Impact of antibiotic side effects and allergies on patient adherence and attitudes: a mixed methods study in England

Background The overuse and misuse of antibiotics significantly contributes to antimicrobial resistance (AMR). Adverse reactions to antibiotics are well documented, but their impact on patients’ behaviours requires further exploration. Aim To explore how side effects and allergies influence patients’ behaviours to prescribed antibiotic use. Design & setting A mixed-methods explanatory sequential study in England. Method A survey of 1059 adults with prior experience of antibiotic side effects was conducted. Descriptive statistics identified common side effects and behavioural responses, while chi-squared tests explored demographic differences. Focus groups were held with 21 participants, recruited through a research panel. Thematic analysis captured deeper insight into participants’ personal experiences. Results Many antibiotic side effects were identified, presenting shortly after consumption and affecting several aspects of patients’ lives. One-third of respondents (31%, n =325; 95% CI: 28-34%) were unaware of potential side effects beforehand, citing inaccessible patient information leaflets and limited communication from healthcare professionals as barriers. Almost half (42%, n =440; 95% CI: 37-47%) did not complete their antibiotic course following the side effects, with 32% ( n =142; 95% CI: 28-37%) stopping without medical advice. Many allergy diagnoses were made in childhood without follow-up assessments. Conclusion Antibiotic side effects can significantly disrupt patients’ lives and discourage appropriate use of antibiotics. Providing accessible information before prescribing may help manage expectations and support self-management of side effects. Patients with longstanding allergy labels should be encouraged to undergo reassessment to ensure that they are not contributing to AMR by unnecessarily avoiding the use of first-line antibiotics.