Background. Many believe antibiotic use results in a tragedy of the commons, since overuse may lead to antibiotic resistance and limiting use would benefit society. In contrast, mass antibiotic treatment programs are thought to result in community-wide benefits. A survey was conducted to learn the views of infectious disease experts on the individual- and societal-level consequences of antibiotic use. Methods. The survey instrument was designed to elicit opinions on antibiotic use and resistance. It was sent via SurveyMonkey to infectious disease professionals identified through literature searches. Descriptive statistics were used to analyze the data. Results. A total of 1,530 responses were received for a response rate of 9.9%. Nearly all participants believed antibiotic use could result in a tragedy of the commons, at least in certain circumstances (96.0%). Most participants did not believe mass antibiotic treatment programs could produce societal benefits in an antibiotic-free society (91.4%) or in the United States (94.2%), though more believed such programs would benefit antibiotic-free societies compared to the United States ( ). Conclusions. The experts surveyed believe that antibiotic use can result in a tragedy of the commons and do not believe that mass treatment programs benefit individuals or society. 1. Introduction A tragedy of the commons occurs when multiple individuals, acting solely out of self-interest, ultimately exhaust a limited shared resource despite the fact that it is not in the community’s long-term interests [1, 2]. Antibiotic use has been called a tragedy of the commons, because although individuals might benefit from the use of antibiotics, concerns exist about the irreparable societal effects of antibiotic resistance developing from the overuse and misuse of antibiotics in clinical and agricultural settings [3–5]. Limiting the use of antibiotics is recommended to reduce antibiotic resistance [6, 7]. Many hospitals have implemented antibiotic stewardship programs to limit the overuse and misuse of antibiotics, in part to prevent the detrimental societal-level consequences that result from a loss of antibiotic effectiveness [8, 9]. In fact, several countries have even launched national programs to reduce unnecessary antibiotic use [10]. Despite the widespread public perception that antibiotic overuse results in a tragedy of the commons, mathematical models are rarely able to provide evidence for this or define the scenarios required for it to occur [11–15]. At the same time, mass antibiotic treatment programs have been
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