Over prescription of antibiotics is a major factor driving one of the biggest public health concerns today: antibiotic resistance. In a first-of-its-kind study, research led by the George Washington University suggests that public health educational materials may not address the misconceptions that shape why patients expect antibiotics, driving doctors to prescribe them more. The research appeared in October in the journal Medical Decision Making.
Researchers from George Washington, Cornell and Johns Hopkins universities surveyed 113 patients in an urban hospital to test their understanding of antibiotics. They discovered a widespread misconception: patients may want antibiotics, even if they know that, if they have a viral infection, the drugs will not make them better. These patients believe that taking the medication will not worsen their condition - and that the risk of taking unnecessary antibiotics does not outweigh the possibility that they may help.
“Patients figure that taking antibiotics can’t hurt, and just might make them improve. When they come in for treatment, they are usually feeling pretty bad and looking for anything that will make them feel better. These patients might know that there is, in theory, a risk of side effects when taking antibiotics, but they interpret that risk as essentially nil,” said David Broniatowski, assistant professor in GW’s School of Engineering and Applied Science.
Contrary to these patients’ beliefs, there are risks associated with taking unnecessary antibiotics, such as secondary infections and allergic reactions.
“More than half of the patients we surveyed already knew that antibiotics don’t work against viruses, but they still agreed with taking antibiotics just in case,” Dr. Broniatowski said. “We need to fight fire with fire. If patients think that antibiotics can’t hurt, we can’t just focus on telling them that they probably have a virus. We need to let them know that antibiotics can have some pretty bad side effects, and that they will definitely not help cure a viral infection.”
Dr. Broniatowski’s research found that most educational tools used to communicate the dangers of taking unnecessary antibiotics focus on the differences between bacteria and viruses - the idea that “germs are germs” - but do not address patients’ widespread “why not take a risk” belief.
Antibiotics are important drugs. It would be difficult to overstate the benefit penicillin and other antibiotics have played in treating bacterial infections, preventing the spread of disease and minimizing serious complications of disease.
But there is also a problem with antibiotic medications. Drugs that used to be standard treatments for bacterial infections are now less effective or don’t work at all. When an antibiotic drug no longer has an effect on a certain strain of bacteria, those bacteria are said to be antibiotic resistant.
The overuse and misuse of antibiotics are key factors contributing to antibiotic resistance. The general public, doctors and hospitals all play a role in ensuring proper use of the drugs and minimizing the development of antibiotic resistance.
What causes antibiotic resistance?
A bacterium is resistant to a drug when it has changed in some way that either protects it from the action of the drug or neutralizes the drug. Any bacterium that survives an antibiotic treatment can then multiply and pass on its resistant properties. Also, some bacteria can transfer their drug-resistant properties to other bacteria - as if passing along a cheat sheet to help each other survive.
The fact that bacteria develop resistance to a drug is normal and expected. However, the way that drugs are used affects how quickly and to what extent drug resistance occurs.
Overuse of antibiotics
The overuse of antibiotics - especially taking antibiotics even when they’re not the appropriate treatment - promotes antibiotic resistance. Antibiotics treat bacterial infections but not viral infections. For example, an antibiotic is an appropriate treatment for strep throat, which is caused by the bacterium Streptococcus pyogenes. It’s not, however, the right treatment for most sore throats, which are caused by viruses.
If you take an antibiotic when you actually have a viral infection, the antibiotic is still attacking bacteria in your body - bacteria that are either beneficial or at least not causing disease. This misdirected treatment can then promote antibiotic-resistant properties in harmless bacteria that can be shared with other bacteria.
While the study - Germs Are Germs, and Why Not Take a Risk? Patients’ Expectations for Prescribing Antibiotics In an Inner-City Emergency Department - was small, the results signal the need for a shift in the way health care officials educate patients and caretakers. Dr. Broniatowski urges members of the public health community to reconsider their communication tactics and adjust educational materials to address patients’ concerns and beliefs.
In the future, Mr. Broniatowski and his team, which included Eili Klein at Johns Hopkins and Valerie Reyna at Cornell, hope to test these communication strategies in a clinical setting and, ultimately, reduce the rate of over prescription.
School of Engineering and Applied Science
GW’s School of Engineering and Applied Science prepares engineers and computer scientists to address society’s technological challenges by offering outstanding undergraduate, graduate and professional educational programs, and by providing innovative, fundamental and applied research activities. The school has six academic departments, 11 research centers, 90 faculty and more than 2,500 undergraduate and graduate students. Core areas of excellence include biomedical engineering, cybersecurity, high performance computing and simulation of engineering systems, nanotechnologies, robotics and systems engineering.