Symptom Misrepresentation to Obtain Antibiotics
Alistair Thorpe, Andrea Gurmankin Levy, Laura D. Scherer, Rachael A. Lee, Julia E. Szymczak, Jeffrey T. Kullgren, Valerie M. Vaughn, William B. Petty, Isabelle L. Palmer, Christina Yen, Angela FagerlinImportance
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 analyzed 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 behaviors. Additional questions measured antibiotic-related beliefs, experiences, and behaviors 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.