Educating Patients on Unnecessary Antibiotics: Personalizing Potential Harm Aids Patient Understanding

J Am Board Fam Med. 2020 Nov-Dec;33(6):969-977. doi: 10.3122/jabfm.2020.06.200210.


Introduction: Antibiotic resistance is a public health emergency fueled by inappropriate antibiotic use. Public education campaigns often focus on global antibiotic resistance or societal harm of antibiotic misuse. There has been little research into what messages have the greatest impact on patient preferences for nonindicated antibiotics in ambulatory clinics.

Methods: We administered a survey at a primary care clinic in Baltimore, MD. A total of 250 participants rated 18 statements about potential harm from antibiotics on how each statement changed their likelihood to request antibiotics for an upper respiratory tract infection. Statements focused on potential harm either to the individual, to contacts of the individual, to society, and related or not to antibiotic resistance. Initial and final likelihood of requesting antibiotics was measured, and the impact of the statements in each category were compared using general linear models and Wilcoxon rank sum or Kruskal-Wallis tests.

Results: All statements decreased patient likelihood to request antibiotics. Statements about harm to the individual or contacts of the individual decreased participant likelihood to request antibiotics significantly more than statements about societal harm of antibiotic misuse. Statements not discussing antibiotic resistance decreased participant likelihood of requesting antibiotics significantly more than statements discussing antibiotic resistance. Overall likelihood to request antibiotics decreased after the survey by 2.2 points on an 11-point Likert scale (P < .001).

Conclusion: When dissuading patients from requesting nonindicated antibiotics, providers and public health campaigns should focus on potential harm of nonindicated antibiotics to the individual rather than societal harm or antibiotic resistance.

Keywords: Ambulatory Care; Anti-Bacterial Agents; Anti-Bacterial Drug Resistance; Anti-Microbial Stewardship; Baltimore; Health Communication; Health Promotion; Linear Models; Patient Preference; Primary Health Care; Public Health; Surveys and Questionnaires.

MeSH terms

  • Ambulatory Care Facilities
  • Anti-Bacterial Agents* / adverse effects
  • Drug Resistance, Microbial
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Patient Preference
  • Respiratory Tract Infections* / drug therapy
  • Surveys and Questionnaires


  • Anti-Bacterial Agents