Understanding Patient Demand for and Use of Antibiotics for Upper Respiratory Tract Infection: A Qualitative Application of the Necessity-Concerns Framework in Saudi Arabia

Overview

Journal Front Pharmacol

Date 2024 Jul 4

PMID 38962318

Authors

Nouf Almeshal

Holly Foot

Amy Louise Clarke

Amy Hai Yan Chan

Rob Horne

Affiliations

Soon will be listed here.

Abstract

Background: Reducing antimicrobial resistance (AMR) is a priority for public health. Inappropriate patient demand is an important driver of unnecessary antibiotic use. To develop an effective intervention to reduce inappropriate demand for antibiotics in upper respiratory tract infections (URTIs), it is important to identify patient perceptions that influence demand for, and appropriate use of antibiotics.

Aim: To identify and describe the beliefs about antibiotics necessity and concerns that patients with URTIs have, in Riyadh, Saudi Arabia.

Method: An exploratory qualitative approach was used. One-to-one, face-to-face or telephone semi-structured interviews were conducted with participants recruited using purposive sampling (based on age and gender) from primary healthcare centre in Riyadh, Saudi Arabia were conducted. Only adult patients who currently experience URTIs symptoms and agreed to participate were recruited. Recruitment for interviews continued until data saturation point was reached. The interview guide explored patients' necessity beliefs and concerns about antibiotics, AMR perceptions, and expectations from URTIs consultation. Interview transcripts were coded using QSR NVivo 12 using framework analysis informed by the Necessity-Concerns Framework to identify key motivations driving antibiotic requests and consultations.

Results: the study interviewed 32 participants (44% were male, average age was 36.84). Results identified that the patients often relate their personal need for antibiotics when encountering an URTIs symptoms to the type, severity and duration of symptoms. Patients also linked antibiotics with quicker recovery, generally expressing few concerns about antibiotics mainly because of its short duration of use. However, some conveyed their concern about frequent administration of antibiotics and effect on the body's immune system function, which may make them more prone to infections in the future. Participants varied widely in their awareness of AMR; this was associated with many misconceptions, such as confusing AMR with antibiotics efficacy and tolerance. Interestingly, the interplay between necessity beliefs and concerns was observed to influence the decision to start and stop antibiotic, potentially impacting inappropriate antibiotic demand and unnecessary use.

Conclusion: This study highlighted important beliefs and misconceptions about antibiotics and AMR in Saudi population which can be targeted in future interventions to reduce inappropriate demand for antibiotics and optimise appropriate usage.

References

Faber M, Heckenbach K, Velasco E, Eckmanns T . Antibiotics for the common cold: expectations of Germany's general population. Euro Surveill. 2010; 15(35). View

Branthwaite A, Pechere J . Pan-European survey of patients' attitudes to antibiotics and antibiotic use. J Int Med Res. 1996; 24(3):229-38. DOI: 10.1177/030006059602400301. View

OConnor R, ODoherty J, ORegan A, Dunne C . Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review. Ir J Med Sci. 2018; 187(4):969-986. PMC: 6209023. DOI: 10.1007/s11845-018-1774-5. View

Foot H, La Caze A, Gujral G, Cottrell N . The necessity-concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis. Patient Educ Couns. 2015; 99(5):706-17. DOI: 10.1016/j.pec.2015.11.004. View

Chan A, Horne R, Lycett H, Raebel E, Guitart J, Wildman E . Changing Patient and Public Beliefs About Antimicrobials and Antimicrobial Resistance (AMR) Using a Brief Digital Intervention. Front Pharmacol. 2021; 12:608971. PMC: 8045782. DOI: 10.3389/fphar.2021.608971. View

Gaarslev C, Yee M, Chan G, Fletcher-Lartey S, Khan R . A mixed methods study to understand patient expectations for antibiotics for an upper respiratory tract infection. Antimicrob Resist Infect Control. 2016; 5:39. PMC: 5072313. DOI: 10.1186/s13756-016-0134-3. View

Cantarero-Arevalo L, Norgaard L, Sporrong S, Jacobsen R, Almarsdottir A, Hansen J . A Qualitative Analysis of the Culture of Antibiotic Use for Upper Respiratory Tract Infections Among Patients in Northwest Russia. Front Pharmacol. 2022; 13:800695. PMC: 8841995. DOI: 10.3389/fphar.2022.800695. View

Llor C, Bjerrum L, Strandberg E, Radzeviciene R, Reutskiy A, Caballero L . Low Request of Antibiotics from Patients with Respiratory Tract Infections in Six Countries: Results from the Happy Audit Study. Antibiotics (Basel). 2016; 2(4):477-84. PMC: 4790264. DOI: 10.3390/antibiotics2040477. View

Ali K, Sekma A, Messous S, Trabelsi I, Ben Youssef J, Maghraoui H . Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study. BMC Prim Care. 2022; 23(1):295. PMC: 9682766. DOI: 10.1186/s12875-022-01904-7. View

10.

Butler C, Hood K, Verheij T, Little P, Melbye H, Nuttall J . Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ. 2009; 338:b2242. PMC: 3272656. DOI: 10.1136/bmj.b2242. View

11.

Auta A, Hadi M, Oga E, Adewuyi E, Abdu-Aguye S, Adeloye D . Global access to antibiotics without prescription in community pharmacies: A systematic review and meta-analysis. J Infect. 2018; 78(1):8-18. DOI: 10.1016/j.jinf.2018.07.001. View

12.

Lauridsen G, Sorensen M, Hansen M, Rathe J, Jarbol D . Consultation expectations among patients with respiratory tract infection symptoms. Dan Med J. 2017; 64(6). View

13.

Tonkin-Crine S, Yardley L, Little P . Antibiotic prescribing for acute respiratory tract infections in primary care: a systematic review and meta-ethnography. J Antimicrob Chemother. 2011; 66(10):2215-23. DOI: 10.1093/jac/dkr279. View

14.

Mazinska B, Struzycka I, Hryniewicz W . Surveys of public knowledge and attitudes with regard to antibiotics in Poland: Did the European Antibiotic Awareness Day campaigns change attitudes?. PLoS One. 2017; 12(2):e0172146. PMC: 5315279. DOI: 10.1371/journal.pone.0172146. View

15.

Gale N, Heath G, Cameron E, Rashid S, Redwood S . Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013; 13:117. PMC: 3848812. DOI: 10.1186/1471-2288-13-117. View

16.

Strandberg E, Brorsson A, Andre M, Grondal H, Molstad S, Hedin K . Interacting factors associated with Low antibiotic prescribing for respiratory tract infections in primary health care - a mixed methods study in Sweden. BMC Fam Pract. 2016; 17:78. PMC: 4950701. DOI: 10.1186/s12875-016-0494-z. View

17.

Ong S, Nakase J, Moran G, Karras D, Kuehnert M, Talan D . Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction. Ann Emerg Med. 2007; 50(3):213-20. DOI: 10.1016/j.annemergmed.2007.03.026. View

18.

Bianco A, Licata F, Nobile C, Napolitano F, Pavia M . Pattern and appropriateness of antibiotic prescriptions for upper respiratory tract infections in primary care paediatric patients. Int J Antimicrob Agents. 2021; 59(1):106469. DOI: 10.1016/j.ijantimicag.2021.106469. View

19.

Horne R, Chapman S, Parham R, Freemantle N, Forbes A, Cooper V . Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One. 2013; 8(12):e80633. PMC: 3846635. DOI: 10.1371/journal.pone.0080633. View

20.

Al-Baghli N, Al Saif A, Al Dorazi S, Zainaldeen M, Alameer A, Albaghli S . Antibiotic-Prescribing Patterns Among Patients With Respiratory Symptoms in the Eastern Province, Kingdom of Saudi Arabia. Cureus. 2023; 15(8):e44298. PMC: 10462910. DOI: 10.7759/cureus.44298. View