Prescribing antibiotics: It’s time to draw a hard line

This is a call to arms to my fellow providers to protect our patients from themselves and our willingness to comply with their requests.  We live and practice in a society filled with fear of medications and their side effects.  People will not take blood pressure, cholesterol, or diabetic medication because of the side effects they have heard or read about.

However, these same patients will take antibiotics every day of the week for a sniffle or a scratchy throat that started this morning.  Are we facing an epidemic of patients actually addicted to the use of antibiotics?  Where does this laxity in taking antibiotics come from?  Why do the majority of patients believe that antibiotics are harmless, yet pills to prevent stroke are dangerous?

Can we confidently look in the reflection of our professional diplomas and believe that we are doing everything that we can to limit the inappropriate use of antibiotics?  Are we spending adequate time educating patients on adverse effects of antibiotics and their overuse?  I went through a year or two of educating people on methicillin-resistant Staphylococcus aureus or MRSA after it hit the news.  Yet, the majority of patients only came away with a fear of another infection if left untreated rather than an educated concern for use of antibiotics in general.  People wanted more antibiotics for every cut and scrape rather than gaining a true understanding that antibiotics are the cause for such resistance to begin with.  So I am not admitting the full burden of this problem is on the provider, except that we hold the pen that writes the medication.

Today, while I was hospitalizing a toddler with C. diff colitis after three cycles of antibiotics for upper respiratory infections and ear infections (prescribed by multiple area providers), I decided that I am done contributing to the problem.  Being part of the solution will help me sleep much better at night.  I am preparing a handout for patients that will describe in detail the risks associated with taking antibiotics in general and especially repetitive use of antibiotics in inappropriate situations.

I want my patients to be better educated beyond the viral versus bacterial conversation.  Parents should be better informed before being okay with making their children take antibiotics for infections that likely will clear without intervention.  There are many patients that will become unhappy when I refuse to give a-mycin (or one of the other leading off label antivirals on the market) for their new cough or runny nose, but doing the right thing is not always the easy or likable thing.

If you already draw a hard and fast line in the sand, then I applaud you and would like to see your comments and suggestions in a transition of care that I want to make to better my patient population and their overall health.  I applaud those in practice that confidently defer antibiotics in the face of every viral illness that walks through their door.

I want to serve those that seek help and medical advice from me.  I want to use the knowledge I was given in my medical education rather than my willingness to please the patient.    While the news and the reports are not my prime source of information, we are already seeing an increase in hospital infections from bacteria resistant to most if not all antibiotics.  I ask all of us to look at ourselves and our peers and assist in driving a culture shift away from the belief that antibiotics are benign and should be sought for all that ails us.

Wesley Nickens is a family physician who blogs at Family Friendly MD and can be reached on Twitter @FriendlyMD.

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  • Pik Mukherji

    Have refused pts., family members and colleagues their requests for Rx. The more you do, the easier it gets. Soon you won’t be the only voice (of sanity) in your shop. And a few of those folks will actually start feeling better before they find a diff. provider. Stay the course!

    • Suzi Q 38

      I agree. I was one of those patients. My urologist trained me by just saying “no,” since I was asymptomatic.

      • disqus_XpaeflETHK

        Urologists tend to be among the worse with the antibiotics ..constantly presecribing a month of cipro or bactrim for a questionable prostatitis ,

        • Suzi Q 38

          I was having difficulty after a diagnosis of spinal stenosis with urinary incontinence.
          No one had thought to give me a urinalysis, except for my urologist.
          He figured out I needed Cipro. I think I got 10 days.
          My symptoms were better.
          Later, I had to be cleared for my anterior discection with fusion, so the receptionist at the teaching hospital called to tell me that I needed a round of an antibiotic as I still had a UTI.
          The urologist refused to give me one just on my verbal request (as per the hospital), so I called my PCP, who gave me an RX right away.

          I was annoyed with my urologist for saying “no,”
          but I figured I would deal with him after my surgery.

          I talked to him on the phone, and he said something about the “count” and what was the organism, etc. I understood what organism meant ( probably strep or staph, or whatever), so I looked for the causative organism in my lab reports.

          There was nothing. My urologist was right!
          The hospital receptionist probably made an error.
          I have decided to take things more calmly and slowly from now on, with respect to symptoms, fever and antibiotics.

  • K.Lee

    I recently saw an NP for allergy induced ear and sinus trouble (though it was my ear that got me in the door.) She prescribed antibiotic/steriod EAR DROPS, told me to take some sudafed and something for the pain, as well as a different antihistamine…and call her back in a few days if I wasn’t better for oral antibiotics. The sudafed wasn’t helping/was making things worse with my sinuses, but my ear had gotten better. I called back asking if I should switch to a decongestant that I know I tolerate well and see if it makes a difference. She said yes and then the same thing- call back in a few days if not better, for oral antibiotics. I wound up never needing the antibiotics (and I’ve since traded the decongestants for saline nasal spray which is working well for me.)

    • Suzi Q 38

      Same for me. I had a lot of allergies in years past. I used to think it was an infection of some sort, so I used to ask for and get an antibiotic. Now I am glad that doctors are more careful about prescribing them.
      I rarely go in to see the doctor for allergy, nasal, or cold symptoms anymore. I know that I probably don’t need an antibiotic. I don’t want to build up resistance to them.

      This way, when I am truly ill and need that antibiotic, my infection will respond to the drug.

  • Bryan Grumley

    Post your handout when you complete it!

  • David Feig

    Its amazing how many patients really think antibiotics help with a sore throat, a cold or other consistently viral symptoms. Most ear infections in children are due to virus. But if they show up crying with red tympanic membranes…parents are not going to want to leave without an RX. I think until providers are pressured to rush patients in and out as fast as possible, and aren’t at risk for complaints for not giving antibiotics, it won’t change. ER doctors are giving out dilaudid in ERs for fear patients will complain or give negative press ganey reports. The risk of lawsuits and patient complaints drives too many decisions. Poor ones.

    • bill10526

      I remember talking to a doctor at lunch in 1970 or thereabouts about how I found penicillin to be a miracle drug that was dangerous and how its overuse upset me. He said to me “Bill, I can’t get some people out of my office without a prescription.”

      Antibiotics are to be respected as you indicate. Thanks for your welcome comment.

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