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Why Do We Prescribe Antibiotics When They Aren’t Needed?

Posted on by CDC's Safe Healthcare Blog

By: Katherine Fleming-Dutra, MD, Medical Epidemiologist, Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention

Katherine Fleming-Dutra, MD
Katherine Fleming-Dutra, MD

Yesterday, CDC, in collaboration with Pew Charitable Trusts and other experts from across the nation, published an analysis in the Journal of the American Medical Association (JAMA) showing that 30 percent of antibiotic prescribing in doctor’s offices, hospital-based clinics and emergency departments is unnecessary –  meaning no antibiotics were needed at all in those instances. Many of these unnecessary antibiotics were prescribed for acute respiratory conditions, including common colds, acute bronchitis, viral pharyngitis, and even some sinus and ear infections. This estimate of unnecessary use does not account for additional inappropriate antibiotic use, such as selecting the wrong antibiotic or prescribing the wrong dose or duration, meaning that the total inappropriate use is likely even higher. This large amount of unnecessary antibiotic use continues in our country despite years of warnings about increasing antibiotic resistance, superbugs, and calls to use antibiotics appropriately.

Improve Antibiotic Use to Combat Antibiotic Resistance

So as clinicians, why are we still using antibiotics when they are unnecessary? In most instances, it isn’t because we don’t know when we should use antibiotics. Most clinicians know that common colds, viral pharyngitis, and acute bronchitis do not need antibiotics. Instead, clinicians are often worried about customer satisfaction. We perceive that our patients want antibiotics, and we want patients to be satisfied with our care, sometimes leading us to prescribe when we shouldn’t.

Do patients and their families want antibiotics? Sometimes they do because they think it will make them better faster, but many times patients don’t expect antibiotics. Whatever their expectations are, the majority of our patients trust us to make the right diagnosis and recommend the right treatment: antibiotics when they are needed and no antibiotics when they are not needed. When antibiotics aren’t needed, we must take the time to educate our patients that taking antibiotics when they are not needed puts them at unnecessary risk for allergic reactions or the sometimes deadly diarrhea, Clostridium difficile.

  • What most of our patients really want from us is communication. Even most patients who expect antibiotics can still be satisfied if we can effectively communicate the answers to these questions: How do we know whether antibiotics are needed or not—what do we see on a physical exam that helped us make our decision?
  • When can they expect to get better?
  • In the meantime, what can they do to feel better?
  • When should they come back if they aren’t getting better or are getting worse?

Communication can help us provide quality care to our patients: make the correct diagnosis, recommend the right treatments, protect our patients from the harms of unnecessary treatments, and help them feel better. In doing so, we can all work to eliminate unnecessary antibiotic use and to combat antibiotic resistance that is a threat to all of our patients.

Posted on by CDC's Safe Healthcare Blog

7 comments on “Why Do We Prescribe Antibiotics When They Aren’t Needed?”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    I have worked in multiple urgent care facilities over the past 9 years. I have noted that physicians have and do routinely overprescribed antibiotics for one main reason. It’s the push of urgent cares that enforce patient satisfaction. Urgent cares have started to pay bonuses based, in part, upon NPS (patient satisfaction) scores and if the scores are not met, there are no bonuses. I find this model to be unethical as it promotes unnecessary medical care. Medicine, from my experience, has a wide range of outcomes and not all of those outcomes lead to patients being satisfied with their specific outcome. No organization should be basing the payment schedules to physicians based upon patient satisfaction. It should be based on appropriateness of care given based upon the overall picture of the patient and their disease state. Even the best care can lead to outcomes patients arent satisfied with. Patient satisfaction scores are a cancer to health care which I directly contribute to antibiotic over prescribing, substandard care and, potentially, the recent decline in life expectancy in the US. Policies need to change. How can we be the richest country on the planet yet be dead last in care of the industrialized countries? Food for thought.

    Most doctors are under the gun to see a patient every 10 – 15 minutes, leaving little time for quality doctor-patient communication and question/answer responses, after the initial examination. Maybe a large part of the problem is lack of education at the insurance provider level.

    I would like to receive updates on diagnosis and treatment of all diseases. Thanks!

    Yours faithfully;
    Muhammad Kasim
    CHEW/HD Health Education and Health Promotion
    Rank I/C PHC (MDGs/MNCH2)/WFP

    Extreme scarcity of investigation facilities is an important reason of using too many antibiotics and even unnecessarily especially in third world areas. Still we try our extreme best to judge if the antibiotics at all necessary. But the problem is not all of us do that and definitely not always we do that. Thanks for nice writing indeed.

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