Public knowledge and attitudes towards antibiotic use across England – pre- and post-pandemic

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BACKGROUND: Antibiotic misuse is a major preventable driving factor for antimicrobial resistance (AMR). Most antibiotics are prescribed in primary care where demand for consultations for common self-limiting infections is greatest, meaning public knowledge may influence antibiotic prescribing. This study aims to explore how public knowledge of and attitudes towards antibiotics have changed over time. METHODS: Ipsos conducted interviews as part of routine surveys across England in 2020, 2021, 2022 and 2024. Random and quota sampling were used to ensure a representative sample. Questionnaire responses were weighted to ensure the results are broadly representative of the population. Pearson's Chi-squared test was used to test for differences in proportions across levels of categorical variables and between responses across the four years. RESULTS: Responses were obtained from 2,022 (pre-pandemic); 1,676 (pandemic-Y1); 1,663 (pandemic-Y2) and 3,024 (post-pandemic) respondents. The proportion of respondents who felt they had personal responsibility to tackle AMR increased from 57% pre-pandemic to 62% in pandemic-Y1 (p < 0.05), reducing to 46% post-pandemic. The proportion of respondents correctly answering the statement antibiotics will always speed up my recovery from an infection increased from 58% pre-pandemic to 65% in pandemic-Y1 and Y2 (p < 0.05), reducing to 56% post-pandemic. Knowledge regarding the use of antibiotics to treat ear, urine infections and COVID-19 was lowest post-pandemic. Trust in healthcare professionals (HCPs) regarding whether antibiotics are needed peaked during (range: 77% to 91%) and declined post-pandemic (range: 72% to 86%). The proportion of respondents who reported they would be pleased if their GP did not prescribe antibiotics was highest pre-pandemic (84%), decreasing to 65% post-pandemic. The proportion of respondents who were likely to request antibiotics from their GP declined from pre-pandemic (21%) to pandemic-Y1 (19%) but increased post-pandemic (25%). Demographic variations were observed across nearly all questions. CONCLUSIONS: This paper highlights some concerning trends. Knowledge regarding AMR and the specific infections that antibiotics can treat has reverted to pre-pandemic levels, while levels of uncertainty about AMR and antibiotic use have increased. Although high, trust in HCPs has declined. Therefore, future interventions may wish to support HCPs to build trust with their patients and consider how care pathways can promote this.

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