Explaining to Patients that Antibiotics Aren't Always the Answer

Belinda Ostrowsky, MD, MPH, Health Systems Director of Epidemiology, Antimicrobial Stewardship & Infection Prevention, Montefiore Medical Center, and Associate Professor of Clinical Medicine, Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, explains how to treat patients who expect to receive an antibiotic, but should not.

Interview Transcript (slightly modified for readability)

“I think that there’s a growing understanding, even in the lay public, that [we’re] overusing antibiotics, [and that] these are really precious resources. I think that there’s a few [different approaches] you could [take to strengthen prescribing practices].

[The] first is, if a patient comes in, and they’re lucky enough to have something that [does] not [require] an antibiotic, I think [we should be] talking to the patient about their diagnosis, pointing out the factors that go along more with a viral condition. [There’s] a relationship that you have with that patient, and [you can explain to them] that even if they’re here once, there could be a follow-up [to assess if they need an antibiotic at a later time].

There’s some data for what’s called preemptive prescribing, where you basically say, ‘Look, right now it looks like you have a viral infection, but if you were to progress, or you had certain symptoms that sound more bacterial, we could always treat it at that time.’ [You can] go over that there’s very good data that [suggests that] most patients don’t have big complications [that] need treatment, [and] that [treatment could [come] later.

Then, also, [we need to] underscore what the tangible downsides of [prescribing unnecessary] antibiotics for those patients could be, [which could include] diarrhea, such as [Clostridium difficile], or kidney problems, et cetera. In fact, [explain to] them that one of the most common reasons for patients to come in with adverse drug reactions [is] related to [overprescribing of] antibiotics. So, [it’s important to tell] them not only that this probably isn’t a bacterial infection, [but] that there’s a way for us to make sure that [they’re] going to be treated correctly, and [that, with unnecessary antibiotics], there could be downsides.

Sometimes there’s a perception that, just because they’re not getting an antibiotic, [they feel that they are] not getting a therapy or treatment. There are lots of things that we could [recommend instead of prescribing an] antibiotic, [such as] getting fluids, resting, [and] taking antihistamines. Physicians can give patients a prescription for these other supported measures and not have to give them an antibiotic.”