Article Text

Have the public's expectations for antibiotics for acute uncomplicated respiratory tract infections changed since the H1N1 influenza pandemic? A qualitative interview and quantitative questionnaire study
  1. Cliodna McNulty1,
  2. Puja Joshi2,
  3. Chris C Butler3,
  4. Lou Atkinson2,
  5. Tom Nichols4,
  6. Angela Hogan1,
  7. David French2
  1. 1Health Protection Agency, Primary Care Unit, Department of Microbiology, Gloucestershire Royal Hospital, Gloucester, UK
  2. 2Applied Research Centre in Health and Lifestyles Interventions, Coventry University, Coventry, UK
  3. 3Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
  4. 4Statistics Unit, Centre for Infections, Health Protection Agency, London, UK
  1. Correspondence to Dr Cliodna McNulty; cliodna.mcnulty{at}


Objective To investigate the effect of the H1N1 influenza pandemic on the public's expectations for a general practice consultation and antibiotic for acute respiratory illness.

Design Mixed methods.

Participants Qualitative interviews: 17 participants with acute respiratory tract infection (RTI) visiting English pharmacies. Face-to-face survey: about 1700 adults aged 15 years and older were recruited from households in England in January 2008, 2009 and 2011.

Results The qualitative data indicated that the general public had either forgotten about the ‘swine flu’ (H1N1 influenza) pandemic or it did not concern them as it had not affected them directly or affected their management of their current RTI illness. Between 2009 and 2011, we found that there was little or no change in people's expectations for antibiotics for runny nose, colds, sore throat or cough, but people's expectations for antibiotics for flu increased (26%–32%, p=0.004). Of the 1000 respondents in 2011 with an RTI in the previous 6 months, 13% reported that they took care of themselves without contacting their general practitioners and would not have done so before the pandemic, 9% reported that they had contacted their doctor's surgery and would not have done so before the pandemic and 0.6% stated that they had asked for antibiotics and would not have done so before the pandemic. In 2011, of 123 respondents with a young child (0–4 years) having an RTI in the previous 6 months, 7.4% requested antibiotics and would not have done so before the pandemic. Unprompted, 20% of respondents thought Tamiflu© (oseltamivir) was a vaccine.

Conclusions Expectations of the general public for a consultation or antibiotics with an RTI are similar now to before the H1N1 influenza pandemic; therefore, public antibiotic campaign messages and general practice advice to patients can remain unchanged. Parents with young children and those with personal experience of the H1N1 influenza are more likely to consult and will need more reassurance. The public need more education about Tamiflu©.

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  • The Lloyds pharmacy group commented on interviewee information leaflets and pharmacy poster, provided data on Tamiflu© dispensing and commented on the suitability of selected pharmacies, in terms of layout and staffing, for the study, but otherwise had no influence on the study design or interviewee selection.

  • To cite: McNulty C, Joshi P, Butler CC, et al. Have the public's expectations for antibiotics for acute uncomplicated respiratory tract infections changed since the H1N1 influenza pandemic? A qualitative interview and quantitative questionnaire study. BMJ Open 2012;2:e000674. doi:10.1136/bmjopen-2011-000674

  • Contributors CM designed the study. CCB, TN, AH and DF contributed to the refinement of the study. PJ and LA undertook the qualitative interviews and analysis. All authors contributed to the design of the qualitative and quantitative questionnaires. TN undertook the analysis of the quantitative questionnaire. CM wrote the paper. All authors contributed to drafting and have seen and approved the final version of the manuscript.

  • Funding This study was funded by the Health Protection Agency.

  • Competing interests CM leads the development and writes evidence-based antibiotic guidance for primary care and also chairs the ARHAI Public Education Subgroup. Any payment for speaking at conferences goes to a research trust fund.

  • Ethics approval The household survey and interviews were undertaken outside the NHS setting and, therefore, did not need NHS ethical approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data can be obtained from the authors on request.

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