title: 'The body gets used to them': patients' interpretations of antibiotic resistance and the implications for containment strategies.
abstract: BACKGROUND
  Interventions promoting evidence based antibiotic prescribing and use frequently build on the concept of antibiotic resistance but patients and clinicians may not share the same assumptions about its meaning.
  
  
  OBJECTIVE
  To explore patients' interpretations of 'antibiotic resistance' and to consider the implications for strategies to contain antibiotic resistance.
  
  
  METHODS
  Multi country qualitative interview study.
  
  
  METHODS
  One hundred and twenty-one adult patients from primary care research networks based in nine European countries who had recently consulted a primary care clinician with symptoms of Lower Respiratory Tract Infection (LRTI).
  
  
  METHODS
  Semi-structured interviews with patients following their consultation and subjected to a five-stage analytic framework approach (familiarization, developing a thematic framework from the interview questions and the themes emerging from the data, indexing, charting, and mapping to search for interpretations in the data), with local network facilitators commenting on preliminary reports.
  
  
  RESULTS
  The dominant theme was antibiotic resistance as a property of a 'resistant human body', where the barrier to antibiotic effectiveness was individual loss of responsiveness. Less commonly, patients correctly conceptualized antibiotic resistance as a property of bacteria. Nevertheless, the over-use of antibiotics was a strong central concept in almost all patients' explanations, whether they viewed resistance as located in either the body or in bacteria.
  
  
  CONCLUSIONS
  Most patients were aware of the link between antibiotic use and antibiotic resistance. The identification of the misinterpretation of antibiotic resistance as a property of the human body rather than bacterial cells could inform clearer clinician-patient discussions and public health interventions through emphasising the transferability of resistance, and the societal contribution individuals can make through more appropriate antibiotic prescribing and use.
authors: South East Wales Trials Unit, Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, Wales, UK. Brookes-HowellLC@cardiff.ac.uk
authors: Lucy
authors: L
authors: Brookes-Howell
authors: Glyn
authors: G
authors: Elwyn
authors: Kerenza
authors: K
authors: Hood
authors: Fiona
authors: F
authors: Wood
authors: Lucy
authors: L
authors: Cooper
authors: Herman
authors: H
authors: Goossens
authors: Margareta
authors: M
authors: Ieven
authors: Christopher C
authors: CC
authors: Butler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D011307:Drug Prescriptions; D004352:Drug Resistance, Microbial; D005060:Europe; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D036301:Qualitative Research; D012141:Respiratory Tract Infections / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents