More than 70% of doctors said they would administer antibiotics to treat asymptomatic bacteria found in urine tests, disobeying recommended guidelines, survey finds
A study of primary care physicians found that, based on a single positive urine sample, approximately 70% of them would still recommend antibiotics to treat asymptomatic infections. According to a study recently published in the journal Open JAMA Network, this despite long-standing medical standards that advise against this practice. Researchers from the University of Maryland School of Medicine (UMSOM) led the study.
Medical associations have opposed the regular use of antibiotics for people with bacteria found in a urine culture but no signs of urinary tract infection (UTI), such as burning or frequent urination, since 2005 Overwhelming evidence suggests that the drugs are ineffective for asymptomatics. patients and may instead cause side effects such as diarrhea, vomiting, skin rashes and yeast infections. In rare cases, antibiotics can even lead to death due to an excess of harmful bacteria It’s hard in the colon. Overuse of these drugs has also led to an increase in bacterial infections that are difficult to treat and sometimes fatal due to their resistance to antibiotics.
In the study, 723 primary care professionals from Texas, Mid-Atlantic, and Pacific Northwest were asked how they would treat a fictional patient with asymptomatic bacteriuria, i.e. when bacteria are detected in the urine of a patient who shows no signs. of a urinary tract infection. They found that, even if it went against recommended guidelines, 392 of the 551 doctors who responded to the study (71%) would choose to treat such a patient with antibiotics.
“Our study suggests that primary care clinicians are not following widely accepted recommendations against prescribing antibiotics for asymptomatic bacteriuria,” said lead author Jonathan Baghdadi, MD, Ph.D., assistant professor of epidemiology. and public health at UMSOM. “Some primary care clinicians may not be aware of these recommendations, but an inappropriate prescribing culture is also likely a contributing factor.”
Compared to other specialties, family physicians were more likely to prescribe unnecessary antibiotics. Physicians in residence or living in the Pacific Northwest were less likely to administer antibiotics.
“We found that other factors also played a role in prescribing, such as whether a physician had a stronger preference for overtreating a disease and fear of missing a diagnosis; this person was more likely to favor antibiotic prescribing compared to a physician who felt more comfortable with uncertainty in the practice of medicine,” said study leader Daniel Morgan, MD. , MS, professor of epidemiology and public health at UMSOM.
One practice-changing strategy could be an education program targeting doctors who place a high priority on treatment just to make sure they don’t miss a possible infection, the researchers said in the conclusion section of the paper. . For example, redefining “unnecessary treatment” with antibiotics as “potentially harmful” treatment with antibiotics could help curb the trend of overprescribing.
UMSOM faculty and staff Lisa Pineles, MA, Alison Lydecker, MPH, Larry Magder, Ph.D., and Deborah Stevens, LCSW-C, MPH, were study co-authors. Researchers from the University of Colorado School of Medicine and Memorial Sloan Kettering Cancer Center also contributed to this study.
The research was funded by the New Innovator Award from the National Institutes of Health and the University of Maryland, Baltimore Institute for Clinical & Translational Research/Clinical and Translational Science Award.
“This is an important finding that underscores the importance of continuing medical education to help change lingering attitudes toward antibiotics that are outdated with current guidelines,” said E. Albert Reece, MD, Ph. D., MBA, Executive Vice President of Medical Affairs, UM Baltimore, and John Z. and Akiko K. Bowers Professor Emeritus and Dean, University of Maryland School of Medicine. “Doctors first learn to do no harm, and now we know that overtreatment with antibiotics could lead to real harm.”
Reference: “Exploring Primary Care Clinician Attitudes and Cognitive Characteristics Associated with Prescribing Antibiotics for Asymptomatic Bacteriuria” by Jonathan D. Baghdadi, MD, Ph.D., Deborah Korenstein, MD, Lisa Pineles, MA, Laura D. Scherer, Ph.D., Alison D. Lydecker, MPH, Larry Magder, Ph.D., Deborah N. Stevens, LCSW-C, MPH, and Daniel J. Morgan, MD, MS, May 27, 2022, JAMA network open.