PhotoOver time a wide range of bacteria, parasites, viruses and fungi build up a resistance to antibiotic drugs, making these powerful medicines much less effective.

In 2012, the World Health Organization (WHO) reported a gradual increase in resistance to HIV drugs, although it did not reach critical levels. Since then, further increases in resistance to first-line treatment drugs have been reported, which might require using more expensive ones in the near future.

While a number of theories have been cited to explain this growing resistance, a study funded by the Centers for Disease Control and Prevention (CDC) points to a small group of healthcare providers. The authors says 10% of providers write an antibiotic prescription for 95% of patients who walk in with a cold, bronchitis, or other acute respiratory infection (ARI).

The study makes clear that not all providers are to blame, pointing out that 10% of providers only prescribe an antibiotic in fewer than 40% of such patient visits. The problem is the differences in medical routines of individual healthcare providers.

Different ways of practicing medicine

“We were able to see that even if Dr. A works just down the hall from Dr. B they may practice medicine very differently,” said Dr. Barbara Jones, assistant professor of internal medicine at the University of Utah and clinician at the VA Salt Lake City Health Care System. “We all receive similar training, but we can practice differently. The extent of this variation has been hard to measure in the past.”

The concern is real. The more antibiotics are present in the environment, the more bacteria can become resistant to them. In recent years, doctors have been cautioned to be more judicious when prescribing antibiotics.

Doctors at the Mayo Clinic found that the problem largely stems from using antibiotics for illnesses for which they are not intended. It points out antibiotics treat bacterial infections but not viral infections.

For example, an antibiotic is an appropriate treatment for strep throat, which is caused by the bacterium Streptococcus pyogenes. It's not, however, the right treatment for most sore throats, which are caused by viruses.

The study found that the overall proportion of visits in which providers prescribed antibiotics increased by 2% during the 8-year study period. However, the high proportion of antibiotic prescribing for ARIs is not a new problem, and the study found that 68% of all visits for ARI resulted in an antibiotic prescription.

Searching for a solution

On the surface, it would seem that this problem isn't that difficult to solve. Why couldn't you just educate providers about the problem and improve their decision-making? That idea has occurred to the authors too.

“We’d like to use this research to start a conversation among providers and patients about antibiotic prescribing for ARIs, and share the approaches of providers who are prescribing antibiotics less frequently with those who may be prescribing too often,” Jones said.

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