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Bethany Wilken

Fri, 02/25/2022 - 14:20

Hi Emmanuel,

I regrettably had to miss last week’s grand rounds but Pierce’s summary and the insightful discussion that is taking place has definitely sparked my interest. Up until recently, I had never heard the medical community expressing major concerns over antibiotic resistance. As highlighted in various comments, there could be many contributing factors to resistance including antibiotic use in agriculture, inconsistent prescription and as you emphasized, patient compliance.

Antibiotics are considered relatively safe, with mild side effects. Perhaps due to their safety profile, patients are more lenient with their usage. In being critical of patients, I believe we should also be critical of the doctors prescribing the antibiotics. Antibiotic overprescribing is a longstanding clinical concern. The Center for Disease Control and Prevention (CDC) estimates that 30% of antibiotics prescribed in an outpatient setting are unnecessary (1), while up to 40% of antibiotic prescription for acute respiratory tract infections are unnecessary (2). Considering the implications of antibiotic resistance, we must lower the number of unnecessary prescriptions. One idea I had to modify physician antibiotic prescribing is to have a prompt on electronic medical records. The prompt would require the physician to provide a note for antibiotic justification. Interestingly, patient demand is the major reason that physicians feel pressured to overprescribe (3). Thus, pamphlets or other educational tools focused on the potential harms of overprescribing could be distributed to patients. Does anyone else have ideas on how to combat antibiotic overprescribing to help address antibiotic resistance?


1. Harris AM, Hicks LA, Qaseem A, for the High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for highvalue care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164:425-434
2. Barlam TF, Soria-Saucedo R, Cabral HJ, et al. Unnecessary antibiotics for acute respiratory tract infections: association with care setting and patient demographics. Open Forum Infect Dis. 2016;3:1-7.
3. Dempsey PP, Businger AC, Whaley LE, et al. Primary care clinicians’ perceptions about antibiotic prescribing for acute bronchitis: a qualitative study. BMC Fam Pract. 2014;15:194.

Bethany Wilken

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