Antibiotic resistance is a major public health threat that requires an organized, comprehensive approach to overcome. Many studies have shown that integrating education programs for clinicians, medical office staff, patients, and targeted audiences such as day care providers make the biggest difference in community-wide antibiotic use. We describe such an integrated approach between our state’s public health programs and our developing curriculum for primary care residents based at the academic health center. Patients receive education directly from both the state programs and their clinicians during office visits for upper respiratory infections. Physicians learn principles of appropriate antibiotic use, how best to educate patients about this important health topic, and how to address patients’ concerns about their illnesses.

Introduction
Antibiotic resistance is recognized as a major public health threat worldwide, but especially in developed countries where antibiotics are widely available. As early as 1998, the Institute of Medicine published a report on Antibiotic Resistance (Harrison & Lederberg, ed. 1998) that detailed the extensive long-term ramifications of antibiotic use. Among these long term ramifications are the growing number of bacteria that are resistant to one or more of the 100 or so available antibiotics. To compound the problem, there have recently been far fewer new antibiotics entering the market. In 2002, 89 new drugs came to the market and none were antibiotics (IDSA, 2004). Exact costs of the burden of antibiotic resistant bacteria are not know, but considering reports that over 70 percent of bacteria that cause hospital infections are resistant to at least one antibiotic, the monetary cost and human costs are staggering.

In response to the growing threat of antibiotic-resistant bacteria in the community, the U.S. Centers for Disease Control and Prevention (CDC) has established a national antibiotic resistance education initiative. Get Smart: Know When Antibiotics Work coordinates and supports educational programs that simultaneously target clinicians, patients and the public. These programs are based in the philosophy that both clinicians and consumers play pivotal roles in the complex interactions that lead to inappropriate antibiotic prescribing and use (Weissman & Besser, 2004). In 2002, the Oregon Department of Human Services founded the Oregon Alliance Working for Antibiotic Resistance Education (AWARE), one of 27 state and local education programs funded through a cooperative agreement with the CDC. Oregon AWARE is a coalition of more than 40 partners that promotes clinician and consumer education about appropriate antibiotic use. The coalition’s patient education efforts complement clinician education programs by targeting health consumers at many points along the behavioral continuum of antibiotic use.