Educating patients about individual harms of antibiotics may reduce requests
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To curb unnecessary antibiotic use, clinicians should educate patients on the potential harms of its use on individuals rather than society or antibiotic resistance, researchers wrote in the Journal of the American Board of Family Medicine.
Previous research has shown that physicians are up to 10 times more likely to prescribe an antibiotic if they believe the patient is expecting one, Ben Miller, BS, an MD candidate at the Johns Hopkins University School of Medicine, and colleagues wrote.
“Understanding what messages about potential harms of antibiotics resonate best with patients could help doctors improve their communication with patients about unnecessary antibiotic use and could also help broader campaigns improve their messaging around antibiotics,” Sara Condron Keller, MD, MPH, MSPH, study co-author and an assistant professor of medicine at Johns Hopkins University School of Medicine, told Healio Primary Care.
Miller, Keller and colleagues developed 18 statements about the potential harms of antibiotics that were “understandable, well-written and were not significantly overlapping in content,” Keller said. They then administered a survey with the 18 statements to 250 patients (women = 184; Black = 152) at a primary care clinic in Baltimore. Patients were asked about their overall likelihood of requesting antibiotics for an upper respiratory infection (URI) before and after completing the survey. These patients also rated each of the 18 statements on an 11-point Likert scale. Zero points meant the patient was “much less likely” to request antibiotics for an URI after reading the statement, while 10 points meant the patient was “much more likely” to request antibiotics for an URI after reading the statement.
Eight statements focused on potential harm to the patient (eg, “Antibiotics can make you more likely to be obese”); four statements depicted possible negative consequences to people close to the patient taking the antibiotics (eg, “Antibiotics can change how babies grow inside pregnant women”); and six statements outlined plausible harm to society (eg, “Each antibiotic-resistant infection costs up to $30,000 more to treat than other infections”). Eight of the 18 statements referenced harm caused by antibiotic resistance.
The researchers reported that pre-survey, the raw mean score of patients was 5.3 points, “meaning slightly more likely to request antibiotics than not.” Post-survey, the likelihood decreased to 3.1 points, meaning “probably will not request antibiotics” (overall difference –2.2 points; P < .001). Though all statements reduced likelihood of requesting antibiotics, statements about both individual harm and harm to contacts of an individual had a significantly greater reduction in likelihood of requesting antibiotics than statements about harm to society (P < .001).
The researchers noted that larger studies are needed to validate their findings, but Miller said in an interview that the results would likely be similar.
“Humans are programmed for survival and protection of those close to us, with a lesser attachment to society at large,” he said. “Antibiotic misuse hurts both the individual and society. Focusing our communication on whatever patients care most about is just good patient-centered care, which also just so happens to help society.”
Perspective
Back to TopTrini Mathew, MD, MPH, FACP, FIDSA
I agree with the findings of Miller and colleagues. We need to personalize messages to curb unnecessary antibiotic use. It has been a standard practice of mine for years to weigh the pros and cons of antibiotic use with each of my patients each time antibiotics come up.
Specifically, I tell patients that though antibiotics may cure one infection, it can also cause other infections such as diarrhea due to Clostridioides difficile or yeast infection. In addition, antibiotics, like many other medications, can cause drug-related rash and medication allergies. I advise patients if they experience one of these conditions, they should see a doctor immediately to ascertain the condition’s cause and receive care.
These conversations need to happen all the time, especially during the pandemic. Studies have shown that in the early days of the COVID-19 pandemic, there was a lot of antibiotic utilization occurring in the hospitals to treat possible sepsis empirically in patients with COVID-19. As we’ve become better at managing COVID-19 infections, we have learned to deescalate antibiotics and not use them for this purpose. Treatment guidelines have also been updated to reflect that azithromycin should no longer be used for treatment of SARS-CoV-2 viral infection. However, there may be some patients who still think antibiotics treat COVID-19 viral infection, underscoring the need to tailor messages about antibiotics for each and every patient.
Medical director of hospital epidemiology and infection control, Beaumont Hospital, Royal Oak, Mich.
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