Overuse of antibiotics


Overuse of antibiotics

The rise of antibiotic resistant bacteria poses one of the biggest threats to human health. The UKs chief medical officer, in a report on the threat of increasing bacterial resistance, described it ‘as big a risk as terrorism’.

A number of factors contribute to this problem, such as the lack of financial incentives for drug companies to develop new antibiotics, but there is no doubt that the biggest reason is the misuse and overuse of antibiotics. In some countries (especially in the developing world) antibiotics are available ‘over the counter’ without a prescription, inevitably leading to their indiscriminate use. However even in countries where antibiotics are only available from a doctor, over-prescribing and unnecessary use are still all too common.

The general consensus is that patients are mostly to blame; they demand access to antibiotics even when advised against this by their physician, placing doctors under pressure to prescribe the drugs even when they think it unnecessary.

It was this assumption that a new study, published today in BMC Family Practice, set out to test. Carried out by Bart Knottnerus and colleagues at the University of Amsterdam, the study tested women’s willingness to delay antibiotic use when consulting their doctor with symptoms of urinary tract infections.

Urinary tract infections (UTIs) are a good focus for this type of study. A common condition in women, it is not a serious infection, but symptoms are bothersome and can reduce quality of life. Guidelines often recommend immediate treatment with antibiotics for any patient presenting with UTI symptoms. However, past studies have shown that in 25-50% of women symptoms will disappear by themselves within a week. This then, seems to be a textbook case of antibiotic overuse; patients, many of whom will recover without treatment, being prescribed antibiotics regardless. The question then: is it true that patients with UTI symptoms expect and demand treatment with antibiotics?

To find the answer, Knottnerus and colleagues recruited a number of General Practitioners (GPs) in the Amsterdam region to take part in their study. They requested that these GPs ask patients presenting with typical UTI symptoms to delay antibiotic treatment for one week; more than a third of patients were prepared to do so. Over 70% of patients delaying treatment had improved symptoms after a week; that it to say, prescribing antibiotics to these women would have been unnecessary and wasteful.

These results suggest that the common perception that patients demand immediate treatment is not always correct. Instead, perhaps it is this perception among doctors that is sometimes to blame for unnecessary antibiotic prescriptions. It is notable that one of the doctors recruited into this study refused, as a point of principle, to ask his patients to delay treatment. Might results from studies such as this encourage GPs to be a bit more trusting of their patients when it comes to using antibiotics responsibly?

Of course one should not overstate these results. After all, almost two thirds of women preferred to begin treatment immediately, even when the reasons why a short delay might be beneficial were explained by their doctor. In addition, almost half of the women who initially agreed to delay treatment did in fact use antibiotics before the week was out; evidently some patients will feel the need for immediate relief from their uncomfortable symptoms, even when they appreciate the good reasons why they should delay treatment.

Even with these caveats, there is no doubt that this study makes an important contribution to the debate on reducing unnecessary use of antibiotics. Perhaps one of the biggest contributions GPs can make is to put a bit more trust in their patients to do the right thing.