Antibiotics have been used for the past 70 years to treat patients, and have significantly reduced the morbidity and mortality associated with many infections. However, resistance has become a global problem that is increasing in incidence. In addition, the healthcare costs associated with resistant infections have been estimated to be as high as $20 billion dollars (Oliphant & Eroschenko, 2015). Evidence has shown that one of the most significant causes of antibiotic resistance is from the inappropriate utilization and overuse of antibiotics. More than half of patients who present to primary care with acute bronchitis and upper respiratory infections are treated with antibiotics. However, most of these are viral in etiology and the use of antibiotics is unnecessary (Ackerman, Gonzales, Stahl, & Metlay, 2013). In my future role as a nurse practitioner, this topic will be extremely important in my everyday practice because cough and respiratory illness are some of the most common patient encounters in primary care. As a registered nurse, I was familiar with problems of antibiotic resistance, but I mostly assumed that it was from patient misuse.
A review of literature using key terms of ‘antibiotic resistance’ and ‘over-prescribing of antibiotics’ revealed numerous articles. I narrowed my search to articles that were written within the last 5 years, and ones that were relevant to primary care providers. A recurring topic revealed that even though primary care providers are aware of problems with antibiotic resistance, they have still been prescribing antibiotics for conditions where evidence has shown them to be ineffective (Dempsey, Businger, Whaley, Gagne, & Linder, 2014). One article discussed some of the reasons clinicians commonly prescribe antibiotics that are not necessary; including wanting to increase patient satisfaction, uncertainty of diagnosis, and gaps in knowledge regarding the recommended treatments (Dempsey et al., 2014). It revealed that over 65% of patients with acute cough or bronchitis are prescribed antibiotics. “Unnecessary antibiotic prescriptions provide no clinical improvement, expose patients to the risk of adverse drug events, increase the prevalence of antibiotic-resistant bacteria, and increase healthcare costs” (Dempsey et al., 2014, p. 195).
A potential innovative solution to the problem of antibacterial resistance is to provide more education to providers and to the general public via electronic applications. Many patients with acute respiratory symptoms often see a primary care clinician seeking a prescription for antibiotics. By having strong communication skills, confidence in their diagnosis, and alternative OTC treatments that can increase patient satisfaction, healthcare providers can decrease the unnecessary reliance on antibiotics (Dempsey et al., 2014).
References
Ackerman, S. L., Gonzales, R., Stahl, M. S., & Metlay, J. P. (2013). One size does not fit all: Evaluating an intervention to reduce antibiotic prescribing for acute bronchitis. BMC Health Services Research, 13(1), 462-462. doi:10.1186/1472-6963-13-462
Dempsey, P. P., Businger, A. C., Whaley, L. E., Gagne, J. J., & Linder, J. A. (2014). Primary care clinicians' perceptions about antibiotic prescribing for acute bronchitis: A qualitative study. Family Practice, 15(1), 194-2. doi:10.1186/s12875-014-0194-5
Oliphant, C. M., & Eroschenko, K. (2015). Antibiotic resistance: Gram-positive pathogens. The Journal for Nurse Practitioners, 11(1), 70-78. doi: 10.1016/j.nurpra.2014.09.018
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