A new study has found that the view that there is potential benefit and very little risk in taking antibiotics is widespread among the public, patients, and clinicians.
The findings, published in the journal Medical Decision Making, are based on three surveys in which 225 emergency department patients and 149 healthcare providers at two urban US academic hospitals, along with 519 online subjects, were presented with a scenario of a patient with symptoms of a common upper respiratory infection—an indication that generally doesn't warrant antibiotics—and then asked to answer questions about antibiotics, including questions about prior use and expectations for antibiotics.
The results showed that while clinicians demonstrated greater knowledge about antibiotics and potential side effects, the predominant strategy (or "gist") for the decision about antibiotic use among both patients and clinicians was "why not take a risk." This strategy compares the status quo of being sick to the potential of benefitting from antibiotics, while assuming that there is negligible risk.
In addition, the results showed that among the online sample, endorsement of the "why not take a risk" gist was positively associated with expectations for antibiotics and prior use of antibiotics. Given that patient expectation has been shown to play a role in outpatient antibiotic prescribing, this finding suggests that agreement with the viewpoint may predict prescribing rates.
There was widespread agreement with this viewpoint even though nearly all subjects acknowledged that there are side effects associated with antibiotic therapy. "Thus, simply informing patients about side effects may be insufficient to change patient's expectations unless it is done in such a way as to communicate the gist of nonnegligible downside risks," the authors write.
Viewpoint downplays side effects, resistance
The authors of the study note that the "why not take a risk" viewpoint, while it may seem individually rational, downplays the real risk of adverse effects from antibiotics, which can occur in up to 20% of patients. It also downplays the larger social impact of unnecessary prescribing on antibiotic resistance.
"The most important driver of antibiotic resistance is antibiotic use," study co-author Eili Klein, a professor in the department of emergency medicine at Johns Hopkins University and fellow at the Center for Disease Dynamics, Economics & Policy, said in a press release. "Eliminating unnecessary antibiotic use would eliminate unnecessary harms to patients, and help reduce the spread of antibiotic resistance, which threatens the medical gains of the last century."
Klein and his coauthors suggest the results imply that a different educational strategy, one that reframes the choice to be one between a patient remaining sick or being worse off because of antibiotic side effects, could potentially alter the equation and reduce unnecessary antibiotic use. "Changing this representation could alter clinicians' and patients' expectation, suggesting opportunities to reduce overprescribing."
Whether that reframing is "going from bad to worse" or "it only takes once," they add, is a question for further research.
See also:
May 30 Med Decis Making study
May 31 CDDEP press release
