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. 2025 Nov 21;25(1):4078.
doi: 10.1186/s12889-025-25233-3.

Public knowledge and attitudes towards antibiotic use across England - pre- and post-pandemic

Ellie Gilham  1 , Brieze Read  1 , Sarah Tonkin-Crine  2   3 , Monsey McLeod  4 , Diane Ashiru-Ordedope  1   5 , Kate Duxbury  6 , Colin S Brown  1   5 , Donna M Lecky  7   8
Affiliations

Public knowledge and attitudes towards antibiotic use across England - pre- and post-pandemic

Ellie Gilham et al. BMC Public Health. .

Abstract

Background: Antibiotic misuse is a major preventable driving factor for antimicrobial resistance (AMR). Most antibiotics are prescribed in primary care where demand for consultations for common self-limiting infections is greatest, meaning public knowledge may influence antibiotic prescribing. This study aims to explore how public knowledge of and attitudes towards antibiotics have changed over time.

Methods: Ipsos conducted interviews as part of routine surveys across England in 2020, 2021, 2022 and 2024. Random and quota sampling were used to ensure a representative sample. Questionnaire responses were weighted to ensure the results are broadly representative of the population. Pearson's Chi-squared test was used to test for differences in proportions across levels of categorical variables and between responses across the four years.

Results: Responses were obtained from 2,022 (pre-pandemic); 1,676 (pandemic-Y1); 1,663 (pandemic-Y2) and 3,024 (post-pandemic) respondents. The proportion of respondents who felt they had personal responsibility to tackle AMR increased from 57% pre-pandemic to 62% in pandemic-Y1 (p < 0.05), reducing to 46% post-pandemic. The proportion of respondents correctly answering the statement antibiotics will always speed up my recovery from an infection increased from 58% pre-pandemic to 65% in pandemic-Y1 and Y2 (p < 0.05), reducing to 56% post-pandemic. Knowledge regarding the use of antibiotics to treat ear, urine infections and COVID-19 was lowest post-pandemic. Trust in healthcare professionals (HCPs) regarding whether antibiotics are needed peaked during (range: 77% to 91%) and declined post-pandemic (range: 72% to 86%). The proportion of respondents who reported they would be pleased if their GP did not prescribe antibiotics was highest pre-pandemic (84%), decreasing to 65% post-pandemic. The proportion of respondents who were likely to request antibiotics from their GP declined from pre-pandemic (21%) to pandemic-Y1 (19%) but increased post-pandemic (25%). Demographic variations were observed across nearly all questions.

Conclusions: This paper highlights some concerning trends. Knowledge regarding AMR and the specific infections that antibiotics can treat has reverted to pre-pandemic levels, while levels of uncertainty about AMR and antibiotic use have increased. Although high, trust in HCPs has declined. Therefore, future interventions may wish to support HCPs to build trust with their patients and consider how care pathways can promote this.

Keywords: Antibiotic use; Antimicrobial resistance; Public attitudes; Public knowledge.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: The Ipsos MORI surveys and interviews were undertaken outside the NHS setting, therefore NHS Research Ethics Committee review was not required. This ethical position was confirmed by the Head of Research Governance, Research Translation & Innovation Division at Public Health England. Ipsos is an independent research agency bound by the rules of the Market Research Society (MRS). The study was conducted in accordance with the MRS Code of Conduct ( https://www.mrs.org.uk/standards/code-of-conduct ). Consent for personal responses to be used by Ipsos clients for research purposes is indicated by verbal or written agreement and by the member of the household voluntarily completing the survey questionnaire/interview. Participants were free to withdraw their participation during the interview. All data processing and storage comply with the General Data Protection Regulation and UK Data Protection Act 2018. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Total antibiotic consumption within general practice, hospital inpatient, hospital outpatient, dentist and other community settings, expressed as defined daily doses (DDD) per 1,000 inhabitants per day (DID) in England from 2019 to 2023. Permission was gained to use this figure which was originally published in the 2023-24 ESPAUR report [6]
Fig. 2
Fig. 2
Percentage of respondents answering true or false to five knowledge statements in pre-pandemic (2020), pandemic Y1 (2021), pandemic Y2 (2022) and post-pandemic (2024). Statements If there is any doubt about whether an infection needs to be treated with antibiotics, it is better to take them just in case,There is nothing society can do to prevent antibiotics from becoming less effective at treating infections, and Antibiotics will always work when you really need them to were not included in the post-pandemic (2024) questionnaire
Fig. 3
Fig. 3
Percentage of respondents correctly answering whether antibiotics are effective at treating ear infections, urinary tract infections, COVID-19, and colds/flu in pre-pandemic (2020), pandemic-Y1 (2021), pandemic-Y2 (2022) and post-pandemic (2024) In 2022, a change in question wording occurred with the statement Antibiotics do not treat COVID-19. This changed from Antibiotics work for the symptoms of COVID-19 to Antibiotics do not treat COVID-19. In 2024, a change in question wording occurred with statements Antibiotics do not treat COVID-19 and Antibiotics work for the majority of cold or flu viruses to the following: Antibiotics work for the symptoms of COVID-19 and Antibiotics are effective against colds
Fig. 4
Fig. 4
Responses to statements reflecting attitudes towards antibiotic prescribing in pre-pandemic (2020), pandemic-Y1 (2021), pandemic-Y2 (2022) and post-pandemic (2024). For the statement I would be pleased if the GP said I didn’t need antibiotics for an infection, from pre-pandemic to pandemic-Y2 the questions responses were true/false. This changed to agree/disagree post-pandemic with a neither agree nor disagree response option also added
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