The Context of Antibiotic Overuse

Editorials7 August 2012The Context of Antibiotic OveruseSara Ackerman, PhD, MPH and Ralph Gonzales, MD, MSPHSara Ackerman, PhD, MPHFrom University of California, San Francisco, San Francisco, CA 94143. and Ralph Gonzales, MD, MSPHFrom University of California, San Francisco, San Francisco, CA 94143.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-3-201208070-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Overuse of antibiotics is a vexing problem in biomedicine. Antibiotic use, especially broad-spectrum antibiotics, is increasing around the world, and a substantial proportion of prescriptions in the United States and other countries is used for viral illnesses that do not respond to these drugs. Antibiotic overuse is costly and contributes to bacterial resistance, but unnecessary prescribing is commonplace. Antibiotic prescribing also varies widely among individual clinicians and geographic regions.The persistence and variability of this problem point to the reality that prescribing decisions, in particular those for respiratory illnesses, are rarely based on clinical factors alone. As a result, antibiotic ...References1. Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations—a questionnaire study. BMJ. 1997;315:520-3. [PMID: 9329308] CrossrefMedlineGoogle Scholar2. Steinman MA, Landefeld CS, Gonzales R. Predictors of broad-spectrum antibiotic prescribing for acute respiratory tract infections in adult primary care. JAMA. 2003;289:719-25. [PMID: 12585950] CrossrefMedlineGoogle Scholar3. Gonzales R, Barrett PH, Crane LA, Steiner JF. Factors associated with antibiotic use for acute bronchitis. J Gen Intern Med. 1998;13:541-8. [PMID: 9734791] CrossrefMedlineGoogle Scholar4. 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[PMID: 18665065] CrossrefMedlineGoogle Scholar14. Temte JL, Shult PA, Kirk CJ, Amspaugh J. Effects of viral respiratory disease education and surveillance on antibiotic prescribing. Fam Med. 1999;31:101-6. [PMID: 9990499] MedlineGoogle Scholar15. Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. BMJ. 1998;317:637-42. [PMID: 9727992] CrossrefMedlineGoogle Scholar16. Scott JG, Cohen D, DiCicco-Bloom B, Orzano AJ, Jaen CR, Crabtree BF. Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J Fam Pract. 2001;50:853-8. [PMID: 11674887] MedlineGoogle Scholar17. Stivers T. Participating in decisions about treatment: overt parent pressure for antibiotic medication in pediatric encounters. Soc Sci Med. 2002;54:1111-30. [PMID: 11999506] CrossrefMedlineGoogle Scholar18. Gabbay J, le May A. Evidence based guidelines or collectively constructed "mindlines?" Ethnographic study of knowledge management in primary care. BMJ. 2004;329:1013. [PMID: 15514347] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Sara Ackerman, PhD, MPH; Ralph Gonzales, MD, MSPHAffiliations: From University of California, San Francisco, San Francisco, CA 94143.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1493.Corresponding Author: Ralph Gonzales, MD, MSPH, 3333 California Street, Box 1211, San Francisco, CA 94118; e-mail, [email protected].Current Author Addresses: Dr. Ackerman: 185 Berry Street, Suite 5700, Box 0560, San Francisco, CA 94107.Dr. Gonzales: 3333 California Street, Box 1211, San Francisco, CA 94118. 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Flanders, MD, and Sanjay Saint, MD, MPHAntibiotic prescribing for the future: exploring the attitudes of trainees in general practiceThe State of Overuse MeasurementPaying the doctor: evidence-based decisions at the point-of-care and the role of fee-for-service incentives 7 August 2012Volume 157, Issue 3 Page: 211-212 Keywords Antibiotics Antivirals Epidemiology H1N1 Health economics Motivation Perception Prevention, policy, and public health Pulmonary diseases Reasoning ePublished: 7 August 2012 Issue Published: 7 August 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...