Efforts to promote antibiotic stewardship in doctor’s offices and other outpatient settings often conflict with the pressure clinicians sometimes feel to prescribe antibiotics to patients who believe they need them for an illness, regardless of whether their symptoms are caused by a bacterial infection, reports CIDRAP News.
In these scenarios, patients might emphasise how sick they feel, how they need to get better quickly so they can return to work, or how antibiotics have helped them with a similar illness in the past. Parents of sick children might say they just want something to help a miserable child with an earache feel better.
But two new surveys by the same group of researchers indicate that nearly one-third of patients might use an additional tactic: misrepresenting their or their child’s symptoms.
The surveys, published in JAMA Network Open, found that 28% of adult respondents reported misrepresenting their symptoms so they could obtain antibiotics for an illness at some point, while in the companion study, 27% of caregivers did the same to get antibiotics for their child. The misrepresentation of symptoms included exaggerating symptoms, making up symptoms, or both.
In the national survey of 959 American adults, 27.9% said they had exaggerated or made up symptoms to obtain antibiotics, with implications for outpatient stewardship.
The authors wrote that cold-like symptoms were misrepresented most often, and of those who misrepresented symptoms, 76.9% reported obtaining antibiotics this way at least once.
Contagion Live reports that outpatient settings account for most human antibiotic use in the US, with around 255.9m prescriptions issued annually.
Clinicians rely on patient-reported symptom onset, severity, and duration when deciding whether antibiotics are warranted. Inaccurate reporting can therefore lead to inappropriate prescribing and drive antimicrobial resistance (AMR).
Colds and pain
The investigators had recruited a national, non-probability sample for an online survey conducted from 8 January to 13 February this year. Of 1 371 eligible participants, the final sample included 959 respondents with a mean (SD) age of 50.7 (17.6). Of these, 478 (49.8%) were female.
Overall, 268 respondents (27.9%) reported ever misrepresenting symptoms to a clinician to get antibiotics. Among them, 108 (40.3%) only exaggerated existing symptoms, 19 (7.1%) only fabricated symptoms, and 141 (52.6%) did both.
Cold-like symptoms were misrepresented most often, followed by stomach symptoms and joint or muscle pain.
Most respondents (66.0%) were at least moderately confident the tactic would work, saying they learned what to say from their own experience (43.1%), friends or family (34.5%), clinicians (30.7%), social media (21.7%), and AI chatbots (11.6%).
More than half said they know their body and medical history better than a healthcare practitioner, while nearly one-third said they did not think antibiotic resistance is real.
In an exploratory multiple logistic regression, respondents aged 18 to 33 (odds ratio [OR], 3.20; 95% CI, 1.58-6.63) had higher odds of misrepresentation than those 65 years or older. So did respondents aged 34 to 55 years (OR, 3.05; 95% CI, 1.55-6.17). Higher odds were also linked to often feeling clinicians do not take symptoms seriously (OR, 2.19; 95% CI, 1.49-3.22) and needing help reading health materials (OR, 2.40; 95% CI, 1.62-3.54).
Believing AMR is a hoax (OR, 1.98; 95% CI, 1.34-2.93) and higher lying-acceptability scores (OR, 1.49; 95% CI, 1.23-1.80) also raised the odds. Greater antibiotic knowledge (OR, 0.73; 95% CI, 0.58-0.91) and dislike of taking antibiotics (OR, 0.89; 95% CI, 0.81-0.99) were associated with lower odds.
Only 77 respondents (28.7%) regretted misrepresenting symptoms. Their regret stemmed more often from adverse effects or lack of efficacy than from concerns about dishonesty.
“It should be a priority for us to identify strategies for reassuring people, re-earning trust, and finding the right ways to address their concerns,” said co-first author Alistair Thorpe, PhD, research assistant professor of population health sciences at University of Utah Health.
Co-first author Andrea Gurmankin Levy, PhD, MBe, professor of social sciences at Connecticut State Community College Middlesex, warned clinicians against responding with distrust.
“The practical takeaway is not for clinicians to become more suspicious of their patients,” Levy said. Instead, she noted, clinicians should build interactions where patients feel heard enough to have no reason to exaggerate.
The authors noted the non-probability sample is not fully representative of the US population, so estimates should be viewed as hypothesis-generating.
They also called for strategies to improve antibiotic knowledge and patient-clinician communication.
Study details
Symptom Misrepresentation to Obtain Antibiotics
Alistair Thorpe, Andrea Gurmankin Levy, Laura Scherer et al.
Published in JAMA Network Open on 30 October 2026
Abstract
Importance
Misrepresentation of symptoms, whether through exaggeration, omission, or fabrication, can represent an important barrier to effective patient-clinician communication and shared decision-making, including in the context of antibiotic treatment.
Objective
To examine the prevalence, reasons for, and characteristics associated with self-reported misrepresentation of symptoms to obtain antibiotics.
Design, Setting, and Participants
This survey study recruited a national, nonprobability sample of US adults to participate in an online survey from January 8 to February 13, 2026. Data were analysed from February to March 18, 2026.
Main Outcomes and Measures
Outcomes of interest were 2 types of symptom misrepresentation (exaggeration and fabrication) to obtain antibiotics and the reasons underlying these behaviours. Additional questions measured antibiotic-related beliefs, experiences, and behaviours and demographics.
Results
Of 1371 eligible participants, the final sample included 959 individuals (mean [SD] age of 50.7 [17.6] years; 478 [49.8%] female). Overall, 268 respondents (27.9%) reported ever misrepresenting their symptoms to a clinician to get antibiotics. This included 108 respondents (40.3%) who exaggerated existing symptoms (eg, told their clinician they had a cough for 2 weeks when they only had it for 1 week), 19 respondents (7.1%) who fabricated symptoms (eg, told their clinician they had a fever when they did not), and 141 (52.6%) who did both. Cold-like symptoms (eg, cough, sore throat) were the most frequently misrepresented (176 respondents [65.7%]). The most commonly endorsed reasons for misrepresenting symptoms were illness severity, perceived antibiotic efficacy, returning to responsibilities, and desire for autonomy in their treatment decisions. Younger age (age 18-33 vs ≥65 years: odds ratio [OR], 3.20 [95% CI, 1.58-6.63]; age 34-55 vs ≥65 years: OR, 3.05 [95% CI, 1.55-6.17]), often feeling that clinicians do not take their symptoms seriously (OR, 2.19 [95% CI, 1.49-3.22]), believing that antibiotic resistance is a hoax (OR, 1.98 [95% CI, 1.34-2.93]), reporting more comorbidities (OR, 1.16 [95% CI, 1.05-1.28]), having higher lying-acceptability scores (OR, 1.49 [95% CI, 1.23-1.80]), and needing help reading health materials (OR, 2.40 [95% CI, 1.62-3.54]) were associated with higher odds of reporting symptom misrepresentation to obtain antibiotics. In contrast, dislike of taking antibiotics (OR, 0.89 [95% CI, 0.81-0.99]) and higher antibiotic knowledge (OR, 0.73 [95% CI, 0.58-0.91]) were associated with lower odds of misrepresentation.
Conclusions and Relevance
In this survey study of US adults, nearly 30% of respondents reported misrepresenting symptoms to get antibiotics from a clinician, most commonly cold-like symptoms. Findings highlight the need for strategies to promote antibiotic knowledge and improve patient-clinician communication to address factors contributing to symptom misrepresentation.
JAMA Open Network article – Symptom Misrepresentation to Obtain Antibiotics (Open access)
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