Tuesday, July 4, 2017

Antibiotic Overuse: A Tragedy of the Commons and the Challenge of Physician Autonomy

Antibiotic overuse is tragedy of the commons, whereby over-prescribing a shared good, antibiotics, reduces therapeutic efficacy as a result of antibiotic resistance. 

Silverman and colleagues recently reported that 46% of patients from an ambulatory cohort were prescribed broad spectrum antibiotics for acute, upper respiratory infections, which are almost always viral in etiology. Mid - or late-career physicians, physicians with high patient volume and practitioners trained outside of the USA or Canada were more likely to write a prescription for an upper respiratory infection.

Outpatient antimicrobial stewardship programs along with financial incentives and peer-comparison approaches may curb excessive antibiotic prescribing. This likely works best for physicians practicing under the umbrella of a healthcare system or a university hospital where there is oversight by antimicrobial stewardship programs. What about the rest of them?

Approximately 33% of US physicians work independently. The website of my state's medical society explicitly states that "No one knows the medical needs of your patients better than you." 

Physician autonomy and independence are powerful forces in the USA. Curbing unnecessary antibiotics and imposing antimicrobial stewardship programs against this tide is no small task.

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