University of Maryland School of Medicine: Study finds more than 70% of doctors still prescribe unsafe antibiotics

A study of primary care physicians found that based on a single positive urine sample, an estimated 70% would still recommend antibiotics to treat asymptomatic infections, despite long-standing medical standards advising against this practice. The study was recently published in JAMA Network Open. Researchers from the University of Maryland School of Medicine (UMSOM) conducted the study.

Since 2005, medical societies have opposed the routine use of antibiotics in people who have bacteria found in a urine culture but who do not have signs of a urinary tract infection (UTI), such as a burning sensation or frequent urination. A large body of evidence shows that these drugs are ineffective in asymptomatic patients and can cause side effects such as diarrhea, vomiting, rashes and yeast infections. In rare cases, antibiotics have even caused death due to an overabundance of harmful bacteria, Clostridium difficile, in the colon. The overuse of these drugs has also led to a rise in bacterial infections that are difficult to treat and sometimes fatal because of their resistance to antibiotics.

In the study, 723 primary care professionals from Texas, the Mid-Atlantic region, and the Pacific Northwest were asked how they would treat a fictitious patient with asymptomatic bacteriuria, which is when bacteria are detected in the urine of a patient with no signs of a urinary tract infection. They found that, despite doing so being contrary to recommended guidelines, 392 of the 551 responding physicians (71%) would choose to treat such a patient with antibiotics.

"Our study suggests that primary care physicians are not following widely accepted recommendations to not prescribe antibiotics for asymptomatic bacteriuria," said lead author Jonathan Baghdadi, PhD, assistant professor of epidemiology and public health at UMSOM. "Some primary care physicians may not be aware of these recommendations, but an inappropriate prescribing culture may also be a contributing factor."

Family physicians were more likely to prescribe unnecessary antibiotics than other specialties. Physicians who were doing residency or living in the Pacific Northwest were less likely to prescribe antibiotics.

"We found that other factors also play a role in prescribing, such as whether a physician is more inclined to overtreat a condition and fears missing a diagnosis; that individual is more likely to be inclined to prescribe antibiotics compared to physicians who are more comfortable with uncertainty in their practice," said study leader Daniel Morgan, MD, professor of epidemiology and public health at UMSOM.

One strategy to change practice could be educational programs for doctors who place a high priority on treatment, to ensure they don't miss possible infections, the researchers said in the article's conclusion. For example, reframing the term "unnecessary treatment" with antibiotics as "potentially harmful" treatment with antibiotics could help curb the trend toward overprescribing.

UMSOM faculty members Lisa Pineles, Alison Lydecker, Larry Magde and Deborah Stevens are co-authors of the study. Researchers from the University of Colorado School of Medicine and Memorial Sloan-Kettering Cancer Center also contributed to the study.

The research was supported by a National Institutes of Health New Innovator Award and a University of Maryland, Baltimore School of Clinical and Translational Research/Clinical and Translational Science Award.

"This is an important finding that points to the importance of continuing medical education to help change outdated attitudes about antibiotics," said E. Albert Reece, MD, executive vice president for medical affairs at the University of Maryland, Baltimore County, and the John Z. and Akiko K. Bowers Distinguished Professor and dean of the University of Maryland School of Medicine. "Physicians are taught to first do no harm, and now we know that overuse of antibiotic therapy can lead to real harm."

From cnBeta.COM