It is well known that antibiotics are overused. Even when
the diagnosis of an infectious disease is correct, the choice or combination of
antibiotics is commonly inappropriate.
Here is an interesting article on how diagnostic errors can
impact the misuse of anti-infectives.
In the VA Health System, blinded reviewers judged the
accuracy of the initial provider diagnosis for the condition that led to an
antimicrobial course and whether the course was appropriate. The
diagnoses were correct in 291 cases (58%), incorrect in 156 cases (31%), and of
indeterminate accuracy in 22 cases (4%). In the remaining 31 cases (6%), the
diagnosis was a sign or symptom rather than a syndrome or disease.
Here is where things become more interesting. Even with a correct diagnosis, 181/292 courses (62%) were appropriate, compared with
only 10/208 (5%) when the diagnosis was incorrect or indeterminate or when
providers were treating a sign or symptom rather than a syndrome or disease
(P<.001).
This is an important point: to impact inappropriate antibiotics use, without a systematic approach to improving clinical-diagnostic reasoning, current efforts will fall short. This is a tall order and I am not optimistic.
