Overuse of Antibiotics
There is much controversy and attention given to the rise of drug-resistant organisms in the United States, yet many physicians continue to prescribe antibiotics for infections that may be viral. One potential reason for this may be the perceived expectation of patients or, in the case of children, their parents, that antibiotics will be prescribed for them. Surveys have shown that some physicians do prescribe antibiotics, even when they know they are not indicated in treatment.106-108 The findings of one study suggested that physicians were more inclined to make a diagnosis of bronchitis in children and prescribe antibiotics when they felt that the parents expressed an expectation of treatment with a course of antibiotics.107 Another survey of pediatricians found that approximately one third of these physicians occasionally or more frequently complied with parents’ requests for treatment with antibiotics. However, 78% of these physicians felt that the single most important program for reducing inappropriate oral antibiotic use would involve educating parents — as opposed to concerns over legal liability or practice efficiency.104
Regardless of the source for the overprescription of antibiotics, the effects are real. Of particular concern is the emergence of penicillin-resistant Streptococcus pneumoniae PRSP). S pneumoniae is a common cause of many infections, ranging from otitis media and sinusitis to community acquired pneumonia. PRSP rates are on the rise, too, which puts patients with a “common” infection at risk of developing serious complications.109-111 A nationwide, multicenter surveillance study in 1997 found that the rates of PRSP in the United States were up to 34.6%.110 Therefore, physicians should be careful to prescribe and administer antibiotics only when indicated, and to get involved in educating patients about the dangers of antibiotic overuse.
Outpatient Parenteral Antimicrobial Therapy
Outpatient parenteral antimicrobial therapy has been shown to be safe, effective, and cost-effective for carefully selected patients with a wide range of infectious diseases.112-115 Their use in these instances also reduces the chance of patients contracting a hospital-acquired infection — an added benefit. Skin and soft-tissue infections, osteomyelitits, joint infections, bacteremia, endocarditis, pulmonary infections, and ENT infections have been effectively reated with outpatient parenteral antimicrobial therapy.
Patients must meet the following 3 criteria to be candidates for outpatient therapy:
- Patients must have an active infectious disease thatwould require treatment beyond the expected hospitalization.
- There should be no other need for hospitalization besides the infectious disease.
- There must be no equally safe and effective oral antibiotic therapy available.116