Can We Stop Overprescribing Antibiotics? Readers Speak Out

Laura A. Stokowski, RN, MS

| Disclosures | July 17, 2014

You Read My Mind, Doc

Which claim is true? Are clinicians' perceptions that they are pestered endlessly for unnecessary antibiotics accurate, or are patients correct in saying that they don't pressure clinicians for antibiotic prescriptions? Little current research is available to support either view, nor are retrospective surveys likely to settle the question. Much research on this topic relies on such surveys, the reliability of which can be questioned. In fact, the way that the WebMD reader survey posed the question to consumers ("Have you ever asked a healthcare provider to prescribe antibiotics even though you were not certain that antibiotics were needed?") leaves open the possibility that respondents were thoroughly convinced that they needed antibiotics, thus significantly underestimating the number of patients who do, in reality, expect and even pressure clinicians to prescribe antibiotics.

Another fair question is how much clinician perception enters into the equation. John G. Bartlett, MD, Professor Emeritus at the Johns Hopkins University School of Medicine in Baltimore, Maryland, and an advisor to Medscape Infectious Diseases, suggests that patients might not explicitly ask for antibiotics, but it is a natural assumption on the part of the clinician that this is why the patient made the appointment. "If someone with a bad cold goes to the doctor and pays the copay, he or she doesn't expect to walk out empty-handed. The patient didn't come in for a lecture -- it's implicit that the patient wants antibiotics."

Support for this view comes from a study by Coenen and colleagues,[1] who found that out of 3402 adults presenting to primary care with cough, roughly 45% "expected" antibiotics, 41% "hoped for" antibiotics, and 10% "asked for" antibiotics. Clinician perceptions of patient expectations and desires did not necessarily match what patients wanted. However, these perceptions strongly influenced whether antibiotics were prescribed. In other words, when clinicians thought patients expected antibiotics, they were more likely to prescribe them.

A family physician suggests that clinicians need to take a good, hard look in the mirror too. "I find it distressing that medical care providers continue to minimize their role in the overprescribing of antibiotics. The survey indicates that medical providers, on average, report prescribing unnecessary antibiotics 20% of the time. Until medical providers are willing to admit the level of inappropriate use of antibiotics, it will be hard to address the growing concerns regarding antibiotic resistant bacteria."

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  1. Coenen S, Francis N, Kelly M, et al; GRACE Project Group. Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough. PLoS ONE. 2013;8:e76691.

  2. Zgierska A, Rabago D, Miller MM. Impact of patient satisfaction ratings on physicians and clinical care. Patient Prefer Adherence. 2014;8:437-446.

  3. Fenton JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med. 2012;172:405-411. Abstract

  4. Coenen S, Michaels B, Renard D, Denekens J, Van Royen P. Antibiotic prescribing for acute cough: the effect of perceived patient demand. Br J Gen Pract. 2006;56:183-190. Abstract

  5. Mangione-Smith R, McGlynn EA, Elliott MN, Krogstad P, Brook RH. The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics. 1999;103:711-718. Abstract

  6. Karras DJ. Patients who demand antibiotics and the doctors who prescribe them. Emergency Medicine News 2002;24:15-16.

  7. Hamm RM, Hicks RJ, Bemben DA. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Physician. 1996;43:56-62.

  8. Whaley LE, Businger AC, Dempsey PP, Linder JA. Visit complexity, diagnostic uncertainty, and antibiotic prescribing for acute cough in primary care: a retrospective study. BMC Fam Pract 2013;19:14-20.

  9. Blaser MJ. Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues. New York: Henry Holt and Co.; 2014.

  10. Colgan R, Powers JG. Prescribing: approaches that limit antibiotic resistance. Am Fam Physician 2001;64:999-1005.

  11. Spurling GK, Del Mar CB, Dooley L, Foxlee R, Farley R. Delayed antibiotics for respiratory infections. Cochrane Database Syst Rev. 2013;4:CD004417.

  12. Spurling GK, Del Mar CB, Dooley L, Foxlee R. Delayed antibiotics for respiratory infections. Cochrane Database Syst Rev. 2007;18:CD004417.

Authors and Disclosures


Laura A. Stokowski, RN, MS

Freelance writer

Disclosure: Laura A. Stokowski, RN, MS, has disclosed no relevant financial relationships.

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