Antibiotics may well be the single most important invention of the 20th century. Without antibiotics, simple bacterial infections would undoubtedly cause mortality. But although these medications have become an essential aspect of patient treatment, many clinicians have trouble deciding when antibiotics are appropriate to prescribe.
The first step is deciding if a patient’s infection is viral or bacterial in nature. Many patients present with the following vague symptoms that have persisted for three to five days: nasal congestion, productive or non-productive cough, sore throat, fever or chills. Data indicate that for the majority of these encounters, the illness is almost always viral. Yet these patients often demand antibiotics.
In a recent patient encounter I completed a full respiratory, cardiovascular, and head, eyes, ears, throat and neck assessment. Findings were consistent with a viral upper respiratory infection.
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To further confirm my diagnosis, I carefully went over the history of the present illness with the patient, being sure to note symptom duration and whether the symptoms seemed to be improving or worsening – all of which pointed to viral illness.
I proceeded to educate the patient about the best options for symptom relief and recommended a nasal decongestant. But she became very irritated and demanded that I prescribe an antibiotic, claiming that this was the treatment she had always received in the past.
As a recent graduate, I believed that properly and judiciously would be fairly easy, but this patient was challenging. I found myself struggling with the desire to be understanding of my patient’s needs, while being objective about implementing the treatment plans I know are evidence-based. There appears to be a fine line between the two.
Education is the only solution to change antibiotic misuse. Not just patient education, but reeducating providers who continue to prescribe antibiotics improperly. Although it is important to be flexible with patients and individualize care, it is never appropriate to prescribe antibiotics for non-bacterial infections.
I encourage my fellow clinicians to take a moment to review the antibiotic prescribing guidelines for both adult and pediatric patients that are available on the CDC’s website.
