Superbugs. MRSA. Hospital ward closures. Ten million people predicted to die. No new antibiotics. If you’ve read headlines such as these, chances are they’ll come to mind when thinking about antibiotic resistance. The problem seems distant and removed from anything happening in everyday life.
But antibiotic resistance affects everyday life: any time an antibiotic is used, the risk of developing resistance increases. This resistance can spread to family and other members of the community, creating a pool of resistant bacteria. These resistant bacteria become problematic when an infection occurs and antibiotics that would have treated the infection are no longer effective.
A study we published today in the Journal of Antimicrobial Chemotherapy investigated perceptions about antibiotic resistance. We looked at results from 54 studies involving a total of 55,225 people who answered questionnaires or took part in interviews.
The data showed that on average, across the studies, 70% of people had heard of antibiotic resistance but most did not understand it: 88% of those surveyed thought the body became resistant to the antibiotics, rather than bacteria becoming resistant to the antibiotics.
But gaps in knowledge do not appear to be the main issue. More than 70% of people knew that using too many or unnecessary antibiotics caused antibiotic resistance.
The problem was they did not think they used too many or that their antibiotic use was unnecessary. In fact, they typically thought that other people were the issue – doctors prescribing too many, other people using them unnecessarily and governments not tackling the issue.
It is not only the public that feel this way. Another review of studies we recently completed included 11,593 health professionals from 57 studies. Most (90%) of those surveyed thought using too many antibiotics caused resistance, but less than 70% believed it was a problem for their clinical practice.
Around half said antibiotic resistance influenced whether they prescribed an antibiotic.
Some also said they did not see antibiotic resistance as a priority when faced with treating an individual patient. They attributed responsibility to patients, other countries and health-care settings.
Why do we think we’re not to blame?
It’s unclear why people do not think they personally contribute to antibiotic resistance. Perhaps it is because there are so many contributors to the resistance problem – antibiotic use in humans, animals and the environment – that it is easy to overlook individual contributions as a “drop in the ocean”. Not only that, the consequences of antibiotic resistance may seem distant and have been dehumanised, fostering the belief that “it will not happen to me”.
In contrast, sitting with a doctor in a one-to-one consultation is very much a personal interaction where the doctor and their patient might be more concerned about treating a specific infection than the risk of antibiotic resistance to society. This type of thinking is an example of the “tragedy of the commons”, where shared resources are used for individual benefit until the point where they are used up and nobody can benefit.
Many people also tend to think they need something when they are sick and doctors may feel pressure to meet their patients’ expectations of treatment. Expectations are often inaccurate – people overestimate the benefits and underestimate the harms of treatment. Research shows that antibiotics offer little or no benefits for some common infections such as colds, coughs and sore throats.
What can be done?
There is no simple answer. But there is no doubt a societal approach is needed. Governments, health professionals, veterinarians, members of the public and various industries are all working towards solutions. The World Health Organisation suggests that surveillance of antimicrobial resistance, regulating antibiotic use in humans and animals, infection prevention and control, and research innovations are all needed to tackle the crisis.
The challenge is ongoing. But a key message to take away from our recent research is that although antibiotic resistance might feel distant, it is everyone’s problem. It is individuals who decide to use antibiotics, and it is individuals who have the power to minimise use and halt antibiotic resistance.
Amanda McCullough receives funding from NHMRC.
Chris Del Mar receives funding from NHMRC and royalties from books about evidence-based practice.
Tammy Hoffmann receives funding from NHMRC and royalties from books about evidence-based practice.