Antibiotic Use as a Tragedy of the Commons: A Cross-Sectional Survey

Table 2

Comparisons by area of work (𝑁=1530)¹.

Variable	Area of work^2								Total		𝑃 value^3
	Clinical care		Microbiology		Public health		Modeling
	𝑁	%	𝑁	%	𝑁	%	𝑁	%	𝑁	%
Antibiotic resistance is a major public health problem
Agree	341	98.0	708	98.7	162	99.4	47	97.9	1258	98.6	0.50
Disagree	7	2.0	9	1.3	1	0.6	1	2.1	18	1.4
The overuse of antibiotics is a major cause of resistance
Agree	339	98.6	670	97.5	160	98.2	48	92.3	1217	97.7	0.08
Disagree	5	1.5	17	2.5	3	1.8	4	7.7	29	2.3
An individual decision to use antibiotics has an impact on antibiotic resistance in a population
Agree	311	96.6	589	94.4	141	95.3	41	97.6	1082	95.2	0.49
Disagree	11	3.4	35	5.6	7	4.7	1	2.4	54	4.8
Physicians should only consider the needs of the patient when prescribing an antibiotic
Agree	120	41.4	345	58.9	57	41.6	14	35.9	536	51.0	<0.001
Disagree	170	58.6	241	41.1	80	58.4	25	64.1	516	49.0
Before prescribing an antibiotic, physicians should weigh the potential benefit to the patient against the potential harm to society
Agree	260	88.4	504	83.7	130	92.2	33	76.7	927	85.8	0.01
Disagree	34	11.6	98	16.3	11	7.8	10	23.3	153	14.2
The use of antibiotics benefits society
Agree	280	91.5	587	92.2	140	95.2	48	98.0	1055	92.6	0.26
Disagree	26	8.5	50	7.9	7	4.8	1	2.0	84	7.4
Limiting the use of antibiotics would benefit society
Agree	290	92.4	590	90.2	134	93.1	43	91.5	1057	91.2	0.61
Disagree	24	7.6	64	9.8	10	6.9	4	8.5	102	8.8
When determining whether or not to prescribe antibiotics, which consideration is more important?
Long-term societal wellbeing	40	11.7	174	24.8	40	24.2	9	18.0	263	20.9	<0.001
Immediate patient wellbeing	301	88.3	529	75.3	125	75.8	41	82.0	996	79.1
In an antibiotic-free society, would it be beneficial to provide everyone with a broad-spectrum antibiotic nonspecifically once per year?
Yes^4	19	5.6	65	9.2	18	11.2	6	11.8	108	8.6	0.08
No	321	94.4	644	90.8	143	88.8	45	88.2	1153	91.4
In the United States in 2012, would it be beneficial to provide everyone with a broad-spectrum antibiotic nonspecifically once per year?
Yes^4	11	3.3	49	7.2	9	5.6	3	6.0	72	5.8	0.07
No	327	96.8	632	92.8	153	94.4	47	94.0	1159	94.2
Do you think that antibiotic use results in a “tragedy of the commons”?^5
Yes (always or typically)	154	44.8	283	40.5	77	47.2	21	40.4	535	42.5	0.57
Under certain circumstances	179	52.0	387	55.4	79	48.5	28	53.9	673	53.5
No	11	3.2	29	4.2	7	4.3	3	5.8	50	4.0
In general, which type of strain will spread more easily in a population?
Antibiotic-susceptible	64	18.7	107	15.3	28	17.8	17	35.4	216	17.3	0.043
Antibiotic-resistant	131	38.3	289	41.3	62	39.5	12	25.0	494	39.7
Neither	147	43.0	303	43.4	67	42.7	19	39.6	536	43.0
In general, which type of strain will be more virulent in an individual?
Antibiotic-susceptible	74	21.5	85	12.1	17	10.8	4	8.3	180	14.4	0.003
Antibiotic-resistant	101	29.4	259	37.0	59	37.6	19	39.6	438	35.1
Neither	169	49.1	356	50.9	81	51.6	25	52.1	631	50.5

1Note that participants were allowed to opt out of responding to any question, so the total number of responses varies depending on the particular question.
²“Other” category excluded.
³<0.001 considered significant.
⁴“Yes” includes collapsed categories.
⁵Question prompt in the survey included the following definition of “tragedy of the commons”: Garrett Hardin’s classic dilemma, the “tragedy of the commons,” arises when multiple individuals, acting solely out of their own self-interest, ultimately exhaust a limited shared resource despite the fact that it is in no one’s long-term interest for this to happen. A well-known example of this situation involves a group of individuals grazing cattle on a tract of common land. Each individual will seek to maximize his/her gains, and each individual will benefit from grazing additional cattle on the land.
This continued increased use will eventually deplete or even destroy the utility of the common land, and these negative effects will be felt by everyone. Since the negative effects of grazing additional cattle are shared by the group, but the benefits of additional cattle reside with the individual, each rational individual will continue to graze additional cattle despite the ultimate detriment to the group.