The status quo is unacceptable and, frankly, embarrassing.
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ACEP Now: Vol 33 – No 09 – September 2014
Dr. Radecki is assistant professor of emergency medicine at The University of Texas Medical School at Houston. He blogs at Emergency Medicine Literature of Note (emlitofnote.com) and can be found on Twitter @emlitofnote.
References
- National Committee for Quality Assurance. Avoidance of antibiotic treatment in adults with acute bronchitis: percentage of adults 18 to 64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription. Agency for Healthcare Research and Quality Web site. Available at: http://www.qualitymeasures.ahrq.gov/content.aspx?id=47167. Accessed August 11, 2014.
- Smith SM, Fahey T, Smucny J, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014;3:CD000245.
- Barnett ML, Linder JA. Antibiotic prescribing for adults with acute bronchitis in the United States, 1996-2010. JAMA. 2014;311:2020-2.
- Cooper RJ, Hoffman JR, Bartlett JG, et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Ann Emer Med. 2001;134:509-17.
- Petersen I, Johnson AM, Islam A, et al. Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ. 2007;335:982.
- Olivier C. Rheumatic fever—is it still a problem? J Antimicrob Chemother. 2000;45:13-21.
- Newman DH. Antibiotics for strep do more harm than good. Emergency Physicians Monthly Web site. Available at: http://www.epmonthly.com/columns/ in-my-opinion/antibiotics-for-strep-do-more-harm-than-good. Accessed August 11, 2014.
- Fairlie T, Shapiro DJ, Hersh AL, et al. National trends in visit rates and antibiotic prescribing for adults with acute sinusitis. Arch Intern Med. 2012;172:1513-4.
- Lemiengre MB, van Driel ML, Merenstein D, et al. Antibiotics for clinically diagnosed acute rhinosinusitis in adults. Cochrane Database Syst Rev. 2012;10:CD006089.
- Dias R, Caniça M. Emergence of invasive erythromycin-resistant Streptococcus pneumoniae strains in Portugal: contribution and phylogenetic relatedness of serotype 14. J Antimicrob Chemother. 2004;54:1035-1039.
- Reynolds CA, Finkelstein JA, Ray GT, et al. Attributable healthcare utilization and cost of pneumonia due to drug-resistant streptococcus pneumonia: a cost analysis. Antimicrob Resist Infect Control. 2014;3:16.
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4 Responses to “Emergency Physicians Don’t Follow Evidence When Prescribing Antibiotics, and That Needs to Change”
October 3, 2014
AnthonyDr. Radecki,
I appreciate the extensive review of the research in regards to the perils of providing antibiotics to mostly viral etiologies. When people do things contrary to the evidence and rational thought it sometimes is helpful to ask why. It might be helpful to review: “The Real Reason People Won’t Change” HBR November 2001 by Robert Kegan and Lisa Laskow Lahey.
Good work.
Anthony
May 27, 2015
New Treatment for Recurrent C. difficile Shows Promise - ACEP Now[…] is often triggered by exposure to antibiotics, particularly in the elderly, and has a recurrence rate of 25 to 30 percent among affected […]
September 16, 2015
Many Hispanic Adults Still Believe Antibiotics Will Treat a Cold - ACEP Now[…] U.S. adults, including almost half of Hispanics, believe that taking antibiotics will ease the symptoms of a cold, a new study shows, even though most colds are viral and […]
April 23, 2023
TED WESLEY SWITZERI appreciate the article and advice to EM physicians to limit the use of antibiotics in acute pharyngitis and other respiratory infections.
However, in my experience, it may be even more important that this message be delivered to non-physician midlevel providers who very frequently prescribe a Z-pak and steriods for every sore throat, sinusitis and bronchitis that walks through the door.