Why Primary Care Clinicians Don't Always Comply with Antibiotic Guidelines
the MPR take:
Numerous guidelines have been issued for clinicians on appropriate antibiotic prescribing for optimal treatment and reduction of antibiotic resistance, but these are not always followed due to misinformation about broad-spectrum antibiotics, reports a study conducted by the Centers for Disease Control and Prevention (CDC). In-depth interviews with 36 primary-care providers (PCPs) were conducted on self-reported antibiotic prescribing practices, perceived prescribing practices of their peers, attitudes toward clinical practice guidelines for common bacterial infections, knowledge of narrow- versus broad-spectrum antibiotic agents, preferred resources and methods for medical education and antibiotic treatment, and attitudes toward antibiotic resistance. The PCPs widely believed that broad-spectrum antibiotics were more successful for curing an infection vs. narrow-spectrum antibiotics, despite research supporting the efficacy of narrow-spectrum antibiotics over broad-spectrum ones. Only when the diagnosis was more certain or when a patient was perceived to have a benign clinical condition were narrow-spectrum antibiotics perceived to be a better option. While the PCPs generally agreed that antibiotic resistance is a concern for their patients and public health, it was infrequently discussed as a factor in selecting an antibiotic to prescribe. Changing the prescribing habits of clinicians is a difficult challenge, but encouraging the use of first-line agents could be one means of intervention to improve patient care and reduce antibiotic resistance.
Appropriate selection of antibiotic drugs is critical to optimize treatment of infections and limit the spread of antibiotic resistance. To better inform public health efforts to improve prescribing of antibiotic drugs, we conducted in-depth interviews with 36 primary care providers in the United States (physicians, nurse practitioners, and physician assistants) to explore knowledge, attitudes, and self-reported practices regarding antibiotic drug resistance and antibiotic drug selection for common infections.