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Home Eurosurveillance Weekly Release  2004: Volume 8/ Issue 13 Article 3
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Eurosurveillance, Volume 8, Issue 13, 25 March 2004

Citation style for this article: Madle G, Kostkova P, Mani-Saada J, Weinberg J. Using the internet to educate the public about antimicrobial resistance: a project from the UK's National electronic Library of Infection. Euro Surveill. 2004;8(13):pii=2426. Available online:

Using the internet to educate the public about antimicrobial resistance: a project from the UK’s National electronic Library of Infection

Gemma Madle (, Patty Kostkova, Jane Mani-Saada and Julius Weinberg, City eHealth Research Centre (CeRC), City University, London, United Kingdom

Educating and informing the public is an essential component of any strategy for reducing the further development and spread of antimicrobial resistance. Research has shown that doctors believe patient expectations play a major role in inappropriate use of antibiotics (1). A number of influential recent reports have emphasised the role of public education in reducing the pressure on general practitioners to prescribe antibiotics (2, 3). Investigations into the impact that community-wide campaigns and videotapes about antimicrobial resistance have on prescribing patterns and patient expectations have shown that they can reduce the expectation of antimicrobial prescribing (4). But does the internet have the same impact on patient and public knowledge and attitudes?

An antimicrobial resistance digital library ( was developed as an interface for the public to information held in the National electronic Library of Infection (NeLI,, 5). The NeLI is a specialist library of the United Kingdom National electronic Library for Health (NeLH, and provides a freely accessible, online, evidence based, quality tagged internet portal to the best available evidence on prevention, treatment and investigation of infectious disease. Education of the public about antimicrobial resistance is a key to tackling this global problem. Although the NeLI is aimed at health professionals, it was considered important to provide an access point for the public to evidence based information around antimicrobial resistance. The aim of the site is to to inform the public of current evidence based guidelines on antimicrobial prescribing and the issues surrounding those guidelines in an effort to reduce patient pressure on doctors and subsequently reduce inappropriate prescribing. The main content of the site is found in over 60 frequently asked questions (FAQs), grouped into 22 categories. These FAQs provide short evidence based answers, written by the NeLI team, with links to the evidence and related questions on the site. The FAQs were written using evidence based documents (3,4,6).

Each FAQ is indexed using MeSH keywords to permit keyword searching. Each category is assigned a collection of relevant external resources, all catalogued using the NeLI electronic catalogue card. A short summary of the resource is provided to indicate the target audience, content and level of quality. The site also provides links to antimicrobial resistance stories in the general media.

We have conducted a number of research studies looking at the impact of this website on user knowledge and attitudes. These studies have involved the public, medical professionals and medical students. We are still continuing this research and planning an online study in the near future, more information on how to take part will be available from the website. The research involves completing a questionnaire about antibiotics and their use in acute otitis media, then looking through the website and completing the same questionnaire again. These studies have shown very positive results with clear improvements in the knowledge of users and decreased expectations of receiving antibiotics for AOM following use of the website (7,8).

Although the site is currently only available in English, it will soon be translated into Spanish, and the NeLI team are looking for opportunities to enable translation into other European languages. The team has links with the European Society of Clinical Microbiology and Infectious Diseases (ESCMID, and the Alliance for the Prudent Use of Antibiotics (APUA, and is keen to hear from anyone interested in this project from a European perspective.

  1. Bauchner H, Pelton S, Klein J. Parents, physicians, and antibiotic use. Pediatrics 1999; 103: 395-401.
  2. House of Lords Select Committee on Science and Technology. Resistance to antibiotics and other antimicrobials. London: Stationery Office; 1998. (session 1997/98, 7th report; HL Paper 81-I)
  3. Sub-Group on Antimicrobial Resistance. The Path of Least Resistance. London: Standing Medical Advisory Committee, Department of Health; 1998. ( [accessed 25 March 2004]
  4. Bauchner H, Osganian S, Smith K, Triant R. Improving parent knowledge about antibiotics: a video intervention. Pediatrics 2001;108:845-50.
  5. Kostkova P, Madle G, Mani-Saada J. National electronic Library of Infection in the United Kingdom – contributing to changing clinical practice. Eurosurveillance Weekly 2004; 8(8): 19/02/2004. (
  6. Glasziou PP, Del Mar CB, Sanders SL, Hayem M. Antibiotics for acute otitis media in children (Cochrane Review). Update Software. Chichester: John Wiley & Sons, Ltd; 2003.
  7. Madle G, Kostkova P, Mani-Saada J, Weinberg JR. Evaluating the changes in knowledge and attitudes of digital library users. In: Koch T, Torvik Sølvberg I, editors. Research and Advanced Technology for Digital Libraries, 7th European Conference, ECDL 2003, Trondheim, Norway, August 17-22, 2003, Proceedings. Trondheim: LNCS Springer Verlag; 2003. p. 29-40.
  8. Madle G, Kostkova P, Mani-Saada J, Weinberg JR, Williams P. Changing public attitudes to antibiotic prescribing: can the Internet help? Inform Prim Care. In press 2004.

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