Sometimes I think nothing changes when it comes to the responsible use of antibiotics (boldface mine):
Antibiotic prescriptions were given to nearly half of all flu patients, and half of those prescriptions were for broad-spectrum antibiotics…
Out of 14,487 patients with flu symptoms seen at outpatient clinics during two consecutive flu seasons, 42% were given antibiotic prescriptions, and 56% of those prescriptions were broad-spectrum antibiotics, according to Fiona Havers, MD, MHS, of the CDC in Atlanta….
“I’d like to make the point, that if you’re an outpatient clinician, a large proportion of your patients who are coming in during influenza season have influenza, and they don’t benefit from antibiotics,” Havers said. “I think that there needs to be still a lot of education work among providers and patients. If [patients] come in, for example, with acute bronchitis, [they] should not be getting azithromycin. There are very few specific indications that require antibiotic prescribing.“
This is the really frustrating bit:
All of the participants were ages 6 months and older, had acute respiratory illness, and were tested for influenza by the RT-PCR assay. “Clinicians at four of the five sites were unaware of the laboratory testing results,” Havers said….
In a subanalysis, researchers looked at streptococcal testing for the 2014-2015 season at four out of the five sites, and 40% of those with pharyngitis received an antibiotic, Havers said. “43% of those who had pharyngitis and who received an antibiotic actually had a negative strep test.”
But more than half of the patients who received prescriptions were being treated for conditions rarely or never indicated for antibiotics, such as cough, bronchitis (acute and NOS), and acute respiratory infection.
Out of the entire group of patients, 22% had PCR-confirmed influenza, 31% of them were given an antibiotic, and 19% were given an antiviral. “Overall, 17% of all the antibiotic prescriptions were written for those who had laboratory confirmed influenza,” Havers said.
Not only were the test results routinely ignored, but they also indicated that antibiotics were the wrong therapy. I suppose the ‘good’ news is that most of the ‘misprescriptions’ were for amoxicillin and azithromycin (the latter is not awesome, but not a disaster either), with only three percent of misprescriptions for levofloxacin.
Still, this has to be cut way back. Very disturbing.
Perhaps part of this is a job for “The Cloud.”
If a doc waits for test results before issuing a prescription, it means the patient is going to have to make a second visit for little more than getting a prescription, which costs money and physician time. If the doc could issue a contingent prescription (CP) on the first visit, then the patient wouldn’t have to return, assuming the CP was for the correct antibiotic.
If the CP carried a suitably lengthy serial number, also associated with the test order, either the lab, or the doc’s office on receipt of the test results, could post, somewhere in that magic cloud, a simple fill/don’t-fill/call-doc flag for the serial number. I think this could be done without any need for posting anything that would identify the patient in any way.
A patient with internet access, or perhaps even by phone (fully automated) could check for their results in the required day or two. The pharmacy, on being handed the contingent prescription, could likewise check for approval to fill.
The whole thing would be very much akin to the way shipment tracking numbers are now used by courier companies. Very little data would need to be stored, since each serial number could be purged in a week or two, at the most. The Central Bureaucracy would either have to issue all serial numbers (e.g. as bar-code sticker sheets), or issue each doc with a unique number that would form part of the SN, allowing the doc to assign the rest of the SN.
I am old enough to remember when this sort of thing was handled by phone. Which was a safer means of communication. 😉