Can We Stop Overprescribing Antibiotics? Readers Speak Out

Laura A. Stokowski, RN, MS

| Disclosures | July 17, 2014
 

Don't Confuse Me With the Facts

A previously well patient, nondiabetic and nonsmoking, comes in with bronchitis or cough and demands antibiotics. What do you do? Dr. Glatter would explain to this patient that the bulk of upper respiratory infections are viral in nature, and although the cough can linger as long as 3 weeks, the patient will not benefit from antibiotics. 

Clinicians who don't immediately capitulate to antibiotic demands often attempt the education and persuasion routes first. Dr. Steele firmly believes that education is the key to dealing with parents who demand antibiotics for their children, and that giving unnecessary antibiotics sends the wrong message. "From the very beginning, we have to let parents know that there are circumstances when it's appropriate to prescribe an antibiotic and other times when it will cause harm."

Opinions of Medscape readers are mixed on whether efforts to educate patients are a worthwhile use of the clinician's time. One view is that education won't compensate for unfulfilled expectations. "Patients don't care about the facts. If they have colds, antibiotics are the only answer. They have lost or never had any sense about self-care or tolerance for the simple trials of life. They didn't come in for my opinion or my knowledge. They don't care what our country thinks about resistance or superbugs. They have had a cold for 2 days and they need a Z-Pak -- period."

A family medicine physician relates that he "spent 40 years trying to educate patients as to why they didn't need penicillin or a Z-Pak for their runny nose. More often than not, the patient still demanded the prescription. It was a futile exercise." Another family medicine clinician, who admits to being a pessimist, agrees. "Why waste time and pull your hair out trying to explain science to people who don't want to hear it? Why alienate a patient who will just transfer to Dr. Easy down the street?"

An ED physician doubts that the survey results (in which respondents were largely female, white, older, and educated) represent settings with less sophisticated patient populations. In some populations, comprehension is a major stumbling block when attempting, through education, to dissuade patients from their objective of leaving with an antibiotic prescription.

Not every clinician who commented believes that education is fruitless. One ED practitioner finds teachable moments when patients come to the ED "for follow-up or a second opinion on why they are not getting better after taking antibiotics." A nurse practitioner in cardiology maintains that clinicians "need to take the time to educate our patients so they understand the gravity of this problem. This education does not always make a happy patient, but in the end it is in their best interest."

For his part, Dr. Bartlett thinks we are being too soft on patients and need to start delivering more pointed, blunt messages about the health repercussions of antibiotic abuse. "C difficile can kill you. Antibiotics are destroying your microbiome." He recommends the work of Dr. Martin Blaser, author of Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues.[9] Dr. Blaser believes that the rise in food allergies, celiac disease, and inflammatory bowel disease are linked to the overuse of antibiotics, which eradicate the normal intestinal flora.

 
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References

  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

Author(s)

Laura A. Stokowski, RN, MS

Freelance writer

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

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