Posters that Contain Information About Antibiotic Related Harm Reduce Expectations for Antibiotic Treatment of Viral Upper Respiratory Tract Infections

BACKGROUND: Patient-directed education that aims to lower patients’ expectations for antibiotics is a promising strategy to reduce antibiotic usage for viral upper respiratory tract infections (URTI). We aimed to test three posters on a patient population to see whether the messages were comparable in reducing expectations for antibiotics to treat URTI. METHODS: We developed three posters about antibiotic treatment of URTI (figure). The first indicated that antibiotics are not helpful (futility), the second indicated that antibiotics can cause personal harm (ADR), and the third indicated that antibiotic usage promotes the development of antimicrobial resistance (resistance). We surveyed hospital inpatients over the age of 15 years to measure their expectations to receive antibiotics if they had a hypothetical URTI. We then showed each participant one of the three posters selected randomly, and after 20–30 minutes completed a follow-up survey. RESULTS: 299 participants completed both surveys. There was a statistically significant association between participants’ responses and highest education level (P < 0.001). Eighty-one/299 (27%) expected their doctor to prescribe antibiotics for a “bad cold or flu” and this reduced to 38/299 (13%) after viewing the posters (P < 0.01). This result did not vary between posters, but participants shown poster 2 (ADR, n = 101) and 3 (resistance, n = 100) were less likely to agree that “antibiotics are safe” compared with participants shown poster 1 (futility, n = 98) (P < 0.001). The majority of the participants thought the information would affect their future behaviour (192/299, 64%) and that they would be likely to discuss this information with their friends and families (232/299, 78%). The overall opinions of participants shown poster 2 (ADR) and poster 3 (resistance) were significantly different from the opinions of participants shown poster 1 (futility) (P < 0.01). CONCLUSION: Our brief, inexpensive intervention reduced expectations to receive antibiotics for a hypothetical URTI. Information about personal harms (ADR) and public harm (resistance) might have more impact than information solely about futility. Further study is required to test the effect of this intervention at the time a person presents with URTI. DISCLOSURES: All authors: No reported disclosures.