Awareness of appropriate antibiotic use in primary care for influenza-like illness: Evidence of improvement from UK population-based surveys

Supplementary Materials: The following are available online at https://www.mdpi.com/2079-6382/9/10/690/s1, Figure S1: Changes from Survey 1 (red) to Survey 3 (blue) in the percentage of individuals who would go to the GP with ILI by population subgroup; Figure S2. Changes from Survey 1 (red) to Survey 3 (blue) in the percentage of individuals would ask for antibiotics by population subgroup; Figure S3. Changes from Survey 1 (red) to Survey 3 (blue) in the percentage of individuals that have taken antibiotics for ILI in the past 12 months by population subgroup; Figure S4. Changes from Survey 1 (red) to Survey 3 (blue) in the percentage of individuals that would go to GP with a child with ILI by population subgroup; Figure S5. Changes from Survey 1 (red) to Survey 3 (blue) in the percentage of individuals that would ask for antibiotics for a child with ILI by population subgroup; Figure S6. Changes from Survey 1 (red) to Survey 3 (blue) in the percentage of individuals that think antibiotics would help for a child with ILI by population subgroup; Figure S7. Changes from Survey 1 (red) to Survey 3 (blue) in the percentage of individuals for which child has taken an antibiotic for ILI in the past 12 months by population subgroup; Figure S8. Changes from Survey 1 (red) to Survey 3 (blue) in the percentage of individuals for which AMR information was surprising/new by population subgroup.Copyright © 2020 by the authors. Influenza-like illnesses (ILI) account for a significant portion of inappropriate antibiotic use. Patient expectations for antibiotics for ILI are likely to play a substantial role in ‘unnecessary’ antibiotic consumption. This study aimed to investigate trends in awareness of appropriate antibiotic use and antimicrobial resistance (AMR). Three sequential online surveys of independent representative samples of adults in the United Kingdom investigated expectations for, and consumption of, antibiotics for ILI (May/June 2015 (n = 2064); Oct/Nov 2016 (n = 4000); Mar 2017 (n = 4000)). Respondents were asked whether they thought antibiotics were effective for ILI and about their antibiotic use. Proportions and 95% confidence intervals (CI) were calculated for each question and interactions with respondent characteristics were tested using logistic regression. Over the three surveys, the proportion of respondents who believed antibiotics would “definitely/probably” help an ILI fell from 37% (95% CI 35–39%) to 28% (95% CI 26–29%). Those who would “definitely/probably” visit a doctor in this situation fell from 48% (95% CI 46–50%) to 36% (95% CI 34–37%), while those who would request antibiotics during a consultation fell from 39% (95% CI 37–41%) to 30% (95% CI 29–32%). The percentage of respondents who found the information we provided about AMR “new/surprising” fell from 34% (95% CI 32–36%) to 28% (95% CI 26–31%). Awareness improved more among black, Asian and minority ethnic (BAME) than white people, with little other evidence of differences in improvements between subgroups. Whilst a degree of selection bias is unavoidable in online survey samples, the results suggest that awareness of AMR and appropriate antibiotic use has recently significantly improved in the United Kingdom, according to a wide range of indicators.The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (PHE) [grant numbers HPRU-2012-10041 and NIHR200915], and the NIHR HPRU in Evaluation of Interventions at the University of Bristol, also in partnership with PHE [grant number HPRU-2012-10026]. Michele Peters is an Associate Professor supported by the NIHR funded Policy Research Unit on Quality, Safety and Outcomes (QSO), a collaboration between the Universities of Kent and Oxford, the London School of Hygiene and Tropical Medicine, the Hull-York Medical School and the Picker Institute. Laurence S. J. Roope, James Buchanan, Derrick W. Crook, Tim Peto, A. Sarah Walker and Sarah Wordsworth are partly funded by the Oxford NIHR Biomedical Research Centre. Tim Peto, Christopher C. Butler and A. Sarah Walker are NIHR Senior Investigators. Enrique Castro-Sánchez is affiliated with the NIHR HPRU in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London in partnership with Public Health England [grant number HPRU-2012-10047], is a National Institute for Health Research Senior Nurse and Midwife Research Leader and acknowledges the support of the BRC. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research (NIHR), the Department of Health, or Public Health England (PHE)