Why do patients want antibiotics

Be Antibiotics Aware is the Centers for Disease Control and Prevention’s (CDC) national educational effort to help improve antibiotic prescribing and use and combat antibiotic resistance.

Antibiotic resistance is one of the most urgent threats to the public’s health. Antibiotic resistance happens when germs, like bacteria and fungi, develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow. More than 2.8 million antibiotic-resistant infections occur in the United States each year, and more than 35,000 people die as a result.

Antibiotics can save lives, but any time antibiotics are used, they can cause side effects and contribute to the development of antibiotic resistance. Each year, at least 28% of antibiotics are prescribed unnecessarily in U.S. doctors’ offices and emergency rooms (ERs), which makes improving antibiotic prescribing and use a national priority.

Helping healthcare professionals improve the way they prescribe antibiotics, and improving the way we take antibiotics, helps keep us healthy now, helps fight antibiotic resistance, and ensures that these life-saving drugs will be available for future generations.

Antibiotics are only needed for treating certain infections caused by bacteria, but even some bacterial infections get better without antibiotics. We rely on antibiotics to treat serious, life-threatening conditions such as pneumonia and sepsis, the body’s extreme response to an infection. Effective antibiotics are also needed for people who are at high risk for developing infections. Some of those at high risk for infections include patients undergoing surgery, patients with end-stage kidney disease, or patients receiving cancer therapy (chemotherapy).

Antibiotics DO NOT work on viruses, such as those that cause colds, flu, or COVID-19.

Antibiotics also are not needed for many sinus infections and some ear infections.

When antibiotics aren’t needed, they won’t help you, and the side effects could still cause harm. Common side effects of antibiotics can include:

• Rash
• Dizziness
• Nausea
• Diarrhea
• Yeast infections

More serious side effects can include:

• Clostridioides difficile infection (also called difficile or C. diff), which causes severe diarrhea that can lead to severe colon damage and death
• Severe and life-threatening allergic reactions, such as wheezing, hives, shortness of breath, and anaphylaxis (which also includes feeling like your throat is closing or choking, or your voice is changing)

Antibiotic use can also lead to the development of antibiotic resistance.

• Ask your healthcare professional about the best way to feel better while your body fights off the virus.
• If you need antibiotics, take them exactly as prescribed. Talk with your healthcare professional if you have any questions about your antibiotics.
• Talk with your healthcare professional if you develop any side effects, especially severe diarrhea, since that could be a C. diff. infection, which needs to be treated immediately.
• Do your best to stay healthy and keep others healthy:
  • Clean hands by washing with soap and water for at least 20 seconds or use a hand sanitizer that contains at least 60% alcohol
  • Cover your mouth and nose with a tissue when you cough or sneeze
  • Stay home when sick
  • Get recommended vaccines, such as the flu vaccine.

To learn more about antibiotic prescribing and use, visit CDC’s Antibiotic Prescribing and Use website.

To learn more about antibiotic resistance, visit CDC’s Antibiotic Resistance website.

Background: Inappropriate use of antibiotics is a worldwide issue. In order to help public health institutions and each particular physician to change patterns of consumption among patients, it is important to understand better the reasons why people accept to take or refuse to take the antibiotic drugs. This study explored the motives people give for taking or refusing to take antibiotics.

Methods: Four hundred eighteen adults filled out a 60-item questionnaire that consisted of assertions referring to reasons for which the person had taken antibiotics in the past and a 70-item questionnaire that listed reasons for which the person had sometimes refused to take antibiotics.

Results: A six-factor structure of motives to take antibiotics was found: Appropriate Prescription, Protective Device, Enjoyment (antibiotics as a quick fix allowing someone to go out), Others' Pressure, Work Imperative, and Personal Autonomy. A four-factor structure of motives not to take antibiotics was found: Secondary Gain (through prolonged illness), Bacterial Resistance, Self-defense (the body is able to defend itself) and Lack of trust. Scores on these factors were related to participants' demographics and previous experience with antibiotics.

Conclusion: Although people are generally willing to follow their physician's prescription of antibiotics, a notable proportion of them report adopting behaviors that are beneficial to micro-organisms and, as a result, potentially detrimental to humans.

Keywords: Adherence to treatment; Antibiotics; Non-adherence; Patients’ preferences.

