Parents' perceptions of antibiotics and antibiotic resistance: what does it mean for families at home?

Problem

Antibiotic resistance is recognised as an important societal health issue. The greatest risk factor for developing a resistant infection is antibiotic use. Almost 75% of all antibiotics in the UK are prescribed in primary care. Antibiotic-resistant infections are more difficult to treat, making people more unwell for longer. However, there is widespread public misconception about antibiotic use and resistance. This is important to address because consultation behaviour and expectations for antibiotics are a significant determinant of antibiotic use in primary care. Preschool children are at particular risk of receiving unnecessary antibiotics because they commonly present in primary care, and many childhood infections are self-limiting. The limited number of qualitative studies to date has either explored adults' views of antibiotic resistance regarding their own health or focused on expectations of parents for antibiotics when their child is ill. None have focused on exploring parents' views of antibiotic resistance, how the risk of antibiotic resistance might affect their decision to use antibiotics, and explore what strategies parents would find acceptable to minimise antibiotic resistance for themselves, and for their children. Our aim was to explore parents' perceptions and understanding of antibiotic use and resistance when considering how to manage their young child with an acute respiratory tract infection (RTI).

Approach

Semi-structured interviews with a purposive sample of 23 parents of preschool children who recently had an acute RTI across the greater Thames Valley region over the 2016-7 winter. Thematic analysis was used to analyse data.

Findings

Parents had a sense of unrealistic optimism about how antibiotic resistance was likely to affect their family. They considered their families to be at low risk of antibiotic resistance because their families were "low users" of antibiotics. They did not perceive any association between their consumption of antibiotics and the development and spread of antibiotic-resistant bacteria in the community. Most parents thought they acted morally responsible and were quite reticent about antibiotics for their children. However, very few parents considered antibiotic resistance as a possible harm of antibiotics. Parents wanted better communication from their clinician about why antibiotics were prescribed and about the potential impact of antibiotic resistance relevant to their families. They wanted future antibiotic awareness campaigns to have a universal message for families that fit into their daily lives. Campaigns should address when antibiotics are likely to be needed for common childhood infections and the chances of speeding up recovery with antibiotic treatment.

Consequences

Future communication about the potential impact of unnecessary antibiotic use and antibiotic resistance needs to focus on outcomes that parents of young children can relate to, and in a format that parents will engage with to make a more informed decision about the risks and benefits of antibiotics for their child.