Clinicians often disregard advice on antibiotic prescription

Many clinicians disregard recommendations on when it is appropriate to prescribe antibiotics, according to a survey of physicians, nurse practitioners (NPs) and physician assistants (PAs) published in Emerging Infectious Diseases.

Researchers, led by Guillermo Sanchez of the Centers for Disease Control and Prevention, conducted and recorded telephone interviews with 27 physicians, five NPs and five PAs. Prior to the interview, respondents filled out a questionnaire ranking how 12 factors, such as patient demand and illness severity, influenced their antibiotic selection, after which they discussed their answers during the interviews.

Sanchez and his team found significant variation in how respondents defined broad- and narrow-spectrum antibiotics. "Although some participants correctly identified amoxicillin as a narrow-spectrum agent, and azithromycin as a broad-spectrum agent, many participants were uncertain of the spectrum of antimicrobial activity for these two widely used antibiotics," they wrote.

The researchers also found several clinicians believed broad-spectrum antibiotics were more effective against fighting infections, despite no evidence for this belief, which may contribute to inappropriate selection. They also found prescribers commonly felt patients expect antibiotics, and that not prescribing them will negatively affect patients' satisfaction ratings. Different patient expectations, they said, would alleviate some pressure on prescribers.

"Future research efforts should be aimed at investigating effective incentives for appropriate antibiotic prescribing and determining alternative communication strategies to encourage use of first-line agents. Although most efforts have focused on reducing unnecessary antibiotic use, more research is needed to clarify which interventions improve antibiotic selection," Sanchez and his team wrote.

A September study found inappropriate or unnecessary antibiotic prescription is widespread in hospitals, with nearly 80 percent of hospitals using inappropriate or unnecessary antibiotic combinations, FierceHealthcare previously reported. "If these cases were representative of all U.S. hospitals over the same time period, more than $163 million could have been saved by reducing the antimicrobial drug use," said Leslie Schultz, R.N, Ph.D., director of the Premier Safety Institute.

To learn more:
- here's the study