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Posted on 06.17.02
UPenn CERTs: Tensions in Antibiotic Prescribing
By Pat French
What constitutes the "best" use of antibiotics can differ according to the perspective of those asked: community representatives versus individual patients. For example, it would be better from the community perspective to delay the use of newer, more powerful antibiotics (so that the rise of resistant "bugs" also is delayed), but from the patient perspective, it would be better to use these drugs because they represent the best chance of eliminating the infection. How often these viewpoints conflict, and what happens when they do, was the subject of a recent survey conducted by the UPenn CERTs.
Dr. Joshua Metlay and colleagues mailed 1600 area physicians a survey asking how they would treat the hypothetical case of a 55-year-old man with uncomplicated pneumonia. Those surveyed included general internists, family practitioners, and specialists in infectious diseases.
The 53% of physicians who responded to the survey, although believing that antibiotic resistance is a major public health issue, appeared not to take this into account when prescribing antibiotics for the hypothetical man with pneumonia. Both the generalists and the specialists would have prescribed the newer antibiotics over the older drugs that are still recommended by national guidelines.
Physicians are not the only component in this equation, however: More than 80% of those surveyed agreed that patient demand was a major reason for the overprescribing of antibiotics. It appears logical that education of patients would reduce the unnecessary prescribing of these drugs.
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