Abstract

Over one million annual deaths have been attributed to bacterial antimicrobial resistance. Although antibiotics have saved countless other lives, overuse and misuse of antibiotics increases this global threat. Developing new antibiotics and retraining clinicians can be undermined by patients who pressure clinicians to prescribe unnecessary antibiotics. So we validated two low-cost, scalable interventions for improving antibiotic decisions in an online randomized control trial and a pre-registered replication (N = 985). Both first-person vignette experiments found that an infographic and text message caused intermediate to large improvements in antibiotic decisions compared to active controls — even when controlling for a dozen confounds. Notably, these educational interventions also reduced trust in a clinician who offered antibiotics for an upper respiratory infection. These data show how low-cost adjustments to existing communication systems can teach people to reduce the existential risks of antibiotic resistance and how inappropriate antibiotic prescribing can erode trust in health systems.