The use of a poster to reduce expectations to receive antibiotics for a common cold

  • Stephen R. RitchieEmail author
  • Lizzie Rakhmanova
  • Eilish Out-O’Reilly
  • Stephen Reay
  • Mark G. Thomas
  • Laszlo Sajtos
Original Article


Many doctors prescribe antibiotics for a cold, to meet patient’s expectations. As a result, patient’s education about antibiotics and antibiotic resistance forms a major component of the WHO’s Global Action Plan on Antimicrobial Resistance. However, it is not known whether simple educational material can change a person’s attitudes about antibiotic therapy. We designed three posters about antibiotic treatment for “cold and flu”. Hospital inpatients answered a baseline survey and then were asked to look at one of three randomly selected posters. The posters highlighted the futility of antibiotic treatment for colds (futility), the risk of adverse drug reactions from antibiotics (harm), and the issue of antimicrobial resistance (resistance). Participants then completed a follow-up survey. Participants’ expectations to receive antibiotics for a “bad cold” reduced significantly after viewing a poster (82/299, 27% expected antibiotics in the baseline survey compared with 13% in the follow-up survey, P < 0.01). Continuing expectation to receive antibiotics after viewing one of the posters was associated with expectation to receive antibiotics in the baseline survey and the strong belief that colds were caused by bacteria. Participants who viewed the resistance poster were more likely to continue to expect antibiotics than participants who viewed the futility poster (OR 2.46, 95%CI 1.16–5.20, P = 0.02). Following discussion of the study, viewing a poster reduced participants’ expectations to receive antibiotics for a hypothetical cold. Changing patients’ expectations to receive antibiotics using simple educational material about antibiotic futility could lead to significant reductions in antibiotic prescription for viral upper respiratory tract infections.



The A+ Trust, Auckland District Health Board provided support in the form of a summer studentship (LR).

Compliance with ethical standards

Ethical approval for this study (16/NTB/187) was provided by the Health and Disability Ethics Committee of the New Zealand Ministry of Health.

Supplementary material

10096_2019_3572_MOESM1_ESM.docx (1.6 mb)
ESM 1 (DOCX 1682 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  2. 2.Auckland District Health BoardAuckland City HospitalAucklandNew Zealand
  3. 3.School of Art and DesignAUT UniversityAucklandNew Zealand
  4. 4.Faculty of Business and EconomicsUniversity of AucklandAucklandNew Zealand

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