Symptom Misrepresentation to Obtain Antibiotics

Importance: Misrepresentation of symptoms, whether through exaggeration, omission, or fabrication, can represent an important barrier to effective patient-clinician communication and shared decision-making, including in the context of antibiotic treatment. Objective: To examine the prevalence, reasons for, and characteristics associated with self-reported misrepresentation of symptoms to obtain antibiotics. Design, Setting, and Participants: This survey study recruited a national, nonprobability sample of US adults to participate in an online survey from January 8 to February 13, 2026. Data were analyzed from February to March 18, 2026. Main Outcomes and Measures: Outcomes of interest were 2 types of symptom misrepresentation (exaggeration and fabrication) to obtain antibiotics and the reasons underlying these behaviors. Additional questions measured antibiotic-related beliefs, experiences, and behaviors and demographics. Results: Of 1371 eligible participants, the final sample included 959 individuals (mean [SD] age of 50.7 [17.6] years; 478 [49.8%] female). Overall, 268 respondents (27.9%) reported ever misrepresenting their symptoms to a clinician to get antibiotics. This included 108 respondents (40.3%) who exaggerated existing symptoms (eg, told their clinician they had a cough for 2 weeks when they only had it for 1 week), 19 respondents (7.1%) who fabricated symptoms (eg, told their clinician they had a fever when they did not), and 141 (52.6%) who did both. Cold-like symptoms (eg, cough, sore throat) were the most frequently misrepresented (176 respondents [65.7%]). The most commonly endorsed reasons for misrepresenting symptoms were illness severity, perceived antibiotic efficacy, returning to responsibilities, and desire for autonomy in their treatment decisions. Younger age (age 18-33 vs ≥65 years: odds ratio [OR], 3.20 [95% CI, 1.58-6.63]; age 34-55 vs ≥65 years: OR, 3.05 [95% CI, 1.55-6.17]), often feeling that clinicians do not take their symptoms seriously (OR, 2.19 [95% CI, 1.49-3.22]), believing that antibiotic resistance is a hoax (OR, 1.98 [95% CI, 1.34-2.93]), reporting more comorbidities (OR, 1.16 [95% CI, 1.05-1.28]), having higher lying-acceptability scores (OR, 1.49 [95% CI, 1.23-1.80]), and needing help reading health materials (OR, 2.40 [95% CI, 1.62-3.54]) were associated with higher odds of reporting symptom misrepresentation to obtain antibiotics. In contrast, dislike of taking antibiotics (OR, 0.89 [95% CI, 0.81-0.99]) and higher antibiotic knowledge (OR, 0.73 [95% CI, 0.58-0.91]) were associated with lower odds of misrepresentation. Conclusions and Relevance: In this survey study of US adults, nearly 30% of respondents reported misrepresenting symptoms to get antibiotics from a clinician, most commonly cold-like symptoms. Findings highlight the need for strategies to promote antibiotic knowledge and improve patient-clinician communication to address factors contributing to symptom misrepresentation.