Antimicrobial Stewardship – Doctors Changing Approach To Antibiotics
You went to bed feeling great but woke up miserable. The symptoms hit you like a ton of bricks. A runny nose, fever, nausea and feeling just plain achy all over. You want to feel better. Now. After all, you have a shift to work and chores that need to get done. You call your doctor and ask him to prescribe an antibiotic. That should make you feel better in no time, right? Not
Recent medical trends show that taking an antibiotic every time you get sick may not be your best course of action, and it could actually do more harm than good.
As a result, family practitioners are engaging in “Antimicrobial Stewardship,” a coordinated effort to use antibiotics wisely and help doctors have a meaningful dialogue with their patients about whether to use
Let’s take a look at why antibiotics may not be the best treatment option for patients in the long run.
Antibiotics Don’t Always Work
In the majority of cases where a patient has a cold or the flu, antibiotics don’t work. They treat bacterial infections, not viruses. Antibiotics have been a simple solution for meeting patient expectations, but doctors are changing their approach based on the emergence of new data about the impact of overusing antibiotics.
According to an article published in Clinical Infectious Diseases, outpatient doctors prescribed more than 260 million courses of antibiotics in 2011. (US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis. 2015;60(9):1308. Epub 2015 Mar 5.). Practitioners prescribed antibiotics primarily for respiratory, skin and urinary tract infections. But when it came to the common cold, researchers (Factors associated with antibiotic misuse in outpatient treatment for upper respiratory tract infections. Antimicrob Agents Chemother. 2015;59(7):3848. Epub 2015 Apr 13.) found that antibiotics were used unnecessarily. In a study including more than 1000 adults that were treated for cold symptoms between 2009 and 2011, eight out of 10 adults were prescribed antibiotics. Only three actually needed them. Similarly, the Centers for Disease Control and Prevention (CDC) (Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. JAMA. 2016;315(17):1864.) found that “[20-50%] of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate.”
The Unintended Negative Consequences of Antibiotic Use
Over time, the medical community has learned that extensive use of antibiotics has unintended negative consequences.
According to the CDC, “Patients who are unnecessarily exposed to antibiotics are placed at risk for serious adverse events with no clinical benefit. The misuse of antibiotics has also contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health.”
Using the same antibiotics over and over again causes the drugs to become ineffective. They can no longer kill bacteria that’s adapted and become resistant from long-term exposure. A prime example is MRSA (pronounced “MER-SA”) infections, which are very difficult to treat and can be fatal.
Overuse can also lead to toxicity in the body and other negative side effects, including nausea, abdominal pain, diarrhea and allergic reactions. It’s important to use antibiotics only when they will be truly effective in treating illness.
Have a Conversation with Your Doctor About Treatment Options
Doctors are making a more concerted effort to engage in shared decision-making with their patients on treatment options.
So, what should you do if your come down with a virus, like the flu?
First, it’s important to recognize that popping a penicillin pill won’t help since the flu is caused by a virus.
Next, talk with your doctor about how you can support your immune system and treat your symptoms. Stay well hydrated and get plenty of sleep. Reduce fever and aches with over-the-counter-medications like acetaminophen or ibuprofen.
Lastly, talk to your doctor about a clear follow-up plan if your health doesn’t improve or your symptoms get worse. For example, you may agree to call or come back in after the first seven days of symptoms. This gives the virus time to run its course and allows your doctor to engage in what’s called “watchful waiting” or “delayed prescribing.” It also gives your doctor the opportunity to determine whether you will benefit from other treatment options while safely reducing antibiotic use in circumstances when they’re not needed.
Education Before Medication
As the medical community learns more about the long-term effects of antibiotics, doctors are more focused on taking the time to educate their patients about antibiotic use and other treatment options, instead of just writing prescriptions and sending patients on their way.
Doctors are actively participating in “Antimicrobial Stewardship” programs and working with patients to make them feel better quickly while minimizing the unintended negative consequences of antibiotic use.
So, the next time you wake up feeling under the weather, contact your doctor to discuss your best course of action, but realize that the optimal long-term treatment may not be popping a pill. Instead, it may be learning how to alleviate symptoms while supporting your body’s natural recovery process.