Amid growing concerns over antibiotic resistance, a new survey finds the vast majority of doctors acknowledge a problem exists and believe inappropriate prescribing most often occurs in physician offices. But at the same time, many doctors do not believe their own practices are to blame, a lack of recognition that contributes to a worsening public health crisis.
Specifically, 94% of doctors agree that antibiotic resistance is a national issue, but just 55% see this as a problem in their own practices. Meanwhile, 91% think inappropriate prescribing can be traced to doctor offices or urgent care settings, yet just 37% say the problem occurs in their own practices. And 60% believe they prescribe antibiotics more appropriately than other doctors.
“There is a disconnect,” said Rachel Zetts, an officer on the antibiotics resistance project at The Pew Charitable Trusts, which surveyed 1,550 internal medicine, family medicine, and pediatric physicians in the U.S. “We’re seeing an increase in stewardship [or the appropriate use of antibiotics] on an inpatient basis [in hospitals], but not as much in outpatient settings,” such as physician offices.
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As an oncologist, I have made an effort to reduce antibiotic prescribing and have done so. I sometimes site an old retrospective study that suggests that antibiotic use in women is associated with an increased risk of breast cancer. (It may or may not be an accurate study but there is such a published study.). I have managed to decrease antibiotic use by about half. But I still see many patients being give Azithromycin, etc, for what is obviously viral upper respiratory infections. Of course, with Covid19, all observations are out the window.
We implemented an education program for plan physicians and members one year and our antibiotic utilization went through the roof. Looked at the data and some patients were getting 5 Zithromax Rxs in 3 months from the same office, same patient, same diagnosis. We put a limit on Z-pak Rxs for each member in a time period that would trigger a clinical review. I would hear “it worked the last time we prescribed it”. Really? I would respond then “why do they need it again”? Maybe it isn’t working? Maybe resistance? Maybe wrong drug for the wrong bug? You get the gist. And the beat goes on…..