In the Journals

PCPs chose inappropriate antibiotics based on cure rate beliefs, patient pressure

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November 20, 2014

Among primary care practitioners in the United States, inappropriate selection of antibiotics is not due to lack of knowledge of guideline recommendations, but instead is related to perceptions about the cure rates of nonrecommended treatments and pressure to satisfy patients, according to recent findings.

CDC researchers conducted telephone interviews with 36 primary care providers about their knowledge, attitudes and self-reported practices pertaining to antibiotic resistance and drug selection for common infections. The providers were recruited via a screening questionnaire administered to physicians, nurse practitioners (NPs) and physician assistants (PAs) from a nationwide marketing database. Eligible participants were required to spend more than half of their medical practice time in a primary care setting, were aged older than 30 years and were fluent in English. These participants included nine pediatricians, nine family medicine physicians and nine internal medicine physicians. Of the five NPs and four PAs, six practiced in family medicine settings.

The researchers found that while participants generally were knowledgeable about guideline recommendations for antibiotic agent selection, they did not always adhere to these recommendations. Reasons for noncompliance included the perception that nonrecommended antibiotics were more likely to cure an infection, as well as pressure to satisfy patients and parents by prescribing an antibiotic. While broad-spectrum antibiotics were widely considered to be more effective than narrow-spectrum antibiotics in curing infections, participants did not share a uniform definition of broad-spectrum or narrow-spectrum antibiotics. Although PCPs expressed significant concern regarding antibiotic resistance, this was not identified as a major consideration when choosing an antibiotic agent.

According to the researchers, these findings suggest a need for increased education and incentives for appropriate antibiotic selection.

“Although most efforts have focused on reducing unnecessary antibiotic use, more research is needed to clarify which interventions improve antibiotic selection,” they wrote. “Although awareness regarding antibiotic resistance appears to be improving, ongoing education efforts promoting appropriate antibiotic use among both patients and health care providers are critical to addressing the growing threat of antibiotic resistance.”

Disclosure: The researchers report no relevant financial disclosures.

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