Identifying Distinct Antibiotic Behavioural Profiles in Singapore's General Population: A Latent Class Analysis

Inappropriate antibiotic use for upper respiratory tract infections (URTIs) is common. However, existing research typically examines single indicators or broad categories of misuse practices, without considering the probabilistic and co-occurring nature of varying behaviours. This study aims to identify and characterise distinct antibiotic behavioural profiles within a general population to inform personalised interventions.

This is a broadly representative population-based study of adult Singapore residents between November 2020 and January 2021. Latent class analysis was first performed to identify distinct profiles, followed by multinomial logistic regression to determine individual characteristics associated with each profile, with interaction effects examined.

Amongst 2004 respondents, the majority were "antibiotic appropriates" (53.0%), followed by "antibiotic avoiders" (24.9%), and "antibiotic seekers" (22.2%). "Antibiotic seekers" expected antibiotics for cold/flu, hopped between doctors to source antibiotics, used leftover antibiotics, stopped antibiotic courses prematurely and perceived antibiotics as harmless and useful for treating cold/flu. Individuals with poor knowledge of antibiotic use (AOR 3.71, 95% CI 2.89-4.76, p < 0.001) and antimicrobial resistance (AOR 3.51, 95% CI 1.05-11.76, p = 0.042), low eHealth literacy (AOR 1.34, 95% CI 1.02-1.77, p = 0.038), and high trust in doctors (AOR 2.14, 95% CI 1.44-3.17, p < 0.001) were more likely to be "antibiotic seekers". Older adults with lower education levels were particularly likely to be "antibiotic seekers".

Approximately one-in-five Singapore residents are antibiotic seekers. Targeted education during multiple clinic visits, given the high trust in doctors, can address antibiotic knowledge gaps and misperceptions, reducing antibiotic misuse.