For many years now, health authorities around the world have been trying to reduce the use of antibiotics in cases where they are not strictly needed, but a new study shows the message still isn't getting through.

The problem is serious. In addition to the risk of side effects when antibiotics are prescribed unnecessarily, the specter of antibiotic resistance is a growing concern in global health, already constituting the third leading cause of death worldwide by some estimates.

The Centers for Disease Control and Prevention (CDC) is mounting efforts to improve antibiotics awareness, as the use of these medications is helping to spur the more than 2 million antibiotic-resistant infections that take place annually in the US

The results of a new survey conducted by researchers at the University of Maryland School of Medicine show that we still have a long way to go.

In the survey, which was completed by 551 primary care clinicians in active practice at medical facilities in Texas, the Mid-Atlantic, and the Pacific Northwest, the participants were presented with a number of hypothetical clinical scenarios.

Mr. Williams is a 65-year-old patient who presents with a medical condition in which large numbers ofbacteria are present in the urine, but there are no symptoms to suggest a urinary tract infection.

In the US, a patient like Mr. Williams shouldn't be given antibiotics if they don't have specific risk factors.

A majority of the people who responded to the survey said they would prescribe antibiotics to Mr. Williams.

Lead author of the study and epidemiologist Jonathan Baghdadi says that the study suggests that primary care clinicians don't follow widely accepted recommendations against the use of antibiotics.

Some primary clinicians may not be aware of the recommendations, but a culture of inappropriate prescribing is likely to be a contributing factor.

The tendency to prescribe antibiotics was most common among clinicians who lived outside of the Pacific Northwest.

The authors write that campaigns to advise doctors not to treat asymptomatic bacteriuria with antibiotics appear to have failed, despite the fact that most clinicians, regardless of degree type, years in practice, or geographic region, reported being willing to prescribe inappropriate antibiotics.

The team says there are a number of reasons why a doctor might prescribe an unnecessary antibiotic.

The public health argument to not prescribe antibiotics does not translate to the bedside according to previous studies.

Sometimes a doctor will misdiagnose a patient if they think antibiotics are needed for a condition when in fact they are not.

The researchers explain in their paper that clinicians who indicated they would prescribe antibiotics estimated that the patient had a high probability of having a UTI, although the case details did not support this diagnosis.

We suspect that many clinicians in our sample were not aware that symptoms are required to prove a UTI diagnosis.

As more recent students of the medical training system, current residents were less likely to prescribe antibiotics in the survey.

The researchers say that doctors who function as medical maximizers are more likely to prescribe antibiotics in a hypothetical scenario.

Medical maximizers favor errors of commission over errors of omission, preferring to treat even when treatment has uncertain value and may introduce a chance of harm, according to the researchers.

The researchers think future interventions designed to discourage over-prescription of antibiotics might benefit from targeting the mindset of medical maximizers more specifically, who may be more resistant to the current messaging used in campaigns.

There are a number of limitations to be aware of, which the researchers acknowledge in their study, that their survey only involved a hypothetical clinical scenario, and how the respondents answered the question doesn't necessarily reflect how they would treat a living

Even so, it seems there is a lot more work to be done in educating professional physicians on the issue of appropriate antibiotic use, at least in this one medical context, if not in others.

We have a job ahead of us when seven out of 10 doctors get the same thing wrong.

The findings are reported in a journal.