Awareness of appropriate antibiotic use in primary care for influenza-like illness: Evidence of improvement from UK population-based surveys

Koen B. Pouwels; Laurence S.J. Roope; James Buchanan; Liz Morrell; Sarah Tonkin-Crine; Michele Peters; Leah F. Jones; Enrique Castro-Sánchez; Derrick W. Crook; Tim Peto; Christopher C. Butler; Julie Robotham; A. Sarah Walker; Sarah Wordsworth

doi:10.3390/antibiotics9100690

Awareness of appropriate antibiotic use in primary care for influenza-like illness: Evidence of improvement from UK population-based surveys

Koen B. Pouwels, Laurence S.J. Roope^*, James Buchanan, Liz Morrell, Sarah Tonkin-Crine, Michele Peters, Leah F. Jones, Enrique Castro-Sánchez, Derrick W. Crook, Tim Peto, Christopher C. Butler, Julie Robotham, A. Sarah Walker, Sarah Wordsworth

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Influenza-like illnesses (ILI) account for a significant portion of inappropriate antibiotic use. Patient expectations for antibiotics for ILI are likely to play a substantial role in ‘unnecessary’ antibiotic consumption. This study aimed to investigate trends in awareness of appropriate antibiotic use and antimicrobial resistance (AMR). Three sequential online surveys of independent representative samples of adults in the United Kingdom investigated expectations for, and consumption of, antibiotics for ILI (May/June 2015 (n = 2064); Oct/Nov 2016 (n = 4000); Mar 2017 (n = 4000)). Respondents were asked whether they thought antibiotics were effective for ILI and about their antibiotic use. Proportions and 95% confidence intervals (CI) were calculated for each question and interactions with respondent characteristics were tested using logistic regression. Over the three surveys, the proportion of respondents who believed antibiotics would “definitely/probably” help an ILI fell from 37% (95% CI 35–39%) to 28% (95% CI 26–29%). Those who would “definitely/probably” visit a doctor in this situation fell from 48% (95% CI 46–50%) to 36% (95% CI 34–37%), while those who would request antibiotics during a consultation fell from 39% (95% CI 37–41%) to 30% (95% CI 29–32%). The percentage of respondents who found the information we provided about AMR “new/surprising” fell from 34% (95% CI 32–36%) to 28% (95% CI 26–31%). Awareness improved more among black, Asian and minority ethnic (BAME) than white people, with little other evidence of differences in improvements between subgroups. Whilst a degree of selection bias is unavoidable in online survey samples, the results suggest that awareness of AMR and appropriate antibiotic use has recently significantly improved in the United Kingdom, according to a wide range of indicators.

Original language	English
Article number	690
Pages (from-to)	1-16
Number of pages	16
Journal	Antibiotics
Volume	9
Issue number	10
DOIs	https://doi.org/10.3390/antibiotics9100690
Publication status	Published - Oct 2020

Bibliographical note

Funding Information:
Funding: The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (PHE) [grant numbers HPRU-2012-10041 and NIHR200915], and the NIHR HPRU in Evaluation of Interventions at the University of Bristol, also in partnership with PHE [grant number HPRU-2012-10026]. Michele Peters is an Associate Professor supported by the NIHR funded Policy Research Unit on Quality, Safety and Outcomes (QSO), a collaboration between the Universities of Kent and Oxford, the London School of Hygiene and Tropical Medicine, the Hull-York Medical School and the Picker Institute. Laurence S. J. Roope, James Buchanan, Derrick W. Crook, Tim Peto, A. Sarah Walker and Sarah Wordsworth are partly funded by the Oxford NIHR Biomedical Research Centre. Tim Peto, Christopher C. Butler and A. Sarah Walker are NIHR Senior Investigators. Enrique Castro-Sánchez is affiliated with the NIHR HPRU in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London in partnership with Public Health England [grant number HPRU-2012-10047], is a National Institute for Health Research Senior Nurse and Midwife Research Leader and acknowledges the support of the BRC. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research (NIHR), the Department of Health, or Public Health England (PHE).

Funding Information:
The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (PHE) [grant numbers HPRU-2012-10041 and NIHR200915], and the NIHR HPRU in Evaluation of Interventions at the University of Bristol, also in partnership with PHE [grant number HPRU-2012-10026]. Michele Peters is an Associate Professor supported by the NIHR funded Policy Research Unit on Quality, Safety and Outcomes (QSO), a collaboration between the Universities of Kent and Oxford, the London School of Hygiene and Tropical Medicine, the Hull-York Medical School and the Picker Institute. Laurence S. J. Roope, James Buchanan, Derrick W. Crook, Tim Peto, A. Sarah Walker and Sarah Wordsworth are partly funded by the Oxford NIHR Biomedical Research Centre. Tim Peto, Christopher C. Butler and A. Sarah Walker are NIHR Senior Investigators. Enrique Castro-S?nchez is affiliated with the NIHR HPRU in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London in partnership with Public Health England [grant number HPRU-2012-10047], is a National Institute for Health Research Senior Nurse and Midwife Research Leader and acknowledges the support of the BRC. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research (NIHR), the Department of Health, or Public Health England (PHE).

Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

Antibiotics
Antimicrobial resistance
Survey

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3390/antibiotics9100690

Cite this

Pouwels, K. B., Roope, L. S. J., Buchanan, J., Morrell, L., Tonkin-Crine, S., Peters, M., Jones, L. F., Castro-Sánchez, E., Crook, D. W., Peto, T., Butler, C. C., Robotham, J., Walker, A. S., & Wordsworth, S. (2020). Awareness of appropriate antibiotic use in primary care for influenza-like illness: Evidence of improvement from UK population-based surveys. Antibiotics, 9(10), 1-16. Article 690. https://doi.org/10.3390/antibiotics9100690

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title = "Awareness of appropriate antibiotic use in primary care for influenza-like illness: Evidence of improvement from UK population-based surveys",

abstract = "Influenza-like illnesses (ILI) account for a significant portion of inappropriate antibiotic use. Patient expectations for antibiotics for ILI are likely to play a substantial role in {\textquoteleft}unnecessary{\textquoteright} antibiotic consumption. This study aimed to investigate trends in awareness of appropriate antibiotic use and antimicrobial resistance (AMR). Three sequential online surveys of independent representative samples of adults in the United Kingdom investigated expectations for, and consumption of, antibiotics for ILI (May/June 2015 (n = 2064); Oct/Nov 2016 (n = 4000); Mar 2017 (n = 4000)). Respondents were asked whether they thought antibiotics were effective for ILI and about their antibiotic use. Proportions and 95% confidence intervals (CI) were calculated for each question and interactions with respondent characteristics were tested using logistic regression. Over the three surveys, the proportion of respondents who believed antibiotics would “definitely/probably” help an ILI fell from 37% (95% CI 35–39%) to 28% (95% CI 26–29%). Those who would “definitely/probably” visit a doctor in this situation fell from 48% (95% CI 46–50%) to 36% (95% CI 34–37%), while those who would request antibiotics during a consultation fell from 39% (95% CI 37–41%) to 30% (95% CI 29–32%). The percentage of respondents who found the information we provided about AMR “new/surprising” fell from 34% (95% CI 32–36%) to 28% (95% CI 26–31%). Awareness improved more among black, Asian and minority ethnic (BAME) than white people, with little other evidence of differences in improvements between subgroups. Whilst a degree of selection bias is unavoidable in online survey samples, the results suggest that awareness of AMR and appropriate antibiotic use has recently significantly improved in the United Kingdom, according to a wide range of indicators.",

keywords = "Antibiotics, Antimicrobial resistance, Survey",

author = "Pouwels, {Koen B.} and Roope, {Laurence S.J.} and James Buchanan and Liz Morrell and Sarah Tonkin-Crine and Michele Peters and Jones, {Leah F.} and Enrique Castro-S{\'a}nchez and Crook, {Derrick W.} and Tim Peto and Butler, {Christopher C.} and Julie Robotham and Walker, {A. Sarah} and Sarah Wordsworth",

note = "Funding Information: Funding: The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (PHE) [grant numbers HPRU-2012-10041 and NIHR200915], and the NIHR HPRU in Evaluation of Interventions at the University of Bristol, also in partnership with PHE [grant number HPRU-2012-10026]. Michele Peters is an Associate Professor supported by the NIHR funded Policy Research Unit on Quality, Safety and Outcomes (QSO), a collaboration between the Universities of Kent and Oxford, the London School of Hygiene and Tropical Medicine, the Hull-York Medical School and the Picker Institute. Laurence S. J. Roope, James Buchanan, Derrick W. Crook, Tim Peto, A. Sarah Walker and Sarah Wordsworth are partly funded by the Oxford NIHR Biomedical Research Centre. Tim Peto, Christopher C. Butler and A. Sarah Walker are NIHR Senior Investigators. Enrique Castro-S{\'a}nchez is affiliated with the NIHR HPRU in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London in partnership with Public Health England [grant number HPRU-2012-10047], is a National Institute for Health Research Senior Nurse and Midwife Research Leader and acknowledges the support of the BRC. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research (NIHR), the Department of Health, or Public Health England (PHE). Funding Information: The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (PHE) [grant numbers HPRU-2012-10041 and NIHR200915], and the NIHR HPRU in Evaluation of Interventions at the University of Bristol, also in partnership with PHE [grant number HPRU-2012-10026]. Michele Peters is an Associate Professor supported by the NIHR funded Policy Research Unit on Quality, Safety and Outcomes (QSO), a collaboration between the Universities of Kent and Oxford, the London School of Hygiene and Tropical Medicine, the Hull-York Medical School and the Picker Institute. Laurence S. J. Roope, James Buchanan, Derrick W. Crook, Tim Peto, A. Sarah Walker and Sarah Wordsworth are partly funded by the Oxford NIHR Biomedical Research Centre. Tim Peto, Christopher C. Butler and A. Sarah Walker are NIHR Senior Investigators. Enrique Castro-S?nchez is affiliated with the NIHR HPRU in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London in partnership with Public Health England [grant number HPRU-2012-10047], is a National Institute for Health Research Senior Nurse and Midwife Research Leader and acknowledges the support of the BRC. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research (NIHR), the Department of Health, or Public Health England (PHE). Publisher Copyright: {\textcopyright} 2020 by the authors. Licensee MDPI, Basel, Switzerland.",

year = "2020",

month = oct,

doi = "10.3390/antibiotics9100690",

language = "English",

volume = "9",

pages = "1--16",

journal = "Antibiotics",

issn = "2079-6382",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "10",

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Pouwels, KB, Roope, LSJ, Buchanan, J, Morrell, L, Tonkin-Crine, S, Peters, M, Jones, LF, Castro-Sánchez, E, Crook, DW, Peto, T, Butler, CC, Robotham, J, Walker, AS & Wordsworth, S 2020, 'Awareness of appropriate antibiotic use in primary care for influenza-like illness: Evidence of improvement from UK population-based surveys', Antibiotics, vol. 9, no. 10, 690, pp. 1-16. https://doi.org/10.3390/antibiotics9100690

TY - JOUR

T1 - Awareness of appropriate antibiotic use in primary care for influenza-like illness

T2 - Evidence of improvement from UK population-based surveys

AU - Pouwels, Koen B.

AU - Roope, Laurence S.J.

AU - Buchanan, James

AU - Morrell, Liz

AU - Tonkin-Crine, Sarah

AU - Peters, Michele

AU - Jones, Leah F.

AU - Castro-Sánchez, Enrique

AU - Crook, Derrick W.

AU - Peto, Tim

AU - Butler, Christopher C.

AU - Robotham, Julie

AU - Walker, A. Sarah

AU - Wordsworth, Sarah

N1 - Funding Information: Funding: The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (PHE) [grant numbers HPRU-2012-10041 and NIHR200915], and the NIHR HPRU in Evaluation of Interventions at the University of Bristol, also in partnership with PHE [grant number HPRU-2012-10026]. Michele Peters is an Associate Professor supported by the NIHR funded Policy Research Unit on Quality, Safety and Outcomes (QSO), a collaboration between the Universities of Kent and Oxford, the London School of Hygiene and Tropical Medicine, the Hull-York Medical School and the Picker Institute. Laurence S. J. Roope, James Buchanan, Derrick W. Crook, Tim Peto, A. Sarah Walker and Sarah Wordsworth are partly funded by the Oxford NIHR Biomedical Research Centre. Tim Peto, Christopher C. Butler and A. Sarah Walker are NIHR Senior Investigators. Enrique Castro-Sánchez is affiliated with the NIHR HPRU in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London in partnership with Public Health England [grant number HPRU-2012-10047], is a National Institute for Health Research Senior Nurse and Midwife Research Leader and acknowledges the support of the BRC. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research (NIHR), the Department of Health, or Public Health England (PHE). Funding Information: The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (PHE) [grant numbers HPRU-2012-10041 and NIHR200915], and the NIHR HPRU in Evaluation of Interventions at the University of Bristol, also in partnership with PHE [grant number HPRU-2012-10026]. Michele Peters is an Associate Professor supported by the NIHR funded Policy Research Unit on Quality, Safety and Outcomes (QSO), a collaboration between the Universities of Kent and Oxford, the London School of Hygiene and Tropical Medicine, the Hull-York Medical School and the Picker Institute. Laurence S. J. Roope, James Buchanan, Derrick W. Crook, Tim Peto, A. Sarah Walker and Sarah Wordsworth are partly funded by the Oxford NIHR Biomedical Research Centre. Tim Peto, Christopher C. Butler and A. Sarah Walker are NIHR Senior Investigators. Enrique Castro-S?nchez is affiliated with the NIHR HPRU in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London in partnership with Public Health England [grant number HPRU-2012-10047], is a National Institute for Health Research Senior Nurse and Midwife Research Leader and acknowledges the support of the BRC. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research (NIHR), the Department of Health, or Public Health England (PHE). Publisher Copyright: © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

PY - 2020/10

Y1 - 2020/10

N2 - Influenza-like illnesses (ILI) account for a significant portion of inappropriate antibiotic use. Patient expectations for antibiotics for ILI are likely to play a substantial role in ‘unnecessary’ antibiotic consumption. This study aimed to investigate trends in awareness of appropriate antibiotic use and antimicrobial resistance (AMR). Three sequential online surveys of independent representative samples of adults in the United Kingdom investigated expectations for, and consumption of, antibiotics for ILI (May/June 2015 (n = 2064); Oct/Nov 2016 (n = 4000); Mar 2017 (n = 4000)). Respondents were asked whether they thought antibiotics were effective for ILI and about their antibiotic use. Proportions and 95% confidence intervals (CI) were calculated for each question and interactions with respondent characteristics were tested using logistic regression. Over the three surveys, the proportion of respondents who believed antibiotics would “definitely/probably” help an ILI fell from 37% (95% CI 35–39%) to 28% (95% CI 26–29%). Those who would “definitely/probably” visit a doctor in this situation fell from 48% (95% CI 46–50%) to 36% (95% CI 34–37%), while those who would request antibiotics during a consultation fell from 39% (95% CI 37–41%) to 30% (95% CI 29–32%). The percentage of respondents who found the information we provided about AMR “new/surprising” fell from 34% (95% CI 32–36%) to 28% (95% CI 26–31%). Awareness improved more among black, Asian and minority ethnic (BAME) than white people, with little other evidence of differences in improvements between subgroups. Whilst a degree of selection bias is unavoidable in online survey samples, the results suggest that awareness of AMR and appropriate antibiotic use has recently significantly improved in the United Kingdom, according to a wide range of indicators.

AB - Influenza-like illnesses (ILI) account for a significant portion of inappropriate antibiotic use. Patient expectations for antibiotics for ILI are likely to play a substantial role in ‘unnecessary’ antibiotic consumption. This study aimed to investigate trends in awareness of appropriate antibiotic use and antimicrobial resistance (AMR). Three sequential online surveys of independent representative samples of adults in the United Kingdom investigated expectations for, and consumption of, antibiotics for ILI (May/June 2015 (n = 2064); Oct/Nov 2016 (n = 4000); Mar 2017 (n = 4000)). Respondents were asked whether they thought antibiotics were effective for ILI and about their antibiotic use. Proportions and 95% confidence intervals (CI) were calculated for each question and interactions with respondent characteristics were tested using logistic regression. Over the three surveys, the proportion of respondents who believed antibiotics would “definitely/probably” help an ILI fell from 37% (95% CI 35–39%) to 28% (95% CI 26–29%). Those who would “definitely/probably” visit a doctor in this situation fell from 48% (95% CI 46–50%) to 36% (95% CI 34–37%), while those who would request antibiotics during a consultation fell from 39% (95% CI 37–41%) to 30% (95% CI 29–32%). The percentage of respondents who found the information we provided about AMR “new/surprising” fell from 34% (95% CI 32–36%) to 28% (95% CI 26–31%). Awareness improved more among black, Asian and minority ethnic (BAME) than white people, with little other evidence of differences in improvements between subgroups. Whilst a degree of selection bias is unavoidable in online survey samples, the results suggest that awareness of AMR and appropriate antibiotic use has recently significantly improved in the United Kingdom, according to a wide range of indicators.

KW - Antibiotics

KW - Antimicrobial resistance

KW - Survey

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U2 - 10.3390/antibiotics9100690

DO - 10.3390/antibiotics9100690

M3 - Article

AN - SCOPUS:85092524089

SN - 2079-6382

VL - 9

SP - 1

EP - 16

JO - Antibiotics

JF - Antibiotics

IS - 10

M1 - 690

ER -

Awareness of appropriate antibiotic use in primary care for influenza-like illness: Evidence of improvement from UK population-based surveys

Abstract

Bibliographical note

Keywords

UN SDGs

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