A new approach may reduce the amount of unnecessary prescriptions
Antibiotics kill bacteria, but they do not kill the common viruses that cause colds or flu. Yet doctors often prescribe antibiotics unnecessarily, out of habit or to satisfy patient demands, thereby increasing the prevalence of antibiotic resistance.
The US Centers for Disease Control and Prevention report that up to 50% of antibiotic prescriptions in the US are unnecessary or not optimally effective.
A new approach may curb the overuse of antibiotics. A recent randomized controlled trial found that asking doctors to sign a pledge to "refrain from prescribing antibiotics in cases where they expect the antibiotic to do more harm than good" reduces inappropriate use of antibiotics during the flu season. Doctors who signed the document reduced antibiotic prescriptions by about a third compared to doctors who did not sign. The findings appeared in the January 27, 2014, online issue of the American Medical Association's Journal of Internal Medicine.
In the study, seven doctors or nurses signed a poster-sized sheet pledging to work according to antibiotic administration guidelines. The letter, which was shown in the examination rooms, also explained that antibiotics cannot cure colds but they can cause side effects and contribute to the development of drug resistance. Seven other doctors served as a control group and did not sign the letter or change their practices.
The doctors who signed the letter of commitment reduced the number of unnecessary prescriptions by about a fifth during the study period, while those who did not sign the poster increased the frequency of unnecessary doses by about a fifth. And yet, even the doctors who signed the poster provided antibiotics to patients who did not need them in about a third of the cases.
Previous studies have tested the effect of posting reminders of the antibiotic guidelines, but they did not include signed commitment letters and did not report the same level of success. "Our hypothesis is that commitment is a fundamental difference between our study and previous studies," claims lead researcher Daniela Meeker, a scientist at the Rand Corporation who specializes in health and behavioral economics.
The study does not provide a definitive answer. The findings should be repeated with a larger group of doctors. But if this approach causes a similar response in other contexts as well, the authors of the study claim that it could save 2.6 million unnecessary prescriptions and save drug costs totaling $70.4 million in the US.
The article was published with the permission of Scientific American Israel
