Lately, I’ve noticed a lot of patients who have recently been seen at urgent care, diagnosed with a viral upper respiratory infection and prescribed antibiotics. When I review their paperwork and confirm what they have shared with me, I am perplexed about why antibiotics were even used. Viruses are not treated with antibiotics.
You may be asking yourself, “What is the big deal about taking antibiotics when I’m sick? Isn’t that when we should use them?” I have even heard patients say that when they are prescribed antibiotics they only take the pills until they feel better and not necessarily the duration recommended by their provider. They use the leftover meds at their discretion.
Antibiotic resistance is caused by the inappropriate use of antibiotics. Annually in the United States, during outpatient medical visits, antibiotics are prescribed approximately 13 percent of those encounters. However, per the annual National Ambulatory Survey, 25 percent of those prescriptions were inappropriate and 18 percent lacked an indication for the prescription.
If we continue to use antibiotics inappropriately, we will have infections that will eventually not respond to the medications. Therefore, simple infections like urinary tract infections could be fatal.
Antibiotics will not make viral infections better. Antibiotics can cause side effects such as nausea, vomiting, bloating, abdominal pain, and diarrhea. Furthermore, mild sinus and ear infections may get better without any antibiotics at all. Occasionally, it is appropriate to do watchful waiting or delayed prescribing. Upper respiratory infections (common colds) are generally caused by viruses and symptoms can last 7-10 days.
Providers also need education. Many clinicians erroneously believe that patients seek antibiotics when they are sick. Studies have shown that though providers understand the recommendations for antimicrobials, they still fail to adhere to the guidelines. A few reasons given for non-adherence include patient satisfaction and fear of complications. In addition, inappropriate diagnostic testing can also lead to inappropriate antibiotic prescribing.
Leaders within organizations can provide education for providers on a regular basis. Another recommendation is the requirement of continuing medical education credits on antibiotic resistance. Some electronic health records (EHR) also have an antimicrobial clinical workflow. For example, conditions such as urinary tract infections, would prompt the provider to order certain antibiotics or not. EHR systems could also require clinicians to justify the use of antibiotics whenever prescribed.
Comparing providers to their peers has been shown to be an effective tool in modifying physician behavior. With this method, the provider’s prescribing habits are observed and recorded. This information would be broken down into easy-to-read graphs that would later be shared with the provider. The report could then be linked to specific modules that would help provide additional education if needed.
In summary, antibiotic stewardship is not just for one individual. Changing patient and provider behaviors and expectations will take concerted efforts from multiple parties. We talk a lot about saving our planet from global warming but I challenge us to also consider cultivating a healthier future for our children and grandchildren by not overprescribing antibiotics.
Denise Hooks-Anderson, M.D., FAAFP, is associate professor at SLUCare Family Medicine and medical accuracy editor of The St. Louis American. Email: firstname.lastname@example.org.