Many patients still believe longer antibiotic courses are better

Clinical takeaway: When prescribing shorter antibiotic courses, proactively explain that treatment duration is based on the best available evidence for the specific infection. Emphasizing effectiveness, safety, and avoidance of unnecessary antibiotic exposure may help align patient expectations with stewardship goals.

Public beliefs about antibiotic duration may be lagging behind current evidence, creating a potential barrier to antibiotic stewardship efforts and adoption of shorter, guideline-concordant treatment courses.

A national survey of 1,475 US adults found that most respondents remain more comfortable with longer antibiotic courses than shorter ones for common bacterial respiratory infections, highlighting a key communication challenge for antimicrobial stewardship programs.

Overall, 60% of participants preferred antibiotic courses of at least 7 days, while 40% favored shorter 3- to 5-day regimens. Approximately 62% viewed longer courses as safer, and 63% believed they were more effective. In addition, nearly 9 in 10 respondents agreed that it is important to “always finish” a prescribed antibiotic course, even if symptoms improve.

The message appears deeply ingrained: 76% reported being told by a healthcare professional to always complete antibiotic therapy, most often by a physician, and 62% recalled seeing similar public health messaging. By contrast, only 18% had ever been told they could stop antibiotics when they felt better.

Notably, attitudes may be more flexible than expected. Despite limited prior exposure to updated guidance, about 59% said they would feel at least somewhat comfortable if their clinician recommended stopping antibiotics once they felt better, and 57% would still view that clinician as competent. Trust in clinicians was high overall, with 93% reporting trust in their doctor's advice regarding antibiotic duration.

As the authors noted, “many US adults’ antibiotic beliefs and preferences conflict with evolving clinical perspectives on appropriate antibiotic durations.” The findings suggest clinicians remain well positioned to normalize evidence-based shorter courses, explain the risks of unnecessary antibiotic exposure, and update long-standing messages about antibiotic use without undermining patient trust.

Source: Thorpe A, et al. (2026 July 21) Open Forum Infect Dis. US Adults' Perspectives on Antibiotic Durations and Adherence to Therapy for Common Bacterial Respiratory Infections: A National Survey