Using Leaflets to Reduce Inappropriate Antibiotics for Upper Respiratory Infections

Abstract

Antibiotics are inappropriately prescribed for upper respiratory infections (URIs) throughout the United States, leading to complications like antibiotic-resistant pathogens, increased morbidity and mortality, adverse drug events, and increased healthcare costs (Lee et al., 2017; Meeker et al., 2016). Upper respiratory infections are one of the most common conditions that primary care providers see in their practice (Meeker et al., 2016). Current evidence does not support the use of antibiotics for URIs because most infections are caused by viruses, are self-limiting, and rarely lead to serious complications (Lee et al., 2017). As a result of overprescribing antibiotics, pathogens are becoming increasingly resistant to existing antibiotics, which leads to increased morbidity and mortality worldwide (Gonzales et al., 2013). According to the Centers for Disease Control and Prevention (CDC), each year in the United States over two million people become infected with antibiotic-resistant pathogens and as a result at least 23,000 people die (CDC, 2013). The use of antibiotics can have undesired consequences from side effects, adverse reactions, and complications. Antibiotics can cause side effects like nausea, diarrhea, rash, itching, photosensitivity, and abdominal discomfort. Moreover, antibiotics can lead to serious complications like acute kidney injury, hepatitis, anaphylaxis and secondary infections like Clostridium difficile diarrhea (CDC, 2013). The health care costs of antibiotics to treat URIs are significant in the United States. Meeker et al. (2014) explains that in the United States alone, 41.2 million prescriptions for antibiotics aimed at treating URIs are prescribed annually. This results in a cost of $1.1 billion dollars (Meeker et al., 2014). According to the CDC (2013), one in five emergency department visits are a direct result of an adverse drug event from prescribed antibiotics. In children antibiotics are the most common cause of emergency department visits resulting from adverse drug effects (CDC, 2013). Unnecessary use of antibiotics increases the healthcare cost from the initial purchase of the antibiotic, but also the emergency department visit associated with possible side effects (CDC, 2013). There is a psychological and sociocultural variable that influences the use of antibiotics in treatment of URIs, and that is the desire to receive antibiotics by patients (Coxeter, Mar, & Hoffmann, 2017). According to Coxeter, Mar, and Hoffmann (2017), many patients overestimate the benefits and underestimate the harms of using antibiotics. This thought process by the public leads to increased demand and desire for antibiotics, regardless of whether or not they are indicated. Furthermore, patients often have inadequate knowledge and misconceptions about antibiotic use for URIs (Coxeter, Mar, & Hoffmann, 2017). For example, most patients believe that antibiotics are beneficial in treating common respiratory infections, including the ability to cure viral infections, and shorten the duration of URIs (Yu...