For many years, health authorities around the world have tried to reduce the overuse of antibiotics in cases where they are not strictly necessary, but a new study shows that the message is still not getting through, even within the medical community.
The problem is serious. Along with the risk of side effects when antibiotics are prescribed unnecessarily, the specter of antibiotic resistance is a growing concern in global health, already being the third leading cause of death worldwide by some estimates.
Against this backdrop, it’s easy to see why organizations like the Centers for Disease Control and Prevention (CDC) are stepping up efforts to improve antibiotic awarenessbecause the overconsumption of these drugs contributes to stimulate the more than 2.8 million antibiotic-resistant infections that occur each year in the United States, thousands of which become fatal.
Unfortunately, we still have a long way to go, because the new survey results conducted by researchers at the University of Maryland School of Medicine reveal.
In the survey, which was completed by 551 practicing primary care clinicians at medical facilities in Texas, Mid-Atlantic and Pacific Northwest, participants were presented with a number of scenarios hypothetical clinics.
One of these hypothetical scenarios involved Mr. Williams, a 65-year-old patient, who presents with asymptomatic bacteriuria: a medical condition in which a large number of bacteria are present in the urine, but there are no symptoms suggesting a urinary tract infection.
Clinical practice guidelines in the United States state that in the absence of specific risk factors, a patient like Mr. Williams should not receive antibiotics.
But in the survey, a clear majority (71%) of respondents who took the survey said they would prescribe Mr Williams antibiotics.
“Our study suggests that primary care clinicians are not following widely accepted recommendations against prescribing antibiotics for asymptomatic bacteriuria,” said lead study author and epidemiologist Jonathan Baghdadi.
“Some primary clinicians may not be aware of these recommendations, but an inappropriate prescribing culture is also likely a contributing factor.”
According to the researchers, the tendency to prescribe antibiotics was more frequent among attending physiciansfamily physicians and clinicians who lived outside of the Pacific Northwest.
“However, most clinicians, regardless of degree type, years of practice, or geographic region, reported being willing to prescribe inappropriate antibiotics,” the authors writenoting that the campaigns advising doctors do not treat asymptomatic bacteriuria with antibiotics seem to have failed.
According to the team, there are a number of reasons why a doctor may inappropriately prescribe an unnecessary antibiotic.
Previous studies have shown that physicians may feel the need to meet their patients’ expectations or may feel that the public health argument for not prescribing antibiotics does not translate to the bedside.
In other cases, a doctor might simply misdiagnose the patient based on the available facts, thinking antibiotics are necessary for a condition, when in fact they are not recommended.
“The overwhelming majority of clinicians who indicated that they would prescribe antibiotics believed that the patient had a high likelihood of having a UTI, although case details do not support this diagnosis,” the researchers said. . explain in their article.
“We suspect that many clinicians in our sample were unaware of what constitutes UTI symptoms or were unaware that symptoms are needed to support a UTI diagnosis.”
Current residents – medical graduates still training in hospitals – were less likely to prescribe antibiotics in the survey, suggesting that as newer students of the medical training system, they may have better assimilated the most recent information on the appropriate management of asymptomatic bacteriuria.
But the attitudes and cognitive characteristics of clinicians also play a role, the researchers say, with physicians playing the role of “medical maximizers” more likely to prescribe antibiotics inappropriately in the hypothetical scenario.
“Medical maximizers favor errors of commission over errors of omission, preferring to treat even when the treatment is of uncertain value and may introduce risk of harm,” explain the researchers.
For this reason, the researchers believe that future interventions designed to discourage overprescription of antibiotics could benefit from more specific targeting of the mindset of medical maximizers, who may be more resistant to current messages used in campaigns. .
Of course, there are a number of limitations to consider here, which the researchers acknowledge in their study – primarily, that their survey only involved a hypothetical clinical scenario, and the way respondents responded to the question does not necessarily reflect how they would do it. treat a patient living in front of them.
Even so, it seems that there is clearly much more work to be done to educate professional physicians on the issue of the appropriate use of antibiotics, at least in this medical setting, if not in others.
When seven out of 10 doctors are wrong about the same thing, we have a job ahead of us.
The findings are reported in Open JAMA Network.