The majority of the public understands that antibiotics are effective against bacterial infections, but a substantial portion does not recognize that they are ineffective against viral infections, in the findings of a systematic review of studies conducted across the globe.1
"Although antibiotic awareness campaigns have expanded globally, public understanding remains insufficient, particularly concerning the ineffectiveness of antibiotics against viral infections and the transmission of antibiotic-resistant bacteria," observe study lead author Asa Auta, BPharm, MPH, PhD, Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK, and colleagues.
"These findings underscore the need for multifaceted strategies to promote public awareness and advance sustainable stewardship worldwide," they indicate.
In their review of evidence on public knowledge of antibiotic use and resistance, the investigators identified 227 studies from 98 countries that evaluated whether participants could correctly identify aspects of antibiotic use consistent with European Union and WHO multi-county knowledge assessment areas.In addition, they estimated the portion of the public that is aware of antibiotic resistance, and recognizing it as a global public health threat.
What You Need to Know
While most people know antibiotics treat bacterial infections, less than half understand they are not effective against viral illnesses like colds and flu, and this misconception has not improved in a decade.
A majority recognize that misuse drives resistance and that completing prescribed courses is important, yet only about 58% see antibiotic resistance as a global public health threat.
Despite widespread awareness campaigns, knowledge gaps remain significant, prompting researchers to call for more targeted, multifaceted public health strategies to clarify the differences between bacterial and viral infections and curb inappropriate antibiotic use.
Auta and colleagues determined that an estimated 73.2% (95% CI: 70.2-76.0) of participants recognize antibiotics are effective in treating bacterial infection.Although they found no significant variations across broad world regions, there were significant differences between countries.The variance ranged from 15.7% in Sri Lanka (12.1-20.1) to 88% (85.7-90.0) in Norway.
In contrast to the broadly held understanding that antibiotics are utilized for bacterial infection, the pooled global estimate of those understanding that they are ineffective against viral infection was 42.1% (39.2-44.9).The investigators noted that these estimated percentages were, again, relatively consistent across world regions but with significant intra-country differences and higher percentages of correct understanding in Europe and Central Asia (49.8% [46.2-53.5] and in North America (62.2% [52.4-71.9).
The investigators found most of the general population (72.5% [69.9-75.0]) aware that unnecessary use of antibiotics contributes to development of resistance and their subsequent ineffectiveness.They also found most (67.9% [64.5-71.2]) understand the importance of completing an antibiotic regimen despite early improvement of symptoms.Antibiotic resistance was recognized as a global public health threat by 58.4% (49.1-67.8).
Auta and colleagues note that their finding that most persons incorrectly understand that antibiotics can be used for colds and flu is consistent with a global systematic review2 published in 2015, which reported the misunderstanding was then held by 53.9% (41.6-66.0) of the public.
"This suggests that public understanding of this outcome has remained unchanged over time," they observed. "This persistent misconception will continue to drive the misuse of antibiotics for viral infections."
The investigators attribute the low levels of public knowledge that antibiotics are ineffective against viral infection partially to the overlap in symptoms, as well to using antibiotics for self-limiting respiratory infections and associating recovery with the antibiotic.
"To address these misconceptions, public health initiatives should focus on improving education among the general population regarding the differences between bacterial and viral infections, the risks of unnecessary antibiotic use, and the global impact of antibiotic resistance," they recommend.
References
1. Auta A, Adewuyi EO, Hedima EW, et al. Global and regional knowledge of antibiotic use and resistance among the general public: a systematic review and meta-analysis. Clin Microbiol Infect. 2025. https://doi.org/10.1016/j.cmi.2025.11.016.
2. Gualano MR, Gili R, Scaioli, G, et al. General population's knowledge and attitudes about antibiotics: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2015; 24:2-10.
