The Grapevine

Risks Of Antibiotics: Patients' Perceptions Influence Doctors' Prescriptions, Study Finds

As far as the use of antibiotics are concerned, both patients and clinicians widely subscribe to the "why not take a risk" belief, a new study found. In other words, many may be opting for unnecessary antibiotic use without acknowledging the extent of risks and the potential for long-term harm.

The study titled "Patients’ and Clinicians’ Perceptions of Antibiotic Prescribing for Upper Respiratory Infections in the Acute Care Setting" was published in the journal Medical Decision Making on May 30.

Patients' expectations influence clinician's prescribing

The decision-making regarding the use of antibiotics in medicine was examined by a team of researchers from George Washington University, Center for Disease Dynamics, Economics & Policy (CDDEP), University of California-Davis, Cornell University, and Johns Hopkins University.

By surveying 149 clinicians, 225 patients, and 519 online non-patients, the research team found patients were more likely to expect antibiotics for recovery as opposed to remaining sick. In turn, this influenced clinicians to prescribe them more despite being aware of the potential downsides.

"The problem is that patients, but more surprisingly clinicians, are not fully recognizing the potential harms from antibiotic use," said Dr. Eili Y. Klein from CDDEP.

Risk of adverse reactions, both mild and severe

Allergic reactions, rashes, yeast infections, and diarrhea are some of the side effects common to most antibiotics. 

"Despite the fact that approximately 20 percent of patients can get some sort of side effect, this does not seem to be as important a factor in decision-making as one would expect," Dr. Klien added.

If a person is severely allergic to antibiotics, they may experience difficulties in breathing and swelling of their face. This is known as anaphylaxis, which can be life-threatening if left untreated. 

Antibiotics are also not effective against viral and fungal infections. Taking them when having a cold or flu, for instance, may actually worsen the infection in addition to unnecessary costs and spending.

Misuse and overuse can fuel bacterial resistance

The biggest concern of unnecessary prescriptions is the link between misuse of antibiotics and antibiotic-resistant infections.

"One of the reasons that antibiotic resistance rates are so high in countries like India or Mexico is that people can buy antibiotics without a prescription," said Professor Colin Garner, founder and chief executive of Antibiotic Research UK.

Drug-resistant bacteria infections can lead to longer and more expensive hospital care for society in the long run. There is also an increased risk of dying from the infection if more and more people overuse antibiotics. By presenting these findings, the researchers hoped to highlight how these widespread attitudes and practices can affect not only the individual but society as a whole.

"The most important driver of antibiotic resistance is antibiotic use," Dr. Klein said. "Eliminating unnecessary antibiotic use would eliminate unnecessary harms to patients, and help reduce the spread of antibiotic resistance, which threatens the medical gains of the last century."