National cultural dimensions as drivers of inappropriate ambulatory care consumption of antibiotics in Europe and their relevance to awareness campaigns

J Antimicrob Chemother. 2012 Mar;67(3):763-7. doi: 10.1093/jac/dkr541. Epub 2011 Dec 26.


Objectives: European countries exhibit significant geographical differences in antibiotic consumption per capita within ambulatory care, especially inappropriate use for colds/flu/sore throat (CFSt). One potential explanation could be national cultural differences resulting in varying perceptions and, therefore, influences.

Methods: Publicly available data on the proportions of respondents in the 2009 Eurobarometer survey who had taken antibiotics for CFSt were tested for association against country scores derived from the Hofstede cultural dimension model. They were also correlated with knowledge of respondents about various key antibiotic facts.

Results: The Eurobarometer dataset incorporated 26,259 responses from all European Union (EU) countries except Cyprus. Using multiple regression, uncertainty avoidance and masculinity were identified as the two national cultural dimensions significantly associated with the use of antibiotics for CFSt (R-adjusted = 0.45; P<0.001). After controlling for these cultural influences, individuals who stated they had received information about antibiotics in the previous year were also more likely to correctly answer antibiotic-related questions (r=0.721; P<0.001). The use of antibiotics for CFSt was found to be inversely correlated with respondents' knowledge that antibiotics are ineffective against viruses (r=-0.724; P<0.001) and that misuse will render them ineffective in the longer term (r=-0.775; P<0.001).

Conclusions: National cultural dimensions, especially uncertainty avoidance and masculinity, appear to have a very significant impact on inappropriate antibiotic use within European countries. Nevertheless, their influence can be reduced by making EU citizens more knowledgeable about antibiotics through appropriate messages and targeted campaigns.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Care / methods*
  • Anti-Bacterial Agents / therapeutic use*
  • Common Cold / drug therapy
  • Cultural Characteristics
  • Drug Therapy / methods*
  • Drug Utilization / statistics & numerical data*
  • Ethnicity
  • European Union
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Influenza, Human / drug therapy
  • Pharyngitis / drug therapy


  • Anti-Bacterial Agents