I'd like to talk to you about a common problem: antibiotic overuse.
I know that in many cases, patients don't understand why an antibiotic isn't needed for an upper respiratory infection. So I want to give you tips for what you can do in your practice to effectively communicate the decision not to prescribe when an antibiotic isn't indicated.
Frequently, patients think that they need an antibiotic to feel better, even though they have a viral infection. And we are often under pressure to prescribe to satisfy our patients.
Unfortunately, overprescribing of antibiotics has contributed to an increase in resistance and treatment failures for bacterial illnesses. And, like all drugs, antibiotics can have side effects.
As clinicians, it's up to us to provide high-quality care by prescribing appropriately and communicating effectively.
Here are 5 communication strategies that can improve patient satisfaction and understanding when it comes to this issue.
Provide a specific diagnosis to help patients feel validated. For example, say "viral bronchitis" instead of referring to an illness as "just a virus."
Recommend symptomatic relief. This can make a difference when a patient does not require an antibiotic. Often, patients request an antibiotic because they think it will help them or their child feel better. They may not realize that effective symptomatic therapies can give them the relief they are seeking. One option is to provide patients with cold-care kits to prevent them from leaving your office empty-handed. You can also write a prescription for over-the-counter products. CDC's downloadable symptomatic prescription pad is useful for this.
Share normal findings as you go through your exam. For example, let patients know that their lungs sound clear, or that you aren't seeing inflammation in their child's ear. This reassures the patient or parent that the illness may not be as severe as they thought and may make them more open to the idea that they don't need an antibiotic.
Discuss potential side effects of antibiotic use, including adverse events and resistance. Many patients don't realize that antibiotics can be harmful.
Explain to the patient or parent what to expect over the next few days. This can help them feel reassured and empowered. For example, explain that a cough may persist for several days, or discuss how long it may take for their child's earache to subside. Give patients a plan of action in case symptoms do change or become more severe -- including that you will reevaluate their situation and prescribe antibiotics if it becomes medically appropriate.
We realize that there is little time for patient education in a busy practice. CDC has created a number of resources to expedite communication, and we have tailored these materials for different audiences.
Lauri Hicks, DO , is a medical epidemiologist in the Respiratory Diseases Branch of the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Dr. Hicks attended medical school at the Philadelphia College of Osteopathic Medicine and completed her internal medicine residency and chief medicine residency at the University of Connecticut. This was followed by a 2-year position as an epidemic intelligence service officer at CDC. After completing a postdoctoral fellowship in infectious diseases at Brown University, Dr. Hicks returned to CDC to lead respiratory outbreak response and the Legionnaires' disease program.
In 2008, she became the medical director for the "Get Smart: Know When Antibiotics Work" program, which aims to educate healthcare providers and the public about appropriate antibiotic use. She leads research on antibiotic use and resistance trends and serves as the campaign spokesperson. Globally she has fostered CDC-European Union (EU) collaboration on promoting appropriate antibiotic use and has represented CDC at EU meetings in Sweden, France, the Czech Republic, and a Canadian meeting of public health leaders.
She is Assistant Clinical Professor in the Department of Medicine at the University of Connecticut and Adjunct Assistant Professor of Medicine at the Warren Alpert Medical School of Brown University.
Public Information from the CDC and Medscape
Cite this: Lauri Hicks. CDC Commentary: Don't Give In and Give Those Antibiotics! - Medscape - Nov 08, 2010.