Antibiotic Overuse

Aka: Antibiotic Overuse, Antibiotic Stewardship

1. See Also
   1. Antibiotic Resistance
2. Epidemiology
   1. Antibiotics are not indicated or are incorrectly used in up to 50% of cases
3. Adverse Effects: Antibiotics
   1. Antibiotic Associated Diarrhea (including Clostridium difficile)
   2. Antibiotic Resistance (e.g. MRSA, PRP, VRE, Carbipenem resistant Gram Negatives, Gonorrhea, Tuberculosis)
   3. Life-Threatening Drug-Induced Rashes (e.g. DRESS)
   4. Anaphylaxis (esp. Penicillins)
   5. Stevens-Johnson Syndrome (esp. Sulfonamides)
   6. Tendinopathy (Fluoroquinolones)
   7. Nephrotoxicity (e.g. Aminoglycosides)
   8. Psychosis (Clarithromycin, Ciprofloxacin)
   9. QT Prolongation (Erythromycin, Fluoroquinolones)
4. Prevention: Antibiotic Overuse
   1. Education for patients for when antibiotics are inappropriate (see resources below)
      1. Employ exam room and pharmacy posters and newsletters (see resources below)
   2. Dispel myths
      1. Sputum or nasal drainage color does not indicate Bacterial Infection
      2. Most Upper Respiratory Infections, Bronchitis, Conjunctivitis are viral
   3. Watchful waiting is a reasonable strategy
      1. Otitis Media resolves without antibiotics in two thirds of cases
         1. Contingency plan to start antibiotics for fever, night awakening, Vomiting
      2. Acute Sinusitis in the first 10-14 days
         1. Contingency plan to start antibiotics for persistent symptoms >14 days
      3. Diverticulitis
         1. Uncomplicated cases may be observed for 2-3 days
   4. Shorter antibiotic courses are effective
      1. Uncomplicated Pyelonephritis and Pneumonia antibiotic courses are now 5 days
   5. Viral Infections have effective treatments (just not antibiotics)
      1. Nasal Saline, Guaifenesin (mucinex) and Oxymetazoline (afrin) for sinus congestion
      2. Albuterol for Acute Bronchitis
      3. Ibuprofen or Tylenol for fever and myalgias
   6. Antibiotic allergies are often not allergies
      1. Results in overuse of broader spectrum antibiotics
      2. See Penicillin Allergy
   7. Teach patients to be astute medical consumers
      1. Do I really need that antibiotic, doctor?
5. Resources
   1. CDC: Know When Antibiotics Work
      1. http://www.cdc.gov/getsmart/community/for-hcp/index.html
6. References
   1. (2015) Presc Lett 22(9): 51-2
   2. (2019) Presc Lett 26(12): 70