Antibiotic Prescribing Practices in a Teaching Clinic
Antibiotic Prescribing Practices in a Teaching Clinic
Background: The widespread and often inappropriate use of broad spectrum antibiotics in the outpatient setting is recognized as a significant contributing factor to the spread of bacterial resistance. We hypothesized that residents prescribe broader spectrum antibiotics more frequently than staff physicians and adopt more appropriate prescribing practices with increasing levels of training.
Methods: All patient visits for acute sinusitis in our teaching practice between July 1, 1995, and June 30, 1997, were reviewed. Comparisons of antibiotics prescribed were made between staff and residents at each level of training.
Results: First- and second-year residents were more likely to prescribe narrow spectrum antibiotics (56%) than third-year residents (35%) or staff (34%).
Conclusions: Junior residents in our program are more likely to prescribe narrow spectrum antibiotics for the treatment of acute sinusitis than are senior residents or staff. With advancement in level of training, prescribing practices of residents come to resemble those of their supervising staff physicians.
Antimicrobial drug resistance is a growing problem worldwide. The widespread and often inappropriate use of broad spectrum antibiotics in the outpatient setting is recognized as a significant contributing factor to the spread of bacterial resistance and the development of resistance to multiple drugs. Despite these well-publicized concerns, the inappropriate use of antibiotics (ie, use when not indicated) or use of broad spectrum antibiotics when narrow spectrum drugs would be sufficient remains a serious worldwide problem.
Strategies to combat the growing problem of antibiotic resistance emphasize treatment only for illnesses in which antibiotic use has proven to be beneficial and prescription of drugs with the narrowest reasonable range of activity. Reductions in rates of antimicrobial resistance have been shown after policy changes or other interventions leading to reduced rates of antibiotic usage. Resident education during ambulatory training is theoretically important in establishing a basis for appropriate antibiotic use in the future.
We posed the following question: Do internal medicine residents prescribe antibiotics for acute sinusitis in a pattern similar to that of their general medical staff, or do they form prescribing practices based on other information (ie, subspecialty staff, pharmaceutical representatives, or journal advertisements)? We hypothesized that residents prescribe newer, broader spectrum antibiotics more frequently than do staff physicians and that they learn more appropriate prescribing practices from staff physicians in the ambulatory setting and incorporate this knowledge into their practice as their level of training advances.
We chose to evaluate the influence of teaching on prescribing of antibiotics for acute sinusitis because we thought that physicians who entered this billing diagnosis believed strongly that the patient had a disorder requiring the use of antibiotics. Published guidelines and a recent meta-analysis support the use of a narrow spectrum agent such as amoxicillin or a folate inhibitor as the best initial therapeutic choice, reserving broader spectrum agents for treatment failures and more serious illness. The setting was ideal for our study because residents and staff work in the same environment, see a similar patient population, and have similar support mechanisms (nurses, front desk, etc).
Background: The widespread and often inappropriate use of broad spectrum antibiotics in the outpatient setting is recognized as a significant contributing factor to the spread of bacterial resistance. We hypothesized that residents prescribe broader spectrum antibiotics more frequently than staff physicians and adopt more appropriate prescribing practices with increasing levels of training.
Methods: All patient visits for acute sinusitis in our teaching practice between July 1, 1995, and June 30, 1997, were reviewed. Comparisons of antibiotics prescribed were made between staff and residents at each level of training.
Results: First- and second-year residents were more likely to prescribe narrow spectrum antibiotics (56%) than third-year residents (35%) or staff (34%).
Conclusions: Junior residents in our program are more likely to prescribe narrow spectrum antibiotics for the treatment of acute sinusitis than are senior residents or staff. With advancement in level of training, prescribing practices of residents come to resemble those of their supervising staff physicians.
Antimicrobial drug resistance is a growing problem worldwide. The widespread and often inappropriate use of broad spectrum antibiotics in the outpatient setting is recognized as a significant contributing factor to the spread of bacterial resistance and the development of resistance to multiple drugs. Despite these well-publicized concerns, the inappropriate use of antibiotics (ie, use when not indicated) or use of broad spectrum antibiotics when narrow