In the ongoing battle against antibiotic resistance, a critical factor has been identified within healthcare practices— inappropriate antibiotic prescribing. This has become a global concern as the misuse of antibiotics is a driver of resistance. On May 6, 2019, CMAJ (Canadian Medical Association Journal) published an article that underscores the urgent need for improved education for both healthcare providers and patients (DOI: 10.1503/cmaj.109-5742). Authored by Caroline Mercer from Toronto, Ontario, the article draws attention to the need to reduce unnecessary antibiotic prescriptions to prevent the escalation of resistance.
Keywords
1. Antibiotic Resistance
2. Inappropriate Prescriptions
3. Doctor Education
4. Patient Awareness
5. Antimicrobial Stewardship
The Problem of Inappropriate Antibiotic Prescriptions
Antibiotic resistance is one of the biggest threats to global health today. It leads to longer hospital stays, higher medical costs, and increased mortality. One of the main drivers of this resistance is the inappropriate prescribing of antibiotics. A study published in the CMAJ noted that inappropriate prescribing prevention and control could significantly impact the stewardship of antibiotics.
In many countries, including Canada, the United States, and England, studies indicate that a large proportion of antibiotics are prescribed incorrectly. This not only exacerbates resistance but also poses a threat to patients who are exposed to potential side effects and drug interactions without a proportionate benefit.
The Role of Physician Education
To address this issue, there is a need to provide continuous education to healthcare providers about antimicrobial stewardship. Inservice training, which refers to on-the-job training for practitioners, is an integral component. By staying informed about the current guidelines and resistance patterns, physicians can make better-informed decisions on whether an antibiotic is necessary.
Unfortunately, many healthcare providers often face pressures—from both time constraints and patient expectations—to prescribe antibiotics. Hence, education is not just about imparting knowledge but also about empowering doctors to communicate effectively why an antibiotic might not be warranted.
Patient Education is Equally Important
Patients often equate prescriptions, especially for antibiotics, with better care. This perception creates a demand for prescriptions where they may not be medically justified. Patient education must focus on the idea that antibiotics are not a one-size-fits-all solution. For viral infections like the common cold or flu, antibiotics are ineffective.
Efforts to educate patients can lead to more sensible expectations and demands regarding antibiotic use. Clear communication on risks associated with antibiotic overuse, how resistance develops, and the limited scenarios where antibiotics are genuinely needed will all contribute to behavior change.
The Impact of Inappropriate Prescriptions
Inappropriate antibiotic prescriptions do not only foster resistance, but they waste resources and can harm patient outcomes. The direct consequences to patients include adverse drug reactions, unnecessary medication costs, and the potential harm of disrupting their microbiome.
Further complicating matters is the globalization of healthcare. As people travel more frequently and extensively, antibiotic-resistant strains can easily spread across borders, making the fight against resistance a truly international issue.
Moving Forward
The evidence indicates that a multifaceted approach is required to reduce inappropriate antibiotic prescriptions. Healthcare systems must prioritize funding and resources to implement effective educational strategies to reach both providers and patients.
1. Campaign for Better Education and Awareness
Healthcare institutions play a pivotal role in providing ongoing education to healthcare providers. Campaigns to enhance awareness about the correct use of antibiotics need to be implemented. This could include integrating more profound discussions about antibiotic resistance into medical school curriculums and continuing medical education for practicing clinicians.
2. Use of Decision Support Systems
Incorporating decision support systems within clinical settings can help guide and remind healthcare practitioners about appropriate prescribing practices in real-time. These systems can provide prompts based on the patient’s diagnosis and the latest guidelines, reducing the chances of inappropriate prescriptions.
3. Empowering Patients
Patients need to be empowered to question the necessity of antibiotics and understand when an antibiotic is not the right choice. Health literacy initiatives, patient seminars, and public health messaging campaigns can be powerful tools to shift patient expectations and demands.
4. Policy Reforms
Policy reforms that prioritize antimicrobial stewardship can provide the structure and enforcement necessary to sustainably change prescribing behaviors. This could involve implementing stricter prescription regulations or incentivizing practices that demonstrate good stewardship.
5. International Collaboration
Given the global nature of antibiotic resistance, there must be international collaboration on surveillance, research, and best practices for prescribing. Sharing information across borders can help all countries adopt better practices and reduce the overall load of antibiotic resistance.
Conclusion
The CMAJ’s recent call to action (DOI: 10.1503/cmaj.109-5742) emphasizes that ensuring appropriate antibiotic use is no small feat—it demands collaboration, continuous education, and the engagement of all stakeholders. Mercer’s article acts as a critical reminder that reducing inappropriate antibiotic prescriptions is not just a desirable goal but an absolute necessity for the preservation of effective antibiotics for future generations.
The path forward requires an unyielding commitment to education—at the level of the healthcare provider, the patient, and within policy frameworks. By doing so, healthcare systems worldwide can aim to reduce the rates of antibiotic resistance and ensure that antibiotics remain a pillar of modern medicine.
References
1. Mercer, C. Education needed – for doctors and patients – to reduce inappropriate antibiotic prescriptions. CMAJ. 2019 May 6; 191(18): E514–E515. DOI: 10.1503/cmaj.109-5742
2. Canadian Medical Association Journal (CMAJ). PMCID: PMC6509036
3. Centers for Disease Control and Prevention (CDC). Antibiotic Resistance Threats in the United States. www.cdc.gov/drugresistance/Biggest-Threats.html
4. World Health Organization (WHO). Antibiotic Resistance. www.who.int/news-room/fact-sheets/detail/antibiotic-resistance
5. The Pew Charitable Trusts. Antibiotic Use in Outpatient Settings. www.pewtrusts.org/en/research-and-analysis/reports/2016/05/antibiotic-use-in-outpatient-settings