Prescribing Practices: How to Say "No" to Antibiotic requests

Studies show that over 55% of antibiotics prescribed for upper respiratory infections are unnecessary. You may not be aware of it, but your prescribing practices as a health care provider are extremely influential in the education of your patients. When antibiotics are frequently prescribed to patients for viral infections, the patients learn that this is the standard of care for the situation, and will expect the same treatment at subsequent illnesses. If the medical community provides a consistent message in only offering antibiotics for bacterial infections, patients will learn not to expect antibiotics for viral conditions. They will also learn that viral illnesses resolve without antibiotics.

While it is certainly understood that the medical community is under tremendous pressure from various sources, it is possible to provide care to patients without offering antibiotic prescriptions that you believe are not needed. Here are a few suggestions:

How can I say no to patients when antibiotics won't help?

  • Ask your patients why they feel they need an antibiotic
  • Spend some time educating your patients about why antibiotics aren't helpful against viruses
  • Ask your patients to wait one week without a prescription, and to call back after that time if they are still experiencing symptoms
  • Offer your patients educational materials they can take with them on the differences between viruses and bacteria
  • Offer your patients alternative methods of symptom treatment, such as sample cold care kits, or a prescription for symptomatic remedies

Immediate actions to take to decrease antibiotic resistance

  • Always wash your hands thoroughly or use hand sanitizers between patients
  • Don't give in to your patients' demands for unneeded antibiotics
  • Work with other physicians in your practice and your community to develop consistent messages to patients
  • Use a narrow-spectrum agent whenever possible
  • Isolate hospitalized patients with multi-drug-resistant infections
  • Familiarize yourself with local data on antibiotic resistance
  • Prescribe judiciously and appropriately
  • Instruct proper use when antibiotics are the appropriate treatment
  • Make sure patients' immunizations are up-to-date
  • Educate patients about handwashing and disinfection
  • Remember that seasonal allergies can cause sinus congestion. If these are treated early, bacterial sinusitis may be avoided
  • Always do rapid strep tests in the office setting, and don't prescribe antibiotics for pharyngitis unless it (or strep throat culture) is positive
  • Remember that most sore throats are viral
  • Watch your words - instead of saying "bronchitis" use "chest cold" to emphasize the viral origin of most bronchitis

Infection Control

In addition to the practices for the general public:

  • In addition to handwashing, alcohol-based hand antiseptic agents may be used when your hands are not visibly soiled
  • Always use antibiotics wisely-do not give in to demands for antibiotics when they are not indicated
  • Educate the public-share the facts
  • Be confident with the recommendation to use alternative treatments when antibiotics are not indicated
  • Treat all blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes as though potentially infectious
  • Use gloves, gown, mask, etc (personal protective equipment), as needed, when coming in contact blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes
  • Wash your hands after touching potentially contaminated surfaces
  • Always use clean and sterile techniques as appropriate for the procedure
  • Always keep clean and dirty separated
  • Clean and disinfect all reusable healthcare items between persons
  • Clean and disinfect environmental surfaces regularly and when soiled
  • Dispose of waste appropriately