Drug store and supermarket shelves display aisle after aisle of OTC medications that alleviate the common symptoms of upper respiratory infections. Despite the easy availability of symptom relief, a significant number of people consult clinicians in primary care offices, emergency departments (EDs), and walk-in or convenient care clinics for help when they feel that they’re “coming down with something.” During these visits, many of these patients expect, and sometimes demand, antibiotics.
Antibiotics may be viewed by the patient as a quick fix, with the demand undoubtedly fueled by busy lifestyles, long work hours, and little time for patients to stay home while ill. Patients so inclined may “doctor shop” if their demands are not met; clinicians know better but may feel pressure to “satisfy the customer” and may rationalize that an antibiotic might prove helpful in a particular case.
Lee et al studied outpatient antibiotic prescribing in the United States for acute respiratory tract infections (ARTI), including acute nasopharyngitis, upper respiratory tract infection, bronchitis, influenza, pharyngitis, and sinusitis. In 2000, antibiotics were prescribed during outpatient visits for ARTI to 64% of patients; by 2010, that percentage had increased to 73%.1 Although antibiotics are neither effective nor appropriate for the treatment of ARTI, most of which are viral infections, they are commonly prescribed. Further, while 17% of ARTI prescriptions in 2000 were for broad-spectrum antibiotics, that percentage jumped to 46% in 2010.1,2
Patient insistence on antibiotics may stem either from little knowledge of or little regard for the health problems caused by unnecessary antibiotic use. For example, one study found that 19.3% of drug-related ED visits were related to systemic antibiotics; nearly 80% of those were for allergic reactions.3,4 With an estimated 50% of antibiotic prescriptions considered inappropriate, the overuse of antibiotics creates unnecessary personal health risks and health care expenditures. Further, a more serious consequence of this overuse is the growing public health problem of antibiotic resistance (see Figure 1).1,2
Clinicians are ideally positioned to address these issues by incorporating effective, proactive strategies into selected patient encounters to specifically explain appropriate versus inappropriate antibiotic use.
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