Throughout the past 2 decades, interventions targeting both physicians and patients have effectively decreased inappropriate antibiotic use. However, physician concern relating to patient satisfaction scores may limit the overall efficacy of these interventions. “A recent study showed an 85% decrease in antibiotic prescribing for ARTI and increased satisfaction ratings when providers gave advice on symptomatic therapy and explained why antibiotics were not needed for ARTI,” wrote Dr Harris and colleagues.
Clinicians are advised to consider implementing one of the following evidence-based strategies to limit antibiotic prescription while maintaining patient satisfaction:
- Label acute bronchitis as a “chest cold” or “viral upper respiratory infection”
- Provide patient information sheets about appropriate antibiotic use and alternatives to antibiotics for managing symptoms
- A symptomatic prescription pad can be used to provide recommendations for management of symptoms
- When it is unclear whether an antibiotic is needed, offer the possibility of future antibiotic treatment if the condition does not improve. This is known as the wait-and-see approach
“Reducing antibiotic prescriptions on a large scale will require a multidimensional approach,” concluded Dr Harris. “A systematic review of 39 studies showed that multifaceted interventions that combine physician, patient, and public education in various settings are most effective.… Reducing inappropriate antibiotic prescribing will improve quality of care, decrease healthcare costs, and preserve the effectiveness of antibiotics.”
- Harris AM, Hicks LA, Qasseem A. Appropriate antibiotic use for acute respiratory tract infection in adults: Advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 19 January 2016; doi: 10.7326/M15-1840