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Physician knowledge of antibiotic prophylaxis guidelines in endoscopy 'suboptimal'
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Physician knowledge of guidelines regarding prophylactic antibiotic use before endoscopic procedures is inadequate, according to data from a recent survey.
“In our multi-center study there was overall inadequate knowledge and adherence to practice guidelines when providing theoretical scenarios to physicians who refer for gastrointestinal endoscopic procedures,” Joseph D. Feuerstein, MD, from Beth Israel Deaconess Medical Center, Harvard Medical School in Boston, told Healio Gastroenterology. “Practice guidelines are meant to summarize the literature and provide succinct recommendations to help create a safer medical system. The use of antibiotics for situations in which the evidence does not support their usage may place patients at unnecessary risk.”
Joseph D. Feuerstein
Aiming to assess overall physician knowledge of current guidelines and to determine variables that predict better knowledge, Feuerstein and colleagues developed a questionnaire based on the American Heart Association guidelines from 2007 and the American Society for Gastrointestinal Endoscopy guidelines from 2008, which recommended against antibiotic prophylaxis before endoscopic procedures to prevent bacterial endocarditis. The survey, which was completed by 740 attending physicians and trainees at three academic medical centers in Massachusetts, involved 10 theoretical scenarios in which participants were asked if they would recommend prophylactic antibiotics before gastroscopy or colonoscopy. Familiarity with guidelines also was reported, and demographics regarding education and practice were assessed, as well.
The median number of correct responses was seven (IQR, 5-9), which was similar among institutions. Overall 7.3% of participants answered all questions correctly. The number of correct responses was comparable between attending physicians and trainees, but gastroenterologists were more likely to answer correctly compared with other subspecialists or primary care physicians (P < .0001). Multivariate analysis showed that demographic predictors of correctly answering all questions included self-reported guideline familiarity (0.21; 95% CI, 0.08-0.34), specialty (0.56; 95% CI, 0.3-0.82) and year of medical school graduation (0.22; 95% CI, 0.07-0.37); the odds of correctly answering all questions increased by 3% (95% CI, 0.016-0.052) for every subsequent graduation year since 1950.
“Further studies are needed to assess the actual use of antibiotics prior to endoscopic procedures in clinical practice,” Feuerstein said. – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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