The role of household size and living with children in antibiotic use and antibiotic-related behaviours and beliefs: results from a general population survey in Poland.

Background: The threat of antimicrobial resistance (AMR) is driven by both infection transmission and the overuse of antibiotics. These factors may interact with sociodemographic contexts, as larger households or those with children could increase opportunities for pathogen transmission and informal antibiotic sharing. Objectives: We aimed to determine if antibiotic use, or related beliefs and behaviours, were associated with household status (with/without children) or size (single, two persons, 3-4 persons, more than four persons). Methods: This was a pre-registered, cross-sectional survey of 1000 adults representative of the general population in Poland. The questions addressed (1) antibiotic use/behaviours; (2) opinions on antibiotics and (3) opinions on AMR. Results: Household size or the presence of children were unrelated to the antibiotic use. However, the presence of children in the household was associated with a tendency to acquire antibiotics from informal sources (family/friends), interrupt the antibiotic course when symptoms improved and self-test for infections. Living with children was linked to better knowledge of antibiotic effectiveness but limited concern about the effects of AMR. Middle-sized and big households were less likely than smaller households to acquire antibiotics informally but more likely to believe antibiotics accelerate recovery from respiratory tract infections. Conclusions: Cohabitation with children and household size are associated with specific, often contrary, antibiotic-related beliefs and behaviours, but not with antibiotic use. Further qualitative research is required to investigate the underlying reasons for these links. Interventions targeting families with children should capitalize on their self-management skills and knowledge, while addressing their low concern regarding AMR.