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. 2022 Oct 20:10:985188.
doi: 10.3389/fpubh.2022.985188. eCollection 2022.

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

Lixia Duan  1 , Chaojie Liu  2 , Dan Wang  1 , Rujiao Lin  1 , Pan Qian  1 , Xinping Zhang  1 , Chenxi Liu  1
Affiliations

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

Lixia Duan et al. Front Public Health. .

Abstract

Background: The 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.

Methods: A 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.

Results: A 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.

Conclusion: Systemic 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 registration: https://www.crd.york.ac.uk/prospero, identifier: CRD42021266407.

Keywords: CBM; COM-B; antibiotic; systematic review; the public; upper respiratory tract infections.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Review framework.
Figure 2
Figure 2
PRISMA flow diagram.
Figure 3
Figure 3
Qualitative synthesis of the public's antibiotic use for URTIs based on CBM.
See this image and copyright information in PMC

References

    1. O'Neil J. Review on Antimicrobial Resistance Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. London: Review on Antimicrobial Resistance; (2014).
    1. Carlet J, Pulcini C, Piddock LJV. Antibiotic resistance: a geopolitical issue. Clin Microbiol Infect. (2014) 20:949–53. 10.1111/1469-0691.12767 - DOI - PubMed
    1. Årdal C, Baraldi E, Ciabuschi F, Outterson K, Rex JH, Piddock LJV, et al. To the G20: incentivising antibacterial research and development. Lancet Infect Dis. (2017) 17:799–801. 10.1016/S1473-3099(17)30404-8 - DOI - PubMed
    1. van de Sande-Bruinsma N, Grundmann H, Verloo D, Tiemersma E, Monen J, Goossens H, et al. Antimicrobial drug use and resistance in Europe. Emerg Infect Dis. (2008) 14:1722–30. 10.3201/eid1411.070467 - DOI - PMC - PubMed
    1. Monnier AA, Eisenstein BI, Hulscher ME, Gyssens IC, Group D-AW. Towards a global definition of responsible antibiotic use: results of an international multidisciplinary consensus procedure. J Antimicrob Chemotherapy. (2018) 73(suppl_6):vi3–16. 10.1093/jac/dky114 - DOI - PMC - PubMed

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