Information seeking behaviour regarding antibiotics and common infectious ailments: a Google Trends-based infodemiological study

Antibiotics are medicines of critical importance, but the emergence of antibiotic-resistant bacteria (ABR) is serious threat to healthcare institutions worldwide. One of the most important hallmarks in the development of resistance is their imprudent use, including their non-prescription procurement or their use in self-medication, without the supervision of a healthcare-professional. Many international campaigns have aimed to promote and enhance the understanding of the general population regarding the dangers of ABR, including the European Antibiotic Awareness Week (EAAW) and the World Antibiotic Awareness Week (WAAW); nevertheless, several studies have highlighted that the Internet has become one of principal sources of health-related information for many people. The aim of this infodemiological study was to assess the changes in antibiotic-related Internet queries worldwide and to identify the possible association between the information seeking behaviour for antibiotics and various infectious diseases. Qualitative and quantitative data, and spatio-temporal distribution of queries on the topic of antibiotics were extracted from the Google Trends analysis tool for the time-period between 2010.01.01-2020.12.31, corresponding to all searches worldwide. In addition, search intensity data were also collected for keywords “flu”, “common cold”, “UTI”, “sore throat”, “cough”, and “sinus infection”. Search intensity was expressed as relative search volume (RSV), a normalized score ranging between 0-100. Independent sample t-test, ANOVA and Pearson-correlation were performed by IBM SPSS Statistics 22.0. Search intensity for antibiotic-related information (based on the keyword “antibiotic”) has increased by 54.4% (55.5±5.6 vs. 85.7±8.4) between 2010 and 2020, based on RSV values. Countries with the highest search intensity were Romania (RSV: 100), the Philippines (RSV: 58), Jamaica (RSV: 50) and the USA (RSV: 43). The most common related queries were “what is an antibiotic” (RSV range: 54-81), “antibiotic resistance” (RSV range: 60-69), “antibiotic for UTI” (RSV range: 18-40), “antibiotic cream” (RSV range: 12-36) and “antibiotic side effects” (RSV range: 15-27). EAAD and WAAW-related searches corresponded to RSVs <1 throughout the study. Antibiotic-related educational campaigns (EAAD and WAAW) in November did not have significant effects on RSV values (66.6±15.5 vs. 67.9±14.1; p>0.05). Strong positive correlations were found between antibiotic-related online queries and searches for flu (R=0.561), UTIs (R=0.884), sore throat (R=0.734), cough (R=0.780), sinus infection (R=0.553) and the common cold (R=0.535); in every case, p values <0.001 were recorded. Analysis of antibiotic-related Internet queries may be a valuable source of information of collective health utilization trends. The results suggest that antibiotic-related educational campaigns did not influence the temporal distribution of Internet searches on this topic. Noteworthy associations were seen between information-seeking behaviour on commonly occurring infectious ailments (where self-medication with antibiotic commonly occurs) and antibiotic-related queries.