Observational study finds 28% of U.S. adults misrepresent symptoms to obtain antibiotics — Evidence Review
Published in JAMA Network Open, by researchers from Northwestern Medicine, University of Utah School of Medicine
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Table of Contents
Nearly 30% of U.S. adults in a new survey admitted to lying about or exaggerating symptoms to obtain antibiotics from doctors, with similar behavior observed among caregivers for children; this pattern highlights a significant factor in antibiotic overuse and resistance. Related studies broadly support these findings, showing that patient-driven pressures and misconceptions contribute to unnecessary antibiotic prescriptions worldwide, though the scale and context can vary.
- Clinical research consistently finds that patient requests—whether overt or subtly expressed—substantially increase the likelihood of antibiotic prescribing, even when not medically indicated, as shown in both European and global studies 2 3 10.
- Misconceptions about the necessity and effectiveness of antibiotics for viral or mild illnesses, as well as distrust in clinician judgment, are widespread drivers of inappropriate demand and use across diverse populations 4 5 7 12 13.
- Educational interventions and improved clinician-patient communication have been identified as effective strategies to reduce unnecessary prescribing, as studies demonstrate that greater knowledge among patients and providers correlates with more appropriate antibiotic use 1 6 12.
Study Overview and Key Findings
Antibiotic resistance is an escalating public health concern, with inappropriate antibiotic prescribing recognized as a major contributor. The new study, published in JAMA Network Open and conducted by researchers at Northwestern Medicine and the University of Utah School of Medicine, investigates a previously underexplored mechanism: patients and caregivers misrepresenting symptoms specifically to obtain antibiotics. This behavior not only complicates clinical decision-making but also has potential downstream effects on antibiotic resistance.
The study is timely, given recent CDC data indicating a sharp rise in drug-resistant infections and associated deaths in the United States. With outpatient antibiotic prescribing remaining high and rapid diagnostic tools for bacterial infections still limited, understanding the social and behavioral aspects of antibiotic demand is increasingly important for public health.
| Property | Value |
|---|---|
| Study Year | 2026 |
| Organization | Northwestern Medicine, University of Utah School of Medicine |
| Journal Name | JAMA Network Open |
| Authors | Dr. Jeffrey Linder, Julia Szymczak |
| Population | U.S. adults and caregivers of children under 18 |
| Sample Size | n=960, n=236 |
| Methods | Observational Study |
| Outcome | Symptom misrepresentation to obtain antibiotics |
| Results | 28% of adults misrepresented symptoms for antibiotics |
Literature Review: Related Studies
To contextualize these findings, we searched the Consensus research database, which includes over 200 million scientific papers, for studies on symptom exaggeration, patient honesty, and factors influencing antibiotic misuse. The following search queries were used:
- antibiotic prescription symptom exaggeration
- patient honesty antibiotic seeking behavior
- misrepresentation symptoms antibiotic misuse factors
Related Studies Table
| Topic | Key Findings |
|---|---|
| How do patient beliefs and behaviors influence antibiotic prescribing? | - Direct patient requests and perceived need for antibiotics lead to increased prescribing, even when clinical indications are lacking 2 3 7 10 13. - Misconceptions (e.g., antibiotics treat viral infections) and low knowledge levels are associated with higher rates of misuse and symptom exaggeration 7 12 13. |
| What are the effects of delayed versus immediate antibiotic prescribing? | - Delayed antibiotic prescribing for respiratory tract infections is generally as effective as immediate prescribing in symptom control, with fewer complications and lower reconsultation rates 1. - Delayed prescribing is safe for most patient subgroups, but children under 5 may experience slightly higher symptom severity with delays 1. |
| What drives inappropriate antibiotic use in different global contexts? | - Factors include unrestricted access, socioeconomic status, limited healthcare access, and the influence of informal providers, particularly in low- and middle-income countries 4 5 8 9 10 11. - Parental and community misconceptions, economic pressures, and ingrained health-seeking behaviors further contribute to misuse and over-the-counter demand 6 8 9 11 12. |
| Can education and clinician communication reduce antibiotic misuse? | - Improved patient and parental knowledge about antibiotics and resistance is associated with reduced misuse and less symptom exaggeration 6 12. - Clinician resistance to patient pressure and shared decision-making strategies, such as delayed prescribing and point-of-care testing, can lower unnecessary antibiotic use 1 2 3. |
How do patient beliefs and behaviors influence antibiotic prescribing?
Multiple studies from different regions indicate that patient beliefs, explicit requests, and symptom exaggeration are significant contributors to unnecessary antibiotic prescriptions. The new study aligns closely with this body of evidence, demonstrating that misrepresentation of symptoms is a widespread phenomenon that can influence prescriber behavior.
- Patient requests—whether overt or subtly communicated—are consistently linked with higher rates of antibiotic prescribing, even when clinical indications are absent 2 3 7 10 13.
