title: Antibiotic use as a tragedy of the commons: a cross-sectional survey.
abstract: BACKGROUND
  Many believe antibiotic use results in a tragedy of the commons, since overuse may lead to antibiotic resistance and limiting use would benefit society. In contrast, mass antibiotic treatment programs are thought to result in community-wide benefits. A survey was conducted to learn the views of infectious disease experts on the individual- and societal-level consequences of antibiotic use.
  
  
  METHODS
  The survey instrument was designed to elicit opinions on antibiotic use and resistance. It was sent via SurveyMonkey to infectious disease professionals identified through literature searches. Descriptive statistics were used to analyze the data.
  
  
  RESULTS
  A total of 1,530 responses were received for a response rate of 9.9%. Nearly all participants believed antibiotic use could result in a tragedy of the commons, at least in certain circumstances (96.0%). Most participants did not believe mass antibiotic treatment programs could produce societal benefits in an antibiotic-free society (91.4%) or in the United States (94.2%), though more believed such programs would benefit antibiotic-free societies compared to the United States (P < 0.001).
  
  
  CONCLUSIONS
  The experts surveyed believe that antibiotic use can result in a tragedy of the commons and do not believe that mass treatment programs benefit individuals or society.
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, CA 94143-0412, USA.
authors.forename: Kieran S
authors.initials: KS
authors.lastname: O'Brien
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, CA 94143-0412, USA ; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-2220, USA.
authors.forename: Seth
authors.identifier: 0000-0001-5495-4238
authors.initials: S
authors.lastname: Blumberg
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, CA 94143-0412, USA.
authors.forename: Wayne T A
authors.initials: WT
authors.lastname: Enanoria
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, CA 94143-0412, USA.
authors.forename: Sarah
authors.identifier: 0000-0003-0181-6063
authors.initials: S
authors.lastname: Ackley
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, CA 94143-0412, USA.
authors.forename: Nicolas
authors.identifier: 0000-0003-2157-5885
authors.initials: N
authors.lastname: Sippl-Swezey
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, CA 94143-0412, USA ; Department of Ophthalmology, University of California, San Francisco, CA 94143-0730, USA ; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA 94107-0560, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D035843:Biomedical Research; D003141:Communicable Diseases / Q000188:drug therapy; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D006801:Humans; D055552:Infectious Disease Medicine / Q000379:methods*; D011634:Public Health; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents