World Antibiotic Awareness Week and European Antibiotic Awareness Day, November 2018: An analysis of the impact of Twitter activity

Douglas Graham Mackenzie*, David SY Ong, Diane Ashiru-Oredope

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    1 Citation (Scopus)


    Introduction: International antibiotic awareness and stewardship campaigns use social media to disseminate campaign materials. Analysis of campaigns during 2016 and 2017 identified a wide range of hashtags in use, potentially leading to confusion and dilution of the campaign message. This study aimed to examine the impact of different hashtags on the dissemination of information during European Antibiotic Awareness Day and World Antibiotic Awareness Week, November 2018. Methods: Tweets were prospectively extracted using Followthehashtag and analysed in Excel and R (14 400 tweets by 5 899 tweeters, with 60 222 retweets). Descriptive analysis and multivariable logistic regression analyses were adjusted for potential confounders. Results: There was a positive association between retweets received and inclusion of media, hashtag(s), mention of other tweeter(s), and number of followers. There was hashtag drift (e.g. the unofficial #WAAW2018 hashtag was used more frequently than the official campaign #WAAW18 hashtag). Analysis of five popular hashtags from the European and worldwide campaigns found a positive association between retweets and the unofficial hashtag #WAAW2018 and the long-established #AntibioticGuardian hashtag. #AntibioticResistance (another official hashtag) was the most frequently used hashtag but did not have a consistent positive association with retweets. Analysis of the contribution of tweeters – tweeters, retweeters, and mentions of tweeters – demonstrated 32 534 accounts in total, 95% of which tweeted and/or retweeted, the great majority being retweeters. Conclusion: This study demonstrates the breadth of participation in international antibiotic awareness campaigns, but also the need for clarity about campaign hashtags, and the need to search beyond official hashtags when evaluating the impact of a campaign.

    Original languageEnglish
    Article number106209
    JournalInternational Journal of Antimicrobial Agents
    Issue number6
    Publication statusPublished - Dec 2020

    Bibliographical note

    Funding Information:
    This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. No formal Conflicts of Interest. DA-O is pharmacist lead for antimicrobial resistance and stewardship at Public Health England and is directly involved in the Antibiotic Guardian programme referenced in the text. DA-O is also identified as one of the top tweeters in the international campaign studied in this paper (Table 1 and Figure 1). Not required. A relatively small number of tweets used the #StopDrugResistance hashtag: n = 648 in the initial extract. Further searching for information about this hashtag identified a document that listed it as an official hashtag by WHO (along with #WAAW18 and #AntibioticResistance) [15]. A search for tweets that had used the #StopDrugResistance hashtag during the campaign week was performed using the advanced search function on, with a standard internet browser (7 January 2020) identifying a further 111 tweets. Previously used search terms were excluded by adding “-“ to the front of the individual search terms. The 19-digit Twitter ID for the additional tweets were manually extracted and imported into a TAGS extract ( Analysis of this TAGS extract demonstrated that the 111 additional identified tweets were posted by 86 tweeters and received 1 207 retweets by 7 January 2020. Data on individual retweets (up to 100 most recent retweets per tweet) were extracted for the six most retweeted posts via the Twitter API using Postman (method described in a blog) [16], confirming that the great majority of retweets recorded (ca. 97%) had been received during the campaign week. The hashtag was not widely used by international organisations other than WHO and WHO officials. Comparing the 86 tweeters with the original extract, 41 tweeters had not tweeted using other terms included in the analysis, so data on language and number of Twitter followers during the 2018 campaign week were unavailable. This hashtag, and the 111 tweets that used this hashtag exclusively, were therefore not included in the multivariable analysis.

    Publisher Copyright:
    © 2020


    • Antibiotic awareness
    • Antimicrobial resistance
    • Public health
    • Social media


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