Do individual or societal consequences matter more? Reducing antibiotic expectations for uncomplicated urinary tract infections in females.

OBJECTIVES

Antimicrobial resistance (AMR) is an urgent public health threat. Antibiotic prescriptions in primary care, such as for uncomplicated urinary tract infections (UTIs) in females, contribute substantially to antibiotic overuse. We examined whether consequence-based risk communication emphasizing either individual (gut microbiome disruption) or societal (AMR) consequences can reduce expectations to receive antibiotics and improve decision-related outcomes.

DESIGN AND

METHODS

Across three online experiments (N = 3057), women in the United Kingdom were exposed to a hypothetical physician consultation for an uncomplicated UTI. Depending on the experimental condition, the physician explained individual consequences of antibiotic use, societal consequences or no such consequences. Outcomes included expectations to receive antibiotics, trust in the physician and decisional conflict.

RESULTS

An internal meta-analysis showed that both societal and individual consequence messages significantly reduced patients' expectations to receive antibiotics. Neither message type undermined trust in the physician (in Studies 1 and 2), and both communication messages significantly reduced decisional conflict (in Study 3).

CONCLUSIONS

These findings indicate that brief, targeted communication regarding consequences of antibiotic use can lower antibiotic expectations and support decision-making without eroding physician trust. Such messages represent a useful tool that can be adapted to different clinical contexts for patient-centred antibiotic stewardship in primary care.