Infection control: why doctors over-prescribe antibiotics
Over-prescribing
A recent Australian study found that while approximately 40 percent of hospital in-patients receive antibiotics, nearly half of those are actually unnecessary or sub-optimal.
Hospital-based “antimicrobial stewardship programs” to reduce inappropriate prescribing may prompt initial shifts in behavior, but research shows doctors quickly return to inappropriate antibiotic use.
To investigate why, my colleagues and I at the University of Queensland and the Sunshine Coast Health and Hospital Service interviewed thirty hospital-based doctors from a range of specialties.
We found that the hospital environment and medical culture inadvertently promote and perpetuate unnecessary use of antibiotics or overuse of the most potent, broad-spectrum antibiotics.
Despite understanding the long-term risks of resistance, doctors are focused almost exclusively on treating the potential infection in front of them, in their individual patient. Long-term risks are not prioritized and the judicious use of antibiotics is not valued.
On night shifts, junior staff reported over-prescribing antibiotics to avoid having to wake a senior doctor and ask for help. They were also worried about the risk of not acting to prevent or treat the infection.
Senior doctors reported an inability to accept the risk that avoiding prescribing the most potent broad spectrum antibiotic might present.
Towards best practice
This problem of short-term cost for long-term gains speaks to a range of dilemmas currently facing humanity including global financial security and environmental protection; while human beings might understand and worry about long-term consequences, they are drawn to respond to day-to-day immediate risks to themselves and others. And doctors are no different.
The medical fraternity is orientated towards their individual patient and is less concerned about the population-level crisis of antibiotic-resistance. But the reality is, when a doctor is treating their patient, they are, in fact, treating future patients and the broader community.
The question, then, becomes what short-term costs can we tolerate to secure our collective long-term health?
The first logical step to reduce over-prescribing is to create the professional and organizational structures that support careful use of antibiotics, particularly potent, broad-spectrum antibiotics which are our only defense against highly resistant bugs.
Reducing the fear of blame, responsibility or even litigation if all potent antibiotic options aren’t utilized is an important professional issue to address. In other words, we must allow doctors to be more judicious without the potential for blow back if things do go wrong.
Finally, it’s time we all recognized that antibiotics are a diminishing resource and they’re not the solution to all our health problems.
Next time I’m faced with an antibiotics script, I’m going to ask my doctor: do I really need this, or should we let nature take its course? I accept that a small risk to me, and perhaps a slightly longer period being ill, is worth it to secure the future of antibiotics.
Alex Broom is Associate Professor of Sociology & Australian Research Council Future Fellow at University of Queensland. This story is published courtesy of The Conversation (under Creative Commons-Attribution/No derivatives).
