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Antibiotic requests: Tips for physicians dealing with patient demands


 

Antibiotic resistance is one of the world’s major public health challenges, according to the Centers for Disease Control and Prevention. While medical providers are heeding the call, patient pressure about receiving antibiotic prescriptions remains a significant influencer, says the National Committee for Quality Assurance.

It’s the crux of the problem and a serious communications challenge for physicians—patients expect to receive antibiotics for cold or upper-respiratory symptoms, regardless of whether it’s to treat a bacterial or viral infection. When physician’s refuse to prescribe in cases when an antibiotic is probably not warranted, it often strains this relationship.

Over the last 15 years physicians started reducing the number of prescriptions they write for antibiotics for patients with many viral illnesses, but it still has not stopped patients from asking for them.  And the problem of antibiotic resistance has been getting much more attention by the mainstream media and national medical organizations in an effort to safeguard the effectiveness of these drugs.

In recent months, NCQA issued a report calling for more restraint in prescribing for acute bronchitis for routine treatment.

The American Academy of Pediatrics’ Committee on Infectious Diseases recently issued a policy statement on this issue, “Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics.”

This report provides a framework for clinical decision-making regarding antibiotic use. It emphasizes the importance of using stringent and validated clinical criteria when diagnosing acute otitis media, acute bacterial sinusitis, and pharyngitis caused by group A streptococcus. It also reviews situations in which antibiotics are not indicated, in particular for viral respiratory infections.

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Anonymous
My son had a sore throat and was seen by an urgent care physician. Despite a negative rapid strep test, my son was given antibiotics and told to take them until the results of a throat culture were known. If the culture results were negative, he would be told to stop antibiotics. If the culture results were positive, he should finish the course. What is the false negative rate for the rapid strep test? Do you agree with the advice above, or should my son not have been prescribed antibiotics, since the rapid strept test was negative? The throat culture was negative.
Feb 5, 2014