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PCPs encouraged to teach parents about antibiotics

Parents who have misconceptions about antibiotics for respiratory infections want help understanding them, suggesting an opportunity for primary care physicians to provide more information, according to research published in the Annals of Family Medicine.

“Parental demands are often blamed for antibiotic prescription. ... Some parents have misconceptions about antibiotic use for acute respiratory infections, highlighting the need for improved communication during visits, including shared decision making to address overoptimistic expectations of antibiotics,” Peter D. Coxeter, MPH, of the Centre for Research in Evidence-Based Practice, Bond University in Queensland, Australia, and colleagues wrote. “Our findings are largely in line with those of previous studies on parental beliefs about antibiotics’ benefits for acute respiratory infections, although our study is among the first to quantify them.”

Coxeter and colleagues conducted 401 telephone surveys of randomly selected parents of at least one child aged 1 to 12 years. Questions pertained to acute bronchitis, sore throat and acute otitis media; specifically, delayed prescribing (receipt of a prescription with the provision that it not be filled right away), shared decision making, remembering the details of their last medical visit with their child for acute respiratory infections (including discussion about antibiotic benefits or harms), and the respondent’s expectations and knowledge of antibiotic benefits and harms and other treatments.

According to researchers, 78% of respondents knew antibiotics could potentially harm. In addition, 55% of respondents answered “yes” or “sometimes” that antibiotics treat the infection and kill bacteria in cases of acute bronchitis, 70% answered that way for sore throat and 92% answered that way for acute otitis media. For each of these three acute respiratory infections, parents grossly overestimated the benefits of antibiotics in reducing the duration of illness as compared with benefits seen from current empirical evidence, the researchers wrote. Likewise, the minimum reduction in illness duration that parents reported they would want from antibiotics before considering their use grossly exceeded evidence-based estimates, by five to 10 times. When asked to remember the details of their conversations with their doctors for these types of infections, 93% preferred involvement in future decisions about antibiotic use, 78% did not remember any discussion about possible antibiotic harms, 72% reported little or no discussion about reasons why antibiotics might not be used, and 44% of parents reported some discussion about why antibiotics might be used.

“These findings suggest opportunities for improving acute respiratory infection visits by adopting shared decision making, in which the options (using or not using antibiotics) and the benefits and harms of each are explained; parents’ concerns, beliefs, expectations and preferences are explored; and a decision is reached collaboratively,” Coxeter and colleagues wrote. “Shared decision making is an effective strategy for reducing antibiotic prescribing for acute respiratory infections in primary care, but widespread implementation is limited. ... Using shared decision making and possibly incorporating delayed prescribing as a presented option in acute respiratory infection visits may enable clinicians and parents to discuss perceived need for and beliefs about antibiotic use and promote informed decision making.” – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.