What does 'antibiotic resistance' mean to patients?

We've all heard a patient or family member claim that "they've become resistant to an antibiotic." Clinicians and public health campaigns often attempt to communicate the importance of appropriate antibiotic use, yet how patients interpret the concept of 'antibiotic resistance' may impede their best efforts. Thus, could patient misunderstanding hinder antibiotic stewardship efforts?

In July's JGIM (abstract free here), Lucy Brookes-Howell and colleagues from nine European countries completed semi-structured interviews of 121 patients with a recent lower respiratory tract infection, in order to determine their understanding of 'antibiotic resistance'. The most common theme that emerged from this study was that patients conceptualized antibiotic resistance as being 'the resistant human body' with 43 of 121 expressing this idea. Only 28 patients correctly understood that resistance was a property of the bacteria. Thus, substantial confusion was present in the majority of patients.

With almost two-thirds of patients not understanding the basics of antibiotic resistance, it is unclear if current public health campaigns that suggest that individual misuse promotes resistance can ever be effective. The authors of this study correctly wonder whether a community focus might be a better approach and also mention that using terms like 'superbug' might improve patient understanding. Maryn McKenna might be onto something...

Image source: (here)

Addendum: Really nice editorial by Timothy Edgar accompanies the study.