Sarah Tonkin-Crine health psychologist, Ann Sarah Walker professor of medical statistics and epidemiology, Chris C Butler professor of primary care
Tonkin-Crine S, Walker A S, Butler C C.
Contribution of behavioural science to antibiotic stewardship
BMJ 2015; 350 :h3413
doi:10.1136/bmj.h3413
Re: Contribution of behavioural science to antibiotic stewardship. Antibiotic resistance concerns us all
We agree with the BMJ editorial by Tonkin-Crine et al that the government report for the use of behavioral science in tackling antibiotic prescribing is welcome (1). Public misconceptions regarding antimicrobial resistance (AMR) include that it will only affect individuals who over-consume antibiotics. Also, people find it difficult to understand we may carry AMR microbes without being sick, and that we share our normal flora with that of our surroundings. During the last year, chicken consumption has dropped in Norway, it is down with 20% for some distributors. The main reason was findings of AMR E. coli on chicken meat. Assurances that proper kitchen hygiene and heat treatment of produce would render the meat harmless did not completely prevent a behavioral change in the Norwegian people. Even after massive media attention focused on the fact that 6 cases of approximately 500.000 urinary tract infections diagnosed in Norway during 2010-2014 were due to E. coli closely related to a strain common in chickens (2), a proportion of the Norwegian public still refrain from consuming chicken.
In addition to scientific studies on AMR carriage and disease in humans, animals, food and the environment, we have also in cooperation with the Norwegian Broadcasting Company (NRK), during June and July 2015, encouraged the Norwegian public to submit environmental samples to the Norwegian Institute of Public Health for examination of AMR presence. The purpose of this activity was to engage the audience on a national scale in acknowledgement that AMR concerns us all.
Hundreds of people have requested sampling equipment. Submitted microbial samples from soil, creeks, ponds, fountains, etc, represent locations that are meticulously described. They are screened for phenotypic resistance to Cefotaxime, Ceftazidime, and Ciprofloxacin. So far only naturally resistant bacteria have been found in these samples. The results will not be reported individually, but a summary of the findings will be given in radio program in early August. We are also planning to make a questionnaire to ask the public about AMR to better understand their knowledge and attitudes towards AMR, chicken consumption, and antibiotic use.
Our attempt to engage the public provoked an unexpected massive response. School teachers proposed future collaboration and hundreds of requests had to be declined. Thousands of people have stopped consuming chicken, irrespective of scientific advice.
We hope the engagement of behavioral scientists into AMR challenges extend beyond prescribing practices and also include other aspects related to this complex problem.
People will obviously take action when individually challenged, but systematic analysis, controlled observations, and scientific studies may help us better predict which actions may help prevent the development and spread of AMR.
1. Tonkin-Crine S, et al. BMJ 2015; 350
2. Berg, E.S et al. Highly similar cephalosporin resistant Escherichia coli and AmpC resistance plasmids found in both patients and poultry meat in Norway. || Abstract #ECCMD-4286
Competing interests: No competing interests