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.

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.

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 rs = -.945, p < .001).

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. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: ECDC data on antibiotic consumption in the community for the European Union published in: Ventura-Gabarro C et al. ESAC-Net study group3. Rebound in community AB consumption after the observed decrease during the COVID-19 pandemic, EU/EEA, 2022. Euro Surveill 2023; 28(46): article 16/Nov/2023: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2023.28.46.2300604 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability & Ethics Statements The ECDC Eurosurveillance data on antibiotics (community sector) were used as published by Ventura-Gabarró in the Eurosurveillance Journal November 2023. All data used has been provided in the supplement to this publication. No other data was used. For the qualitative assessments of the recommendations, all links consulted have been inventoried per country in the Supplement. The work also adheres to the international standards for authors as proposed by the Committee on Publication Ethics (COPE). The following abbreviations are used in this manuscript: