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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