Infectious Disease

Educating sufferers about particular person hurt from antibiotics can scale back the variety of inquiries

January 15, 2021

2 min read

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To curb the unnecessary use of antibiotics, doctors should educate patients about the potential harm of using them to individuals rather than society or antibiotic resistance, researchers wrote in the Journal of the American Board of Family Medicine.

Previous research has shown that doctors are up to ten times more likely to prescribe an antibiotic if they think the patient is expecting one. I’m Miller, BS, and an MD candidate from Johns Hopkins University School of Medicine, and colleagues wrote.

“Understanding which messages about possible harm from antibiotics resonate best with patients could help doctors improve their communication with patients about unnecessary antibiotic use, and could also help broader campaigns improve their messages about antibiotics.” Sara Condron Keller, MD, MPH, MSPH, The study co-author and assistant professor of medicine at the Johns Hopkins University School of Medicine told Healio Primary Care.

Sara Condron Keller

Miller, Keller, and colleagues developed 18 statements about the potential harm of antibiotics that were “understandable, well-written, and not significantly overlapping in content,” said Keller. They then conducted a survey with the 18 statements in 250 patients (women = 184; black = 152) in a primary care clinic in Baltimore. Patients were asked about their overall likelihood of requesting antibiotics for upper respiratory tract infection (URI) before and after completing the survey. These patients also rated each of the 18 statements on an 11-point Likert scale. Zero points meant that the patient was “much less likely” to request antibiotics for a URI after reading the statement, while 10 points meant that the patient was “much more likely” to request antibiotics for a URI after reading the statement.

Eight statements focused on potential harm to the patient (e.g., “Antibiotics can make you more likely to become obese”). Four statements presented possible negative consequences for people close to the patient who took the antibiotics (e.g. “Antibiotics can change the growth of babies in pregnant women”). and six statements outlined plausible harm to society (e.g., “Each antibiotic-resistant infection costs up to $ 30,000 more than other infections”). Eight of the 18 statements related to damage caused by antibiotic resistance.

The researchers reported that prior to the survey, the patients’ raw mean was 5.3 points, meaning that “antibiotics are requested slightly more often than not”. According to the survey, the probability decreased to 3.1 points, which means that “antibiotics are unlikely to be requested” (total difference –2.2 points; P <0.001). Although all statements reduced the likelihood of requesting antibiotics, the likelihood of requesting antibiotics was significantly higher than the statements about harm to society (P <0.001).

The researchers noted that larger studies are needed to validate their results, but Miller said in an interview that the results would likely be similar.

Benjamin Miller

“People are programmed to survive and protect those close to us, with less attachment to society at large,” he said. “Antibiotic abuse harms both individuals and society. Focusing our communications on what matters most to patients is only good patient-centered care that also helps society. “

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Trini Mathew, MD, MPH, FACP, FIDSA

I agree with the findings of Miller and colleagues. We need to personalize the messages to curb the unnecessary use of antibiotics. For years it has been my standard practice to weigh the advantages and disadvantages of antibiotic use in each of my patients whenever antibiotics occur.

In particular, I tell patients that while antibiotics can cure an infection, they can also cause other infections such as diarrhea due to Clostridioides difficile or yeast infection. In addition, like many other medications, antibiotics can cause drug-related rashes and drug allergies. I advise patients, if they have any of these conditions, to see a doctor immediately to determine the cause of the condition and to receive treatment.

These conversations need to be ongoing, especially during the pandemic. Studies have shown that in the early days of the COVID-19 pandemic, hospitals used a lot of antibiotics to empirically treat possible sepsis in patients with COVID-19. Because we can better treat COVID-19 infections, we’ve learned to de-escalate antibiotics and not use them for this purpose. Treatment guidelines have also been updated to reflect that azithromycin should no longer be used to treat SARS-CoV-2 virus infections. However, there may be some patients who still believe that antibiotics treat the COVID-19 virus infection, underscoring the need to tailor the news about antibiotics for each individual patient.

Trini Mathew, MD, MPH, FACP, FIDSA

Member of the Society of Healthcare Epidemiology of America
Medical Director of Hospital Epidemiology and Infection Control, Beaumont Hospital, Royal Oak, Mich.

Disclosure: Mathew does not report any relevant financial information.

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