NICE, France -- A global survey of 4,500 people in 11 countries who reported taking an antibiotic within the past 12 months found many people were concerned about antibiotic resistance but fewer understood how improper use of antibiotic medications contributes to the problem.Â Based on these results, the international committee of health experts overseeing the survey called for tailored antibiotic education campaigns to address underlying country and cultural differences that contribute to improper use of antibiotics.Â
Preliminary results from the COMPLy (COmpliance, Modalities by Population, Lifestyle and Geography) survey were presented at the European Congress of Clinical Microbiology and Infectious Diseases. Among the initial reported findings, eight out of ten people surveyed reported antibiotic-resistant germs are a very serious problem, but only six in ten believed that taking an antibiotic improperly may reduce its effectiveness the next time it is used.
Twenty-two percent of respondents admitted being noncompliant with their last antibiotic treatment with greater than a 30 percent noncompliance rate in some countries.Â Â Patients were considered noncompliant if they reported skipping treatment days or doses, or if they had leftover antibiotics despite being specifically instructed to take them until they were gone.Â Half of all respondents believed leftover antibiotics could be saved and used again, and nearly three-quarters (73 percent) of those who had leftover antibiotics said they saved them.
COMPLy demonstrates that while many people understand antibiotic resistance is an important global problem, far fewer appreciate the impact noncompliance has on the development of resistance and their personal health, said professor Jean-Claude PechÃ¨re, Department of Genetics and Microbiology, University of Geneva, and COMPLy steering committee chair. This important survey offers new, detailed information which will enable health care professionals and the public to take action to improve antibiotic compliance, aiding the fight against antibiotic resistance.
Noncompliance with antibiotic therapy can lead to antibiotic resistance and is associated with treatment failure and its consequences, including deterioration of health, admission to hospital and additional costs.A recent double-blind, two-year, multicenter study of 2,188 children with pneumonia reported that noncompliance with antibiotics was one of the most important factors that predicted treatment failure.
Antibiotic resistance is considered one of the worlds most pressing public health concerns. Bacteria become resistant in several different ways, all of which involve changes to the bacterias genetic material.Repeated and improper use of antibiotics are two of the main causes of the increase in resistant bacteria.Resistant infections can result in increased illness, death and health care costs, according to the World Health Organization.
COMPLy provides insight into patient behaviors and attitudes that impact compliance, added Giuseppe Cornaglia, associate professor in the Department of Pathology, University of Verona, president-elect of the European Society of Clinical Microbiology and Infectious Diseases, and steering committee member.Â Many patients forget to take medication or interrupt their treatment when they begin to feel better, creating an ideal enviÂronment for bacteria to adapt rather than be killed.
The COMPLy study found that the rate of noncompliance was associated with age.Â Younger patients were much less likely to be compliant than older patients.Â Noncompliance among those 18-29 was twice as high (30 percent) compared to those 60 and older (14 percent).Â The dosage regimen of antibiotic was also a significant predictor of compliance.Â For example, people were more likely to be noncompliant when taking more doses per day, with 15 percent noncompliance among patients taking one dose per day compared to 27 percent among those taking three or more doses per day.Â
Members of the COMPLy steering committee recommend that results of the survey be used to shape noncompliance education campaigns around the world.Â The survey results suggest education efforts be tailored to address varying compliance rates by country and differences in patient attitudes toward antibiotics and health care professionals.Â For example, a country-by-country analysis suggests misperceptions about appropriate antibiotic use is the major factor driving noncompliance in some countries, while in other countries lack of faith in doctors abilities and worry about doctors abilities to manage their illness may be a more important factor.Â
The study was supported by Pfizer.
 Percentages relative to compliance are calculated on a patient base of 4088, excluding respondents who did not know whether or not they were compliant.
 Agarwal, G., et al. British Medical Journal 2004;328(7443):791.