Seeing an apocalyptic post-antibiotic future lowers antibiotics expectations and requests.

ABSTRACT

BACKGROUND: Antibiotic resistance is an ongoing pandemic which represents a global public health threat. To encourage the judicious use of antibiotics, public health discourse and campaigns often engage in threat-based messaging depicting an apocalyptic post-antibiotic future. We studied the effectiveness of the strategy because of mixed evidence for its success, and because it is unclear how experiencing the COVID-19 pandemic might have influenced it. METHODS: We conducted a randomised controlled trial with 378 participants in three waves (before and during the pandemic in 2021 and 2022). Participants were randomly allocated to either the baseline arm, featuring a control film, or the intervention arm featuring a short film, Catch, depicting a post-antibiotic future. Participants expressed expectations and intended requests for antibiotics for a hypothetical ear infection and their adherence to a prescribed antibiotic for a hypothetical kidney infection. In waves 2 and 3, they also reported any COVID-19-related changes to their antibiotic desires. RESULTS: Showing participants a film about a post-antibiotic future substantially lowers clinically inappropriate expectations for antibiotics and their intended requests. Participants report that the experience of the COVID-19 pandemic decreased their desire for antibiotics but only when they watched the intervention film. The intervention slightly decreases participants' adherence intentions towards a prescribed antibiotic treatment. CONCLUSIONS: Presenting a film about an apocalyptic post-antibiotic future lowers expectations and intended requests for antibiotics and therefore has the potential to encourage judicious use of them. However, the adverse effects of such messaging on adherence to a course of antibiotics should be proactively managed.

When bacteria evolve to resist the effects of an antibiotic, often due to repeated exposure, it leads to drug-resistant infections. This antibiotic resistance puts modern medicine at risk as it renders these infections increasingly difficult to treat with standard antibiotics. To avoid unnecessary antibiotic use, public health campaigns sometimes use threat-based messaging about an apocalyptic future in which antibiotics do not work at all. However, it is not clear whether these messages work as intended. In our study, we found that showing people a future where antibiotics do not work made them less likely to want and ask for unnecessary antibiotics for a hypothetical self-limiting infection. People also reported that their experience of the COVID-19 pandemic decreased their desire for antibiotics. However, the apocalypse messaging also made people slightly less likely to take prescribed antibiotics. Overall, showing people a glimpse into a post-antibiotic future may encourage more careful antibiotic use.