The vicious cycle of the public's irrational use of antibiotics for upper respiratory tract infections: A mixed methods systematic review

Abstract

BackgroundThe public's irrational use of antibiotics for upper respiratory tract infections (URTIs) is prevalent worldwide. This study aims to synthesize evidence on how people use antibiotics to treat URTIs, its prevalence and determinants.MethodsA mixed methods systematic review was conducted using a convergent segregated approach. Relevant studies were searched from PubMed, Cochrane Library, Embase, and Web of Science. A qualitative analysis was initiated, exploring the public's antibiotic use experience for URTIS based on the Consumer Behavior Model (CBM). This was followed by a quantitative synthesis, tapping into the prevalence and predictors of public behavior in antibiotic usage for URTIs. The segregated syntheses complemented each other and were further integrated.ResultsA total of 86 studies were included: 48 quantitative, 30 qualitative, eight mixed methods studies. The included studies were conducted in Europe (n = 29), Asia (n = 27) and North America (n = 21), assessing the behaviors of patients (n = 46), their parents or caregivers (n = 31), or both (n = 9). Eleven themes emerged covering the six CBM stages: need recognition, information searching, alternative evaluation, antibiotic obtaining, antibiotic consumption, and post-consumption evaluation. The six stages reinforce each other, forming a vicious cycle. The high prevalence of the public's irrational use of antibiotics for URTIs is evident despite the high heterogeneity of the studies (ranging from 0.0 to 92.7%). The perceived seriousness of illness and misbelief in antibiotics were identified consistently across the studies as the major motivation driving the public's irrational use of antibiotics for URTIs. However, individual capacity (e.g., knowledge) and opportunity (e.g., contextual restriction) in reducing antibiotic use have mixed effect.ConclusionSystemic interventions concerning both supply and demand sides are warranted. The public needs to be educated about the appropriate management of URTIs and health care providers need to re-shape public attitudes toward antibiotic use for URTIs through communication and prescribing practices.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier: CRD42021266407.

Knowledge, Attitudes, and Practices Regarding Antibiotic Sales in Pharmacies in Medellín, Colombia 2023

“…Such practice has been reported in patients as well. The source of this belief may stem from the fact that upper respiratory tract infections are often self-limiting; thus, the relief of symptoms while taking antibiotics is often interpreted as an indicator of their efficacy [ 20 ]. Disrupting this misconception requires interventions involving the participation of all stakeholders: patients, physicians, and pharmacists.…”

The public’s antibiotic use behavioural patterns and their determinants for upper respiratory tract infections: a latent class analysis based on consumer behaviour model in China

“…and their potential determinants (for details, please see publication elsewhere (18)). Briefly, to address RQ1, the CBM was used to depict the whole process of the public's behaviours regarding antibiotic use and served as indicators to identify the public's behavioural patterns through latent class analysis (LCA).…”

“…To inform effective interventions, it is important to understand why people irrationally use antibiotics (18). Existing studies have shown that antibiotic use behaviours among the public include a variety of behaviours (18), such as information seeking, assessing alternatives, and antibiotics acquisition.…”

“…To inform effective interventions, it is important to understand why people irrationally use antibiotics (18). Existing studies have shown that antibiotic use behaviours among the public include a variety of behaviours (18), such as information seeking, assessing alternatives, and antibiotics acquisition. Furthermore, antibiotic use behaviours among the public are highly diversified, and the combination of these behaviours leads to several relatively fixed patterns of behaviours when people use antibiotics, namely "antibiotic use behavioural patterns" (19,20).…”

Knowledge, Attitudes, and Practices Regarding Antibiotic Use and Resistance: A Cross-Sectional Study among Students in Israel

“…Antibiotics have been one of the most significant medical breakthroughs in modern medicine [ 1 ], enabling the treatment of complex medical conditions and saving millions of lives to date [ 2 ]. Antibiotic resistance is one of the most prominent threats to health systems and food security in the world [ 3 ], posing a major risk to human life and public health [ 4 ].…”