eHealth Treatment Recommendations for the Common Cold across 13 European Countries: Correlation with Antibiotic Use

Background

Antibiotic consumption (ABC) often ensues from patients’ misbelief that ABs are needed to treat the common cold. To test the impact of eHealth communication, the treatment recommendations on eHealth portals for patients/consumers were explored, modelled and correlated with ABC.

Methods

Cross-sectional study: identification of eHealth “common colds” pages (13 European countries); qualitative review of the treatment recommendations for antibiotics, nasal saline drops/irrigation, decongestants, other medicines; conversion to scores and correlation with ABC (ECDC-community sector 2022). Traditional use of saline was taken into account as co-variable.

Results

e-sites generally explained why ABs are not needed, yet this message and position, as well as treatment e-recommendations highly differed. ABC differed by major treatment e-recommendations ( p = .017), while a strong negative correlation was found between ABC and the treatment recommendation scores, indicating that ABC was lowest, if the eHealth site recommended saline first-line, while ABC increased if rather decongestants (no saline) were proposed, and even more, if emphasis on various medicines and complications (Spearman r _s = -.945, p < .001).

Conclusions

The strong inverse correlation of ABC with SNI/treatment recommendations suggests that eHealth recommendations for the common cold may significantly affect ABC, and thus the patients’ need for ABs. The findings are in line with independent observations that the messages on prudent use of ABs need empowerment by offering patients effective symptom control. eHealth messages and solutions proposed need urgent further study as to change patient’s expectations and reduce ABC.

Key points

• The common cold is a major driver of antibiotic consumption (ABC) in the community.

• Analysis of the common cold pages of 13 European public eHealth sites revealed they all discouraged ABs but the messages and position on the e-page highly differed.

• The highly variable ABC strongly inversely correlated with recommendations for nasal saline (traditional use as co-variable).

• ABC was lowest, if the eHealth site recommended nasal saline, yet increased if decongestants (no saline) first line, and even further if communicating many medicine options or complications.

• Findings confirmed that messages on prudent use of ABs need empowerment by offering an accessible effective alternative for symptom control.

• Education of the public and physicians, and well-structured, persuasive public eHealth communication about the common cold, recommending nasal saline, may help to reduce ABC. Further research is warranted.