Issue 48 / 14 December 2015

AUSTRALIA is one of the highest users of antibiotics in the developed world, with about 22 million prescriptions written annually in primary care. 
Consumer surveys have identified deficiencies in knowledge on specific antibiotic usage topics, such as lack of efficacy for viruses, side-effect awareness and the association of overuse with resistance.
Public information campaigns designed to boost understanding of appropriate antibiotic use have also focused on these issues. However, few studies have examined consumers’ antibiotic information needs and preferences.
I was part of a research team that conducted the first Australian study to identify antibiotic information priorities and knowledge gaps, based on consumer-derived questions, recently published in Family Practice.
We were interested in whether certain antibiotics generate more concern than others in relation to their use, and whether the nature of consumer knowledge gaps and concerns differed by age group. This information could assist prescribers to align their medicines education with each patient’s desired knowledge, a strategy that is known to improve patient satisfaction and therapeutic outcomes. 
We used a data repository of almost 9000 consumer calls about antibiotics to an Australian national medicines call centre over an 8-year period. We found that the antibiotic information needs of help-seekers are consistent and persist over time.
The most frequent motivations to seek help were inadequate information, wanting a second opinion, a worrying symptom and conflicting information. We identified certain red-flag antibiotics such as metronidazole and ciprofloxacin that generate considerable concern out of proportion to usage. 
Consumers’ knowledge gaps and concerns about antibiotics also vary with age. We were unable to identify any previous studies showing a difference in antibiotic information needs across age groups. 
So what are the implications of our findings for prescribers?
We need to target medicines information to proactively address our patients’ concerns. For example, safety of antibiotics during breastfeeding was a key issue, frequently prompted by a desire for a second opinion or conflicting information. 
This is consistent with current medicines information that is ambiguous or confusing for consumers, shown clearly with metronidazole. While the Therapeutic Guidelines categorise metronidazole as “compatible with breastfeeding”, only 22% of surveyed Australian GPs and 8% of Australian pharmacists knew this. 
This means health professionals will often consult multiple sources before prescribing antibiotics for a breastfeeding mother. Clinicians need ready access to current and accurate information so they can confidently provide evidence-based advice to patients.
Administration of the drug was a key issue raised by callers to the call centre who were concerned about antibiotics and school-aged children, driven by inadequate information. This concurs with literature suggesting that only half of instructions given by doctors are understood and remembered.
Parents require comprehensive, practical and situation-specific advice on giving antibiotics to their children.
Antibiotic interactions, in particular with the oral contraceptive pill, were a concern for young and middle-aged adults. This potential interaction is cited in the consumer medicines information leaflets for most antibiotics and more than half of women of reproductive age in a recent survey were aware of the risk.
Yet pharmacokinetic studies have demonstrated no evidence of clinically significant interactions between the pill and most antibacterial antibiotics. Prescribers need to be aware of evidence-based guidelines and inconsistency of evidence, and inform the consumer accordingly.
Many older callers were unsure of why they were taking an antibiotic. As antibiotics are frequently implicated in adverse outcomes such as hospital admission in elderly Australians, prescribing short-term medicines such as antibiotics requires careful medicines education to avoid confusion in older patients.
Medicines call centres are an underutilised repository for capturing consumers’ real-world medication information gaps.
The issues raised by those seeking help can provide us with insight beyond the scope of questionnaire studies or information campaigns.
Dr Treasure McGuire is an associate professor of pharmacology at Bond University, Queensland, senior lecturer in the School of Pharmacy at the University of Queensland, and assistant director of pharmacy, practice and development at Mater Health Services in Brisbane. Dr McGuire was an author of the Family Practice study investigating what consumers want to know about antibiotics.

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