Prosocial Behaviour and Antibiotic Resistance:Evidence from a Discrete Choice Experiment

Introduction: The health of a community depends on the health of its individuals; therefore, individual health behaviour can implicitly affect the health of the entire community. This is particularly evident in the case of infectious diseases. Because the level of prosociality in a community might determine the effectiveness of health programmes, prosocial behaviour may be a crucial disease-control resource. This study aimed to extend the literature on prosociality and investigate the role of altruism in antibiotic decision making. Methods: A discrete choice experiment was conducted to assess the influence of altruism on the general public’s preferences regarding antibiotic treatment options. The survey was completed by 378 Swedes. Latent class analysis models were used to estimate antibiotic treatment characteristics and preference heterogeneity. A three-class model resulted in the best model fit, and altruism significantly impacted preference heterogeneity. Results: Our findings suggest that people with higher altruism levels had more pronounced preferences for treatment options with lower contributions to antibiotic resistance and a lower likelihood of treatment failure. Furthermore, altruism was statistically significantly associated with sex, education, and health literacy. Conclusions: Antibiotic awareness, trust in healthcare systems, and non-discriminatory priority setting appear to be structural elements conducive to judicious and prosocial antibiotic behaviour. This study suggests that prosocial messages could help to decrease the demand for antibiotic treatments.</p

Harnessing the wisdom of crowds can improve guideline compliance of antibiotic prescribers and support antimicrobial stewardship

open access articleAntibiotic overprescribing is a global challenge contributing to rising levels of antibiotic resistance and mortality. We test a novel approach to antibiotic stewardship. Capitalising on the concept of “wisdom of crowds”, which states that a group’s collective judgement often outperforms the average individual, we test whether pooling treatment durations recommended by different prescribers can improve antibiotic prescribing. Using international survey data from 787 expert antibiotic prescribers, we run computer simulations to test the performance of the wisdom of crowds by comparing three data aggregation rules across different clinical cases and group sizes. We also identify patterns of prescribing bias in recommendations about antibiotic treatment durations to quantify current levels of overprescribing. Our results suggest that pooling the treatment recommendations (using the median) could improve guideline compliance in groups of three or more prescribers. Implications for antibiotic stewardship and the general improvement of medical decision making are discussed. Clinical applicability is likely to be greatest in the context of hospital ward rounds and larger, multidisciplinary team meetings, where complex patient cases are discussed and existing guidelines provide limited guidance

Competitive Centipede Games: Zero-End Payoffs and Payoff Inequality Deter Reciprocal Cooperation

Reciprocal cooperation can be studied in the Centipede game, in which two players alternate in choosing between a cooperative GO move and a non-cooperative STOP move. GO sustains the interaction and increases the player pair’s total payoff while incurring a small personal cost; STOP terminates the interaction with a favorable payoff to the defector. We investigated cooperation in four Centipede games differing in their payoffs at the game’s end (positive versus zero) and payoff difference between players (moderate versus high difference). The games shared the same game-theoretic solution, therefore they should have elicited identical decision patterns, according to orthodox game theory. Nevertheless, both zero-end payoffs and high payoff inequality were found to reduce cooperation significantly. Contrary to previous predictions, combining these two factors in one game resulted in a slight weakening of their independent deterrent effects. These findings show that small changes in the payoff function have large and significant effects on cooperation, and that the effects do not combine synergistically

The social dilemma of antibiotic use

Recently, I was in Cape Town, South Africa. It hadn’t rained in weeks, and the blazing sun had dried out entire riverbeds. The streets were dusty, leaves had turned brown. Water became a scarce commodity. The shower cabins at my hotel had been equipped with electric timers, all taps had been turned off and replaced with hand sanitiser, and people were encouraged to flush the toilet only when necessary.I turned the situation into a personal competition; how quick could my shower be? However, many fellow visitors complained about the severe measures. And there’s no doubt that protecting a common resource as an individual can be challenging. This is due to specific aspects of the situation, which render it a social dilemma: the interests of society are in conflict with those of individual decision makers. Furthermore, a single person only makes a tiny contribution to the problem, so isn’t it tempting to take a longer shower? Nobody will ever know…In the UK, droughts tend to be less of an issue. But there is a similar, less visible, resource problem, which requires our urgent attention – the decreasing availability of effective antibiotic drugs. </p