledge of Antibiotic Risks Contributes to Primary Care Patients’ Expectations of Antibiotics for Common Symptoms, The Annals of Family Medicine 22 (2024) 421–425. https://doi.org/10.1370/afm.3161.
[2] C. Llor, J.M. Cots, The Sale of Antibiotics without Prescription in Pharmacies in Catalonia, Spain, Clinical Infectious Diseases 48 (2009) 1345–1349. https://doi.org/10.1086/598183.
[3] M.H. Väänänen, K. Pietilä, M. Airaksinen, Self-medication with antibiotics—Does it really happen in Europe?, Health Policy 77 (2006) 166–171. https://doi.org/10.1016/j.healthpol.2005.07.001.
[4] H. Goossens, M. Ferech, R.V. Stichele, M. Elseviers, Outpatient antibiotic use in Europe and association with resistance: a cross-national database study, The Lancet 365 (2005) 579–587. https://doi.org/10.1016/S0140-6736(05)17907-0.
[5] C. Jernberg, S. Löfmark, C. Edlund, J.K. Jansson, Long-term impacts of antibiotic exposure on the human intestinal microbiota, Microbiology 156 (2010) 3216–3223. https://doi.org/10.1099/mic.0.040618-0.
[6] M.J. Blaser, Antibiotic use and its consequences for the normal microbiome, Science 352 (2016) 544–545. https://doi.org/10.1126/science.aad9358.
[7] C.C. Butler, S.A. Simpson, F. Dunstan, S. Rollnick, D. Cohen, D. Gillespie, M.R. Evans, S.L. in E. and P. Health, M.F. Alam, M.-J. Bekkers, J. Evans, L. Moore, R. Howe, J. Hayes, M. Hare, K. Hood, Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial, BMJ 344 (2012) d8173. https://doi.org/10.1136/bmj.d8173.
[8] C.A.M. McNulty, P. Boyle, T. Nichols, P. Clappison, P. Davey, Don’t wear me out—the public’s knowledge of and attitudes to antibiotic use, Journal of Antimicrobial Chemotherapy 59 (2007) 727–738. https://doi.org/10.1093/jac/dkl558.
[9] M. André, Å. Vernby, J. Berg, C.S. Lundborg, A survey of public knowledge and awareness related to antibiotic use and resistance in Sweden, Journal of Antimicrobial Chemotherapy 65 (2010) 1292–1296. https://doi.org/10.1093/jac/dkq104.
[10] Home | EUROPEAN ANTIBIOTIC AWARENESS DAY, (n.d.). https://antibiotic.ecdc.europa.eu/en (accessed September 30, 2024).