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