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Page 2

  Mean Factor Score as a Function of Demographic Characteristics    Agree to Take Refuse to Take  

Characteristics	I	II	III	IV	V	VI	I	II	III	IV	N
Age
19–24 Years	8.53	5.07	4.59	4.41	6.77	4.05	3.36	6.61	8.49	5.04	108
25–31 Years	9.88	6.02	5.25	4.75	7.56	4.84	3.22	6.49	8.94	4.91	97
32–47 Years	7.95	6.28	3.65	4.13	6.86	4.55	4.27	6.05	9.13	5.57	111
47 Years +	7.55	5.77	3.30	4.49	6.81	4.63	4.95	6.54	9.03	4.72	98
Gender
Males	7.32	5.34	4.16	4.30	6.11	4.22	4.54	6.07	9.21	5.01	146
Females	9.08	6.02	4.17	4.48	7.46	4.67	3.62	6.60	8.76	5.13	271
Education
Primary	7.32	6.03	4.03	4.60	6.06	4.57	4.85	6.45	9.00	5.16	86
Secondary	8.64	5.92	4.02	4.67	6.95	4.52	3.87	6.38	8.96	5.05	219
Tertiary	8.93	5.29	4.54	3.74	7.72	4.43	3.39	6.41	8.75	5.07	113
Children
No	9.07	5.72	4.64	4.45	7.05	4.52	3.39	6.47	8.83	5.14	227
Yes	7.70	5.84	3.59	4.35	6.88	4.49	4.60	6.32	9.00	5.00	191
Often Ill
No	8.32	5.69	4.04	4.34	7.03	4.46	3.91	6.29	8.93	4.99	327
Yes	9.01	6.08	4.61	4.68	6.73	4.76	3.93	6.94	8.90	5.34	87
Current Health
Bad	8.43	6.86	3.55	4.04	6.49	4.35	4.79	6.59	8.94	5.74	44
Good	8.47	5.65	4.24	4.46	7.04	4.55	3.81	6.41	8.94	4.99	370
Number of prescriptions of antibiotics last year
None	7.87	4.92	3.53	3.94	6.30	4.13	3.42	6.28	9.21	4.74	152
One	8.40	6.01	3.93	4.62	6.85	4.22	4.26	6.48	9.48	5.12	108
Two	9.59	6.76	4.59	4.90	7.95	5.63	4.04	6.40	8.35	5.38	72
More	8.69	6.13	5.24	4.58	7.52	4.63	4.32	6.60	8.16	5.36	84
Out of counter consumption of antibiotics
Never	8.40	5.84	4.23	4.55	7.08	4.63	3.97	6.57	9.02	5.11	335
Sometimes	8.63	5.50	3.86	3.86	6.58	4.04	3.85	5.64	8.46	4.91	82
Keeps antibiotics for further use
Never	8.36	5.82	4.25	4.52	7.08	4.68	3.89	6.40	8.86	4.84	300
Sometimes	8.59	5.63	3.91	4.04	6.69	3.95	4.14	6.51	9.03	5.74	114
Uses to stop treatment before completion
Never	8.34	5.64	3.97	4.10	6.77	4.65	4.12	5.82	8.43	4.60	177
Sometimes	8.55	5.89	4.31	4.64	7.15	4.40	3.76	6.80	9.25	5.40	240
Asks for antibiotics
Never	8.39	5.65	4.20	4.35	6.85	4.51	3.81	6.40	8.97	5.07	368
Sometimes	9.07	6.79	3.88	4.88	7.99	4.63	4.76	6.57	8.62	5.29	47
Has been forced to change treatment
Never	8.24	5.41	4.04	4.24	6.62	4.38	3.85	6.26	8.96	4.84	321
Sometimes	9.17	6.99	4.51	4.99	8.21	4.92	4.25	6.88	8.77	5.78	93
Has been the victim of side effects
Never	8.03	5.43	4.06	4.34	6.59	4.34	3.98	6.02	8.91	4.67	273
Yes	9.23	6.42	4.36	4.54	7.68	4.80	3.87	7.12	8.92	5.86	144
Has experienced useless treatment with antibiotics
Never	8.45	5.38	4.10	4.17	6.65	4.49	3.82	5.82	8.45	4.58	254
Yes	8.45	6.44	4.28	4.81	7.57	4.55	4.19	7.32	9.67	5.87	161
Thinks that antibiotics have many side effects
No	8.69	5.55	4.41	4.44	6.82	4.58	4.03	5.83	8.45	4.64	231
Yes	8.43	6.19	3.86	4.54	7.32	4.39	3.88	7.28	9.44	5.63	171
Thinks that antibiotics are generally effective
No	7.60	6.39	4.13	5.07	6.75	4.83	3.46	7.90	10.00	6.26	35
Yes	8.56	5.71	4.23	4.41	7.05	4.51	4.05	6.12	8.68	4.94	362
Thinks that bacterial resistance is a big public health issue
No	9.49	5.48	5.10	4.53	6.91	4.72	3.25	4.34	7.12	3.75	84
Yes	8.23	5.94	3.97	4.44	7.14	4.45	4.22	7.04	9.39	5.53	320

1. Agree to take: I = Appropriate prescription, II = Protective device, III = Enjoyment, IV = Others’ pressure, V = Work imperative, VI = Personal autonomy
2. Refuse to take: I = Secondary gain, II = Bacterial resistance, III = Self-defense, IV = Lack of trust