• One of the goals of Healthy People 2020 is to “increase immunization rates and reduce preventable infectious diseases.”6 Goal IID-6 is specific: “Reduce the number of courses of antibiotics prescribed for the sole diagnosis of the common cold.”6
• The Institute of Medicine has identified six key issues that must be addressed in today’s health care systems, including safety and effectiveness of care. Safety involves “avoiding injuries to patients from the care that is intended to help them.”7 Surely avoiding inappropriate use of antibiotics qualifies.
I’m not suggesting we should never prescribe antibiotics; we all know there are instances in which it is absolutely appropriate: in patients who are immunocompromised and in cases when we suspect strep throat, bacterial sinusitis, or epiglottitis. When we have these clinical suspicions, we need to obtain cultures to confirm them. And if treatment is the right course, we should prescribe the right antibiotic at the right dose for the right duration and be familiar with regional resistance trends.3
We—as primary care providers—can easily mitigate the global threat of antibiotic-resistant bacteria if we encourage symptomatic therapy for URIs: those simple, “tried and true” treatments. We know them, our patients know them, and just in case we forget, we have seasonal commercials to remind us. The treatment for the average URI is simple: Rest in bed, drink plenty of fluids, and take nonprescription medications to attenuate symptoms such as fever or myalgia. (For helpful patient education, see “When Patients Ask for Antibiotics, Arm Them With Handouts”)
We must base our decision whether to treat common URI complaints with antibiotics on sound clinical findings. Take the time to explain to your patients those findings and educate them about appropriate use of antibiotics. Moreover, when the clinical findings do not support the need for an antibiotic, tell your patients, “I’m not saying you aren’t sick; I’m telling you that you don’t need antibiotics for your illness!” Remind patients that they will get better, as one colleague of mine always said, “in seven days with, or in a week without, antibiotics.”’
So, when you must, write the prescription. But please: Prescribe “tincture of time.”
REFERENCES
1. Johns Hopkins. Upper respiratory infection (URI or common cold). www.hopkinsmed icine.org/healthlibrary/conditions/pediatrics/upper_respiratory_infection_uri_or_common_cold_90,P02966/. Accessed August 14, 2014.
2. World Health Organization. Antimicrobial resistance. www.who.int/mediacentre/fact sheets/fs194/en/. Accessed August 14, 2014.
3. CDC. Delivering smart care for patients: all healthcare providers play a role. www.cdc.gov/getsmart/healthcare/factsheets/hc_pro viders.html. Accessed August 14, 2014.
4. Global Antibiotic Resistance Partnership (GARP) India Working Group. Rationalizing antibiotic use to limit antibiotic resistance in India. Indian J Med Res. 2011;134(3):281-294.
5. Alliance for the Prudent Use of Antibiotics. www.tufts.edu/med/apua/about_us/what_we_do.shtml. Accessed August 14, 2014.
6. United States Department of Health and Human Services. Immunization and infectious disease. www.healthypeople.gov/2020/
topicsobjectives2020/overview.aspx?
topicid=23. Accessed August 14, 2014.
7. The Institute of Medicine. An agenda for crossing the chasm. In: Crossing the Quality Chasm: A New Health System for the 21st Century. 2001:5-6. http://books.nap.edu/openbook.php?record_id=10027&page=5. Accessed August 14, 2014.