title: A systematic review of the public's knowledge and beliefs about antibiotic resistance.
abstract: OBJECTIVE
  The objective of this study was to systematically review quantitative and qualitative studies on the public's knowledge and beliefs about antibiotic resistance.
  
  
  METHODS
  We searched four databases to July 2014, with no language or study design restrictions. Two reviewers independently extracted data. We calculated the median (IQR) of the proportion of participants who agreed with each statement and synthesized qualitative data by identifying emergent themes.
  
  
  RESULTS
  Of 3537 articles screened, 54 studies (41 quantitative, 3 mixed methods and 10 qualitative) were included (55 225 participants). Most studied adults (50; 93% studies) and were conducted in Europe (23; 43%), Asia (14; 26%) or North America (12; 22%). Some participants [median 70% (IQR 50%-84%); n = 8 studies] had heard of antibiotic resistance, but most [median 88% (IQR 86%-89%); n = 2 studies] believed it referred to changes in the human body. Many believed excessive antibiotic use [median 70% (IQR 59%-77%); n = 11 studies] and not completing antibiotic courses [median 62% (IQR 47%-77%); n = 8 studies] caused resistance. Most participants nominated reducing antibiotic use [median 74% (IQR 72%-85%); n = 4 studies] and discussing antibiotic resistance with their clinician (84%, n = 1 study) as strategies to reduce resistance. Qualitative data supported these findings and additionally identified that: participants believed they were at low risk from antibiotic resistance participants; largely attributed its development to the actions of others; and strategies to minimize resistance should be primarily aimed at clinicians.
  
  
  CONCLUSIONS
  The public have an incomplete understanding of antibiotic resistance and misperceptions about it and its causes and do not believe they contribute to its development. These data can be used to inform interventions to change the public's beliefs about how they can contribute to tackling this global issue.
authors.affiliation: Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia amccullo@bond.edu.au.
authors.forename: A R
authors.initials: AR
authors.lastname: McCullough
authors.affiliation: School of Public Health, University of Queensland, Herston, Australia Centre of National Research on Disability and Rehabilitation Medicine, Griffith Health Institute, Griffith University, Queensland 4131, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Parekh
authors.affiliation: Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Rathbone
authors.affiliation: Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia.
authors.forename: C B
authors.initials: CB
authors.lastname: Del Mar
authors.affiliation: Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia.
authors.forename: T C
authors.initials: TC
authors.lastname: Hoffmann
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001208:Asia; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D005060:Europe; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009656:North America
chemical_list: D000900:Anti-Bacterial Agents