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Skipping the Antibiotics Could Help Address the Resistance Problem
Increasingly, antibiotic-resistant bacteria are becoming a real public health crisis. The FDA has tried to address the issue in part by restricting the use of antibiotics in farm animals, which is thought to be a major cause of the problem. But overuse of the medications in people is also a contributing factor, so reducing how much we use the drugs for common infections could help.
To this end, researchers designed a study to see how improving communication between patients and their doctors might affect antibiotic use. They had doctors in five family practice teaching units take part in a virtual training program called DECISION+2, in which doctors and patients are encouraged to make joint decisions on treatment, based on the diagnosis, possible treatments, and the preferences of the patient. Four family practice teaching units served as controls, in which decisions were made as usual.
The patients in the study all had acute respiratory infections, but the decision of whether to use antibiotics to treat them varied greatly between the two groups. Far fewer patients opted for antibiotics in the group encouraged to make joint decisions than did those in the usual care group. And interestingly, there were no more negative outcomes among the patients who opted to skip the medications, suggesting that infections do indeed go away on their own, and antibiotics are not always necessary.
"These studies indicate that a combination of live and media education are generally effective in changing physician performance in the context of antibiotic use for acute respiratory infections," write the authors. "These findings are important given the debate and widespread skepticism about the effect of medical education on the performance of physicians in the practice setting."
Indeed a bit more education devoted to teaching doctors to be more conservative with antibiotics might not be such a bad idea. The DECISION+2 protocol used here was quick – just a two-hour online tutorial and a two-hour interactive workshop. That such a short and simple procedure could make a dent in addressing the antibiotic problem in the country (and perhaps across the world) is encouraging, and hopefully more facilities, including medical schools, will integrate such programs into their doctor training. It certainly can’t hurt.
The study was led by researchers at the Research Centre of the Centre Hospitalier Universitaire de Québec and published in the Canadian Medical Association Journal.
August 11, 2012