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Non-compliance with antibiotic therapy for acute community infections: a global survey

https://doi.org/10.1016/j.ijantimicag.2006.09.026Get rights and content

Abstract

A global patient survey of non-compliance with antibiotic therapy for acute community infections included 4514 adult respondents (aged 18–99 years) in 11 countries. Admitted non-compliance (ANC) was reported in 912/4088 (22.3%) of cases but varied widely between countries. Multivariate analysis identified five independent variables associated with ANC: country, daily dosage regimen, age, attitudes to doctors and attitudes to antibiotics. ANC ranged from 44.0% in China to 9.9% in The Netherlands, and from 14.9% in those prescribed once-daily regimens to 27.0% for three or more daily doses. There was a negative correlation between ANC and age. Analysis of the attitudes to doctors confirmed previous findings that involving the patient in the management of their infection can improve overall compliance. The study identified seven key attitudes to antibiotic use with the potential to improve compliance. However, there was a poor understanding in 10 of the 11 countries of how non-compliance can increase the potential for resistance development. Segmentation and cluster analysis identified four psychographic profiles influencing compliant behaviour, which varied across countries. The global picture of antibiotic non-compliance and psychographic profiling should help identify areas for targeted, country-specific patient educational programmes as well as those areas where physicians can improve their interaction with their patients.

Introduction

Non-compliance with antibiotic therapy for acute community-acquired infections is widespread [1] and can impact treatment effectiveness, with reductions in clinical success rates of between 16% and 52% [2], [3], [4], [5], [6], [7], [8], [9], impacting health-related quality of life [10].

Non-compliance increases costs from treatment failure, doctor visits and hospitalisation, and augments indirect societal costs such as lost productivity and income as well as absenteeism from work or school [11], [12], [13], [14]. In acute exacerbations of chronic bronchitis in particular, a 50% decrease in failure rate (from 21% to 10.5%) is associated with a 33% reduction in the total cost per exacerbation [15].

Non-compliance can also result in failure to achieve optimum drug concentrations, which has been linked with the development of antibiotic resistance [16], [17]. Children treated with lower than recommended doses of oral β-lactams over prolonged periods (>5 days) were shown to be at increased risk of carriage of penicillin-non-susceptible Streptococcus pneumoniae (PNSP) [18], whereas short-course, high-dose amoxicillin treatment of children with respiratory tract infections (RTIs) increased compliance and reduced PNSP carriage [19]. In turn, antibiotic resistance affects clinical efficacy and increases direct healthcare costs, particularly in patients who require hospitalisation.

Previous patient surveys have examined compliance as part of patients’ attitudes to antibiotic therapy [17], [20], [21]. The aim of this paper was to determine those factors that influence non-compliance and the psychographic profile of the non-compliant patient in 11 different countries from four continents.

Section snippets

Subjects

Fieldwork was carried out in 11 countries in the Autumn of 2005. Those qualifying for inclusion in this self-reported study in each country were adults aged ≥18 years who had taken a self-administered antibiotic as an outpatient within the past 12 months. Subjects were excluded if the antibiotic had been administered in a hospital. Those interviewees who were unaware of their antibiotic regimen or were unsure whether or not they complied with their doctor's instructions were excluded from the

Results

A total of 4514 interviews were completed. A total of 4088 respondents conformed with the definitions of compliance or non-compliance: Brazil (393), China (284), Italy (446), Japan (270), Mexico (405), The Netherlands (362), The Philippines (395), Russia (353), South Africa (357), Turkey (371) and the USA (452). The mean age of respondents was 41.5 years (range 18–99 years) and 64.1% were female. A total of 3176 respondents were defined as admitted compliant and 912 respondents were defined as

Discussion

A meta-analysis of previous studies [1] on non-compliance with antibiotic regimens for community-acquired infections has shown that the methodology used to measure compliance can affect the level of non-compliance observed, with higher reported non-compliance (70.0%) when objective measures, such as electronic monitoring, are employed compared with those methods reliant on patient or physician reporting (31.8–44.7% non-compliance). The methodology used for the current study was reliant on

Acknowledgments

Data collection and analysis were sponsored by Pfizer Inc. and were carried out by Multi-sponsor Surveys Inc., in partnership with the Gallup Organization, under the supervision of the authors. Editorial support was provided by K. Littlewood of K·FIFTEEN Ltd., sponsored by Pfizer Inc.

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