Lack of knowledge of antibiotic risks among outpatients is associated with intention to use antibiotics without a prescription

BACKGROUND: Antimicrobial resistance is a major public health issue. Little is known about patients' understanding of the risks associated with antibiotic use or antimicrobial resistance. We conducted a survey in Houston, Texas among ethnically and racially diverse patients to identify factors associated with knowledge of antibiotic risks and to determine whether knowledge of antibiotic risks impacts patients' intention to use antibiotics without a prescription. METHODS: A survey was conducted between January 2020 and June 2021 among adult patients in waiting rooms at six public clinics and two private emergency rooms in Houston, Texas. Univariate and multivariate analyses were performed to identify independent risk factors associated with the intention to use non-prescription antibiotics. RESULTS: Surveys were collected among 564 individuals, of which 62% knew about any risks (individual or public health) associated with antibiotics, 19% had some knowledge of antibiotic resistance, and 6% had knowledge about microbiome effects. Knowledge gaps, younger age, receiving care in public rather than private healthcare setting were independent predictors of intention to use non-prescription antibiotics in the future. CONCLUSIONS: Improving knowledge regarding antibiotic risks may reduce the use of antibiotics without a prescription.