Improving Outpatient Antibiotic Prescribing

Over 250 millions antibiotic medications are prescribed each year and a large percentage of these prescriptions are unnecessary. Unneeded and extended antibiotic use can lead to adverse drug effects and antibacterial-resistant infections. There are regulatory agencies that require acute care hospitals to have stewardship programs to improve antibiotic use. Unfortunately, the majority of antibiotic use occurs in the outpatient setting where there are no steward programs.

A study over 18 months was completed to compare the effect of behavioral interventions that occurred after an antibiotic was prescribed for a respiratory tract infection. The interventions were suggested alternatives to antibiotic use, accountable justification for antibiotic treatment, and peer comparison by other providers. Inappropriate prescribing decreased from 22% to 6% with suggested alternatives, from 23% to 5% with accountable justification, and from 20% to 4% with peer comparison. The control group also had a decrease from 24% to 13%.

This study justifies further investigation to create interventions to decrease inappropriate antibiotic use. This includes specifying tactics toward each outpatient clinics and certain common antibiotics. A suggestion is to require clinicians to justify every prescription for antibiotics with indication documentation and comparison with peers.

This is very interesting. If all prescribers were required to justify their prescriptions, I believe that there would be less antibiotic use. Additionally, the prescribers could provide the pharmacists with test results if applicable, proving that an antibiotic is needed. This would greatly reduce antibiotic resistance and the related complications. Can you think of any cons to this solution?

JAMA. doi: 10.1001/jama.2016.0430. (accessed 11 Feb 2016). 

3 thoughts on “Improving Outpatient Antibiotic Prescribing”

  1. I think that physicians should have justification for every antibiotic prescription they write. Too many times inappropriate antibiotics are prescribed for patients to quiet them from bothering the doctor or to quell worried parents. These doctors just don’t want to make their patients uncomfortable and angry, which is understandable, but the general population needs to come to realize that antibiotic resistance is a real threat to our society and that they are directly contributing to it. We, as healthcare providers, need to learn to say no and to offer an alternative therapy, only prescribing antibiotics for those who truly need them.

  2. I also agree with ideas presented here and believe that something must be done about the over- and unnecessary prescribing of antibiotic medications. Mandating doctors and other prescribers to justify each antibiotic they provide a script for is one small attempt at combating this rather large issue. Beyond that and as stated in the comment above, I think it is important to target general society and educate the patients that we see. Many people feel that the only way they will feel better is by using an antibiotic as it has worked previously and that is what they’re comfortable with. I think it is safe to say that the general population is just simply unaware and uninformed of bacterial antibiotic resistance and how serious of a problem it can become if we continue to prescribe unnecessary medications. Furthermore, what kind of message are we as healthcare providers really sending when pharmacies, Giant Eagle in particular, are constantly advertising the sale of free antibiotic prescriptions? We must work to change the ideas about antibiotics that our society holds and help them to understand the bigger picture and what future implications may result. This might be difficult, especially when speaking with people without a science- or health-related background, so starting simple and evaluating each patient’s individual understanding can be a step in the right direction. Instead of just prescribing the antibiotic to keep the patient happy or filling the script without checking if its really an indicated use, healthcare professionals should take the time to fully assess each patient and counsel them appropriately.

  3. I think that one con of having doctors justify every antibiotic that they prescribe would be sometimes wasted time when an antibiotic is really needed. This might also make prescribers angry because they might think that people are not trusting their judgement. However, I do agree that there should be more strict regulations for giving out antibiotics. I think that some doctors may just give out these prescriptions if family members are asking for them and the appropriate testing may not be conducted. I think that the pharmacist and the doctor could even work together when prescribing. I think that this could work especially for doctors at places such as MedExpress where they see a high volume of patients. I have seen a trend where the same medications are given to almost every patient. I think having a pharmacist to oversee this prescribing could really help cut down on unnecessary prescriptions and antibiotic resistance.

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