I suspect that almost every physician in theUnited Stateswould agree that antibiotics are over-prescribed. Unfortunately, since the total number of antibiotic prescriptions in theUnited Statesgiven to people with “cold” has been estimated at 44 million per year, it would seem that most physicians have not actually decreased their own prescribing habits. I can see how this would be the case. Physicians are stuck in the inertia of “I have always done it this way.” Also, “my patients expect an antibiotic when they come in and they won’t be happy if I don’t prescribe one.” Finally, “The antibiotic can’t hurt and it might help!” Multiply each incident of an unneeded prescription by, oh, a few million, and it adds up.
Of course, inappropriate antibiotic use can and does hurt. It hurts every patient who has an adverse effect from inappropriate antibiotic prescriptions, stuff like diarrhea, yeast infections, nausea or an allergic reaction. It hurts the community by breeding antibiotic resistant bugs. And it hurts because inappropriate antibiotic use is expensive! 40 billion dollars a year expensive! How much of that money is being wasted at your facility?
One of the neatest things that I have discovered about the evidence-based medicine movement is that using evidence-based principles almost always saves money. There is no better example of this than in the area of antibiotic use.
Three years ago, the Centers of Disease Control published evidence-based guidelines for the appropriate use of antibiotics for upper respiratory infections. The guidelines were developed by a panel of experts which included representatives from infectious disease, family practice, emergency medicine, internal medicine and from the CDC itself. The panel used evidence-based principles to review the huge amount of literature on these subjects. In the end, they came up with guidelines entitled “Principles of Appropriate Antibiotic Use for Acute Respiratory Tract Infections in Adults.” The finished guidelines can be found in the March 20, 2001edition of the Annals of Internal Medicine or online at www.cdc.gov/ncidod/dbmd/antibioticresisance/. The final report included pharyngitis (which I reviewed in the last issue of CorrectCare), acute bronchits, and rhinosinusitis.