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Although a third of the public still believe that antibiotics work against coughs and colds, simply getting the public to believe otherwise may not be enough to reduce the level of prescribing. The large Department of Health sponsored household survey demonstrated that those with a greater knowledge about antibiotics were no less likely to be prescribed an antibiotic, and although those with increased knowledge about antibiotics were more likely to complete a course they were also more likely to self-medicate and to keep left-over antibiotics. Future campaigns that are aimed at reducing the level of prescribing should be focused towards those more likely to be prescribed antibiotics at present: younger women and those with a lower level of education. They should also examine and consider modifying consultation behaviour and other behavioural components involved in patient' expectations for antibiotics. This should include delayed antibiotic prescriptions. The easiest way to reduce the use of leftovers may be to shorten the course of antibiotics prescribed to 3 or 5 days. We should also promote a 'Do not recycle antibiotics' message towards the more highly educated, young women who are more likely to store, take and share antibiotics without advice.

Objectives: To assess the public's knowledge and attitudes to antibiotics, their reported antibiotic use and the relationship between them.Patients and methods: A questionnaire was included in the face-to-face Office for National Statistics Omnibus Household Survey in Britain in 2003. Of 10 981 randomly selected adults from England, Scotland and Wales, 7120 (65%) completed the questionnaire.Results: Although 79% of respondents were aware that 'antibiotic resistance is a problem in British hospitals', 38% of respondents did not know that antibiotics do not work against most coughs or colds and 43% did not know that 'antibiotics can kill the bacteria that normally live on the skin and in the gut'. Respondents with lower educational qualifications were less knowledgeable about antibiotics. In a multivariable analysis, better knowledge of antibiotics was not associated with being less likely to be prescribed any in the last year, but was independently associated with being more likely to finish a course of antibiotic as prescribed. Knowledge was also associated with being more likely to take antibiotics without being told to do so. In women, better knowledge was associated with being more likely to give an antibiotic to someone else that was not prescribed for them. Conclusions:We have shown that there is no simple relationship between increased knowledge and more prudent antibiotic use. Future national antibiotic campaigns should have a defined audience and aims in order to facilitate prudent antibiotic use by clinicians and public.

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