Antibiotic overprescribing: Still a major concern
Antibiotic overuse has far-reaching effects on patients’ general health, as well as possible connections to HIV, diabetes, and obesity. Here’s what we can do, now.
PRACTICE RECOMMENDATIONS
› Explain to patients the rationale for not prescribing antibiotics when they are not indicated. A
› Advocate for health care system electronic medical record systems designed to limit antibiotic prescribing to only appropriate cases. A
› Provide patients and your community with educational materials to increase understanding of the risks of antibiotic overprescribing. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Does prescribing antibiotics affect patient satisfaction?
The results are mixed as to whether prescribing antibiotics affects patient satisfaction. Two studies in the early 2000s found that both patients and parents reported higher satisfaction with physicians who explained why antibiotics were not indicated vs physicians who simply prescribed them, and that such explanations do not need to take a lot of time.37,38 (See TABLE 39,37,38 for patient care tips.)
A more recent study found that higher antibiotic prescribing practices in Britain were associated with modestly higher patient satisfaction ratings.39 The authors of this study noted, however, that reduced antibiotic prescribing may be a proxy for other practice patterns that affected satisfaction ratings.
Reducing antibiotic prescribing reduces resistance
There is also strong evidence that when physicians decrease antibiotic prescribing, antimicrobial resistance follows suit. One of the earlier landmark studies to demonstrate this was a Finnish study published in 1997.40 The authors found that a reduction of macrolide antibiotic consumption in Finland led to a reduction in streptococci macrolide resistance from 16.5% to 8.6%.40
Since then, multiple studies have demonstrated similar results for both respiratory and urinary tract infections.41,42 A 2017 meta-analysis analyzing 32 studies found that antibiotic stewardship programs reduced the incidence of infections and colonization with multidrug-resistant Gram-negative bacteria (51% reduction), extended-spectrum beta-lactamase–producing Gram-negative bacteria (48%), and methicillin-resistant Staphylococcus aureus (37%). There was also a reduction in the incidence of C. difficile infections (32%).43
CORRESPONDENCE
David C. Fiore, MD, Department of Family and Community Medicine, University of Nevada, Reno School of Medicine, Brigham Bldg, MS 316, Reno, NV 89557; dfiore@medicine.nevada.edu.