- Erroneous beliefs, such as thinking antibiotics are effective against viral infections or are necessary for routine respiratory symptoms, are common in both adult and parental populations and drive inappropriate demand 7 12 13.
- The new study's findings that patients and caregivers often feel the need to control treatment or believe antibiotics will speed recovery are echoed in research from Saudi Arabia, China, and Lebanon 7 10 12 13.
- These behaviors are not limited to the U.S.; similar patterns are observed in diverse settings, indicating a global challenge for antimicrobial stewardship 2 3 10 13.
What are the effects of delayed versus immediate antibiotic prescribing?
The clinical effectiveness and safety of delayed antibiotic prescribing have been well studied. The new findings support the notion that patient demand, rather than clinical need, often drives immediate prescribing, even though evidence suggests that delays or denials are usually safe and effective.
- Large meta-analyses confirm that delayed prescribing is generally as effective as immediate prescribing for most respiratory tract infections, with similar symptom duration and no increase in complications 1.
- Delayed prescribing strategies can reduce unnecessary antibiotic use, reconsultation rates, and may increase patient satisfaction, except potentially among young children 1.
- These findings suggest that clinicians can safely resist patient pressure or requests—whether honest or exaggerated—by using delayed prescribing and shared decision-making 1 2 3.
- The new study highlights the potential for patient misrepresentation to undermine such strategies, emphasizing the importance of accurate patient-clinician communication 1 2 3.
What drives inappropriate antibiotic use in different global contexts?
International studies highlight that the drivers of antibiotic misuse are multifaceted, involving not only individual beliefs and behaviors but also systemic and socioeconomic factors. The new U.S.-based study adds to this literature by quantifying the prevalence of symptom misrepresentation as a specific behavioral driver in a high-income setting.
- In low- and middle-income countries, unrestricted access, economic constraints, and limited availability of healthcare professionals facilitate both self-medication and inappropriate antibiotic demand 4 5 8 9 10 11.
- Parental and community-level misconceptions, as well as ingrained health-seeking behaviors (such as prescriber-shopping or using leftover antibiotics), further contribute to misuse 6 8 9 11 12.
- The U.S. study's finding that a significant minority of adults and caregivers intentionally misrepresent symptoms reflects similar pressures and misconceptions observed globally, though the regulatory environment differs 4 5 8 9 10 11.
- Interventions targeting these root causes—especially education and improved access to appropriate care—are consistently recommended across studies 6 9 12.
Can education and clinician communication reduce antibiotic misuse?
Educational interventions and effective clinician communication have been shown to reduce antibiotic misuse, both by increasing patient understanding and by empowering clinicians to resist inappropriate prescribing. The new study reinforces this by showing that greater antibiotic knowledge and aversion to unnecessary antibiotics are associated with lower rates of symptom misrepresentation.
- Studies find that higher knowledge levels among parents and patients are linked to more appropriate antibiotic practices and reduced misuse 6 12.
- Clinician strategies such as delayed prescribing, point-of-care diagnostics, and explicit discussion of antibiotic risks and benefits can mitigate the impact of patient pressure 1 2 3.
- The importance of clinician judgment—rather than patient-reported symptoms alone—is emphasized in both the new study and prior research 1 2 3.
- National and community-level education campaigns addressing misconceptions and the dangers of resistance are widely recommended 6 12.
Future Research Questions
While this study sheds light on the prevalence and motivations behind symptom misrepresentation in the U.S., several gaps and questions remain. Further research is needed to explore interventions, contextual factors, and the impact of these behaviors on clinical outcomes and resistance trends.
| Research Question | Relevance |
|---|---|
| How effective are educational interventions at reducing symptom misrepresentation and antibiotic demand in clinical settings? | Understanding the impact of targeted education could inform strategies to reduce both honest and dishonest patient-driven antibiotic requests, addressing a key driver of overprescribing 6 12 13. |
| What are the long-term impacts of patient misrepresentation on antibiotic resistance at the population level? | Quantifying the downstream effects of symptom misrepresentation on resistance trends would help evaluate the true public health burden of this behavior 4 10 11. |
| Which clinician communication strategies are most effective at identifying and addressing patient misrepresentation of symptoms? | Identifying best practices for clinicians to detect and manage symptom exaggeration could improve prescribing accuracy and reduce unnecessary antibiotic use 1 2 3. |
| How do socioeconomic factors influence the prevalence of symptom misrepresentation and antibiotic seeking? | Socioeconomic context is a well-known driver of health-seeking behavior and antibiotic misuse; examining its role in misrepresentation could tailor interventions to high-risk groups 8 9 10 11. |
| What role might rapid diagnostic testing play in reducing unnecessary antibiotic prescribing driven by patient pressure? | Wider use of point-of-care testing could support clinician decision-making and help distinguish legitimate need from patient-driven requests, potentially reducing overprescribing 1 2 3. |