Doctor 'Chagrin' Among Reasons Why Antibiotics May be Overused in Hospitals


One reason doctors may prescribe antibiotics more often than necessary is because they want to avoid withholding a prescription from a hospitalized patient ultimately found to have a bacterial infection, University of Michigan doctors say in a new commentary.

The article, which appears in the Journal of the American Medical Association Internal Medicine, coincides with a report released by the Centers for Disease Control and Prevention highlighting concerns over an overuse of antibiotics. The CDC called on hospitals to evaluate their antibiotic practices in light of the findings that showed clinicians in some hospitals prescribe as many as three times more antibiotics than others.

Overuse of antibiotics leads to the development of bacterial resistance and puts patients at risk for serious infections such as severe diarrheal infection due to Clostridium difficile (C. diff).

“In medicine, there’s a tendency to think there’s no harm in erring on the side of caution – but in this case, it may sometimes put patients at risk,” says lead author Scott Flanders, MD, MHM, professor of internal medicine and director of hospital medicine at the U-M Medical School. “Antibiotics, while incredibly beneficial, are unique because they also have the potential to harm other patients through the spread of C.diff and the development of bacteria resistance.”

Flanders co-authored the JAMA paper with Sanjay Saint, MD, MPH, the University of Michigan’s George Dock professor of internal medicine and the associate chief of medicine at the VA Ann Arbor Healthcare System. The article is titled “Why does antimicrobial overuse in hospitalized patients persist?”

“When it’s not clear whether a patient actually has an infection and treatment decisions are based on an educated guess, no one wants to discover days later that they guessed wrong. We call this the ‘chagrin factor,’” says Saint. “U.S. physicians tend to place the interests of their patients above the broader interests of society. We need to provide physicians with strategies that are viewed as both benefiting the patient and society.”

Both Flanders and Saint are members of the Institute for Healthcare Policy and Innovation. The authors recommend several strategies to improve antibiotic use at hospitals:

• Antimicrobial stewardship programs (which aim to develop guidelines and implement programs that help optimize antibiotic use among hospitalized patients) should partner with front line clinicians to tackle the problem
• Clinicians should better document aspects of antibiotic use in their notes that can be shared with other providers caring for the same patient throughout his or her hospital stay and after discharge
• Clinicians should take an “antibiotic time-out” after 48-72 hours of a patient’s use of antibiotics to re-assess the use of these drugs
• Treatment and its duration should be in line with evidence-based guidelines and institutions should work to clearly identify appropriate treatment duration
• Improved diagnostic tests available to physicians
• Target diagnostic error by working to improve how physicians think when considering whether to provide antibiotics
• Develop performance measures which highlight common conditions in which antibiotics are overprescribed to shine a brighter light on the problem

Source: University of Michigan Health System

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