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High Rates of Unnecessary Prescribing of Antibiotics

Discussion in 'General Issues and Discussion Forum' started by Craig Payne, Oct 7, 2013.

  1. Craig Payne

    Craig Payne Moderator


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    Press Release
    High Rates of Unnecessary Prescribing of Antibiotics For Sore Throat and Bronchitis Observed Across the United States
    Researchers find large discrepancy between outpatient visits requiring antibiotics and national prescribing rates.
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  3. Why are antibiotics over-prescribed here in the US....one word....lawyers!
  4. wdd

    wdd Well-Known Member

    Apparently 80% of the antibotics sold in the USA are for animal use and 80% of these are used on healthy animals?

    In terms of over use in humans a useful starting point might be the Johns Hopkins Antimicrobial Stewardship Program which was created in July 2001 and publishes an annual Antibiotic Management Guidelines booklet which can be downloaded free of charge.

    Unfortunately from 2001 to now the use of antibiotics has continued to rise but to be optimistic maybe they have been used more appropriately, ie for the correct conditions.

  5. Here in the USA, many of the tests we order and medications we prescribe could be branded as "unnecessary" if one was to only look at statistical probabilities of adverse affects occurring if those tests or medications were not ordered or prescribed.

    However, if I were to not give pre-operative antibiotics for my patient's surgery and they got a post-op infection, or if I were to not do an MRI on a slow healing ankle sprain that was later discovered to have a non-radiographically evident osteochoncral injury of the ankle that eventually led to ankle DJD, the patient, if they decided to sue me for medical malpractice, would have an increased chance of winning their malpractice case against me for not prescribing that antibiotic or not doing that MRI.

    Therefore, yes these tests we often order and the medications we often prescribe may be determined by some medical statistician as being "unnecessary". However, until patients can't sue us doctors here in the USA for not doing tests, or not ordering medications, we will likely tend to continue to order these tests "necessarily" in order to meet the standard of medical care of our communities and avoid malpractice lawsuits.

    If I was to put these individuals doing these reports in our place and let them go through the nerve-wracking mental anguish of going through their own medical malpractice trial, they will likely sing a much different song than what they previously sang when they are enlightened to the realities of modern medical practice.
  6. wdd

    wdd Well-Known Member

    Even in the Antibiotics Guidelines the authors actively steer away from the thorny problem of whether or not to give antibiotics in the first place.

    Their guidelines are only concerned with ensuring that those patients who are already on antibiotics receive optimal treatment as the following quote from the introduction demonstrates. '..every patient at Hopkins on antibiotics gets optimal treatment'.

    What if the optimal treatment is, rather than being a different antibiotic, no antibiotic at all?

    Is there such a document as, 'Antibiotics- when to use and when not to use?'

    Is there research evidence to inform such a document?

    What are the economics (financial and emotional) of the situation, ie would it cost more to fight malpractice suits than could be saved by not prescribing antibiotics?

    I don't imagine that the pharmaceutical companies would be too happy if their sales of antibiotics were reduced. I would think that they would try to do everything possible to ensure that their sales of antibiotics at worst stay the same if not increase.

    So you, the practitioner, have not only lawyers but super big business ranged against you plus the patient who in many ways is just a pawn in the game.

    It would seem to me that unless antibiotic- when to prescribe and when not to prescribe guidelines, with a lot of clout, can be produced we will just have to wait for the boil to burst.

    So at best that takes care of 20% of antibiotic use. What about the other 80%?


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