Practice Management

Reducing Antibiotic Overuse in the Outpatient Setting

Are you prescribing antibiotics appropriately?

A spilled bottle of prescription medicine

Each year, at least 2 million people in the United States develop an antibiotic-resistant infection, and at least 23,000 of these people die. Inappropriate prescribing of antibiotics is the most important modifiable risk factor for antibiotic resistance; approximately one-half of all outpatient prescriptions may be for the wrong antibiotic, wrong dose, or wrong duration, and at least 30% of outpatient antibiotic prescriptions are unnecessary.

There are proven methods that can reduce antibiotic overuse or misuse. Lauri Hicks, DO, from the CDC, and Jason Newland, MD, a spokesperson with the Infectious Diseases Society of America, offer several actionable tips for providers.

Make a public commitment to use antibiotics correctly. “Put up a poster in the exam room that includes pictures of the practice’s clinicians and their signatures stating they are committed to using antibiotics appropriately,” Newland suggests.

Develop communication strategies for addressing patient expectations. “The most commonly cited reason that physicians overprescribe antibiotics is that they want to satisfy their patients,” Hicks says. Clinicians should use positive communication approaches to explain why antibiotics aren’t needed, make alternative treatment recommendations, and recommend a contingency plan.

Adopt watchful waiting and delayed antibiotic prescribing when appropriate. These approaches have been shown to decrease antibiotic use in patients with conditions that usually resolve without treatment but who may benefit from antibiotics if the condition doesn’t improve (for example, acute otitis media, acute sinusitis). Provide patients with a postdated prescription and instructions to fill the prescription at a later date if symptoms worsen or don’t improve.

Use the right antibiotic, right dose, and right duration. Refrain from using broad-spectrum antibiotics for conditions in which more narrow-spectrum antibiotics are indicated, Newland says. Appropriate doses are especially important in children, he adds, for whom higher doses of amoxicillin are needed to cover for potential resistance in ear infections and pneumonias. Duration, however, is more complicated. “There aren’t a lot of research data to tell us what the best duration of antibiotic therapy is,” Newland says, although many clinicians shorten treatments for uncomplicated infections.

Consider a self-audit. “One of the most effective approaches to changing and improving antibiotic prescribing is making sure providers are aware of their own prescribing practices,” Hicks says.

 

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