When it comes to inappropriate
antibiotic prescribing, all physicians are not created
equal.
A new Canadian study found that
the doctors most likely to prescribe antibiotics in
error are those who've been in practice longer, see
more patients or trained outside Canada or the US.
PRESCRIBING
ERRORS
The October 9 CMAJ study defined inappropriate
prescribing as using antibiotics for viral respiratory
or urinary tract infections or using second- and third-line
antibiotics in cases where first-line drugs are indicated.
"With antibiotics there's always
a risk of an adverse event that is entirely preventable,"
says study author Genevieve Cadieux, a McGill epidemiology
and biostatistics PhD student, "from a simple rash or
diarrhea or a yeast infection to C difficile
colitis or anaphylactic shock with penicillin." The
problem is primary care physicians aren't always kept
abreast of patients' allergies, says Ms Cadieux.
Public health officials worry themselves
sick over the inappropriate use of antibiotics not only
because patients' conditions can go unresolved, but
also because giving the wrong antibiotics can lead to
more resistant strains of infectious diseases, such
as tuberculosis.
And for physicians, Ms Cadieux
explains, giving in to patient demand for antibiotics
in cases of viral infections increases the likelihood
that those patients will return to your office for a
prescription every time they have a cold.
AT-RISK
DOCTORS
The CMAJ study found that international medical
graduates (IMGs) are a shocking 78% more likely than
Canadian- and American-trained MDs to give antibiotics
inappropriately. That correlation, however, doesn't
appear to be explained by poor knowledge. Ms Cadieux's
hypothesis is that some countries, Spain foremost among
them, simply have more liberal attitudes about antibiotics
use.
The study also found that doctors
who see an average of 34 or more patients per day are
20-27% more likely to give antibiotics where they're
not appropriate. The research also showed that for each
year a physician is in practice, their rate of inappropriate
prescribing increases 4%.
Medical exam results didn't predict
inappropriate prescribing, so Ms Cadieux says changes
in medical education wouldn't necessarily help. In fact,
a 2005 Cochrane Collaboration systematic review found
there were no interventions that effectively improved
antibiotics prescribing.
But Ms Cadieux isn't prepared to
surrender. Her prescription? Encourage physicians to
use rapid tests for viral infections to reduce diagnostic
uncertainty, which can lead to inappropriate antibiotics
use, and include requirements for proper antibiotic
prescribing in College of Physicians and Surgeons maintenance
of certification programs.
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