Risks of use and non-use of antibiotics in primary care: qualitative study of prescribers’ views

Abstract

PurposeThe emergence of antimicrobial resistance has led to increasing efforts to reduce unnecessary use of antibiotics in primary care, but potential hazards from bacterial infection continue to cause concern. This study investigated how primary care prescribers perceive risk and safety concerns associated with reduced antibiotic prescribing.MethodsQualitative study using semistructured interviews conducted with primary care prescribers from 10 general practices in an urban area and a shire town in England. A thematic analysis was conducted.ResultsThirty participants were recruited, including twenty-three general practitioners, five nurses and two pharmacists. Three main themes were identified: risk assessment, balancing treatment risks and negotiating decisions and risks. Respondents indicated that their decisions were grounded in clinical risk assessment, but this was informed by different approaches to antibiotic use, with most leaning towards reduced prescribing. Prescribers’ perceptions of risk included the consequences of both inappropriate prescribing and inappropriate withholding of antibiotics. Sepsis was viewed as the most concerning potential outcome of non-prescribing, leading to possible patient harm and potential litigation. Risks of antibiotic prescribing included antibiotic resistant and Clostridium difficile infections, as well as side effects, such as rashes, that might lead to possible mislabelling as antibiotic allergy. Prescribers elicited patient preferences for use or avoidance of antibiotics to inform management strategies, which included educational advice, advice on self-management including warning signs, use of delayed prescriptions and safety netting.ConclusionsAttitudes towards antibiotic prescribing are evolving, with reduced antibiotic prescribing now being approached more systematically. The safety trade-offs associated with either use or non-use of antibiotics present difficulties especially when prescribing decisions are inconsistent with patients’ expectations.

Unnecessary antibiotic treatment of children hospitalized with RSV-bronchiolitis: risk factors and prescription patterns

“…Accordingly, previous qualitative studies have found that physicians tend to erroneously prescribe antibiotics to patients who seem at high risk for adverse outcomes. 10,11 Similar patterns were identified in previous observational studies examining antibiotic misuse for patients with viral respiratory infections. 22,26 Interestingly, we identified that female sex is an influential predictor for unnecessary antibiotic treatment.…”

“…Antibiotics are frequently unnecessarily administered to respiratory viral infections, often due to incorrect diagnoses, apprehension from bacterial coinfections, or dismissal of the detrimental effects of unnecessary antibiotic treatment. [8][9][10][11] Accordingly, studies have shown positive temporal associations between incidence of viral respiratory tract infections and antibiotic use. [12][13][14] Redundant antibiotic therapy can be detrimental in two main ways: First, it can harm individual patients by increasing their future likelihood for antibiotic resistant infections 15 and for antibiotic-associated diarrhea 16 .…”

Management of Common Infections in German Primary Care: A Cross-Sectional Survey of Knowledge and Confidence among General Practitioners and Outpatient Pediatricians

“…These findings are in contrast with previous studies that show how antibiotic prescribing decisions are rather influenced by multiple psychologically- and socially-rooted factors than being the result of pure scientific reasoning [ 16 ]. Physicians’ prescribing behavior of antibiotics is influenced by several factors, such as patients’ expectations [ 17 , 18 ] and safety concerns [ 19 ]. Patients tend to be more dissatisfied with consultation in low prescribing practices [ 20 ], although, a recent qualitative study found that patients’ beliefs are evolving, probably due to rising awareness and antibiotics are perceived as medicines that should be prescribed when appropriate [ 21 ].…”

Impact of Selected Behavioral and Environmental Factors on the Antibiotic Therapy in Polish Children With Upper Respiratory Tract Infections

“…Previous studies indicated that patients who expected to be prescribed an antibiotic during a medical consultation for an URTI were three times more likely to receive it, even if there were no indications for such therapy. The expectations and pressure related to the hope of using an antibiotic are among the most important predictors of the type of therapy used ( 36 , 37 ). Research in the United Kingdom showed that there was an increased risk of inappropriate antibiotic prescription if the attending physician was older than 40 years, whereas residents who specialized in family medicine, internal medicine, and pediatrics, and who worked in primary practice, especially those supervised by specialists and attending small patient populations, were more wary of prescribing inappropriate antibiotics ( 38 ).…”