Why Do We Prescribe Antibiotics When They Aren’t Needed?Posted on by
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
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.
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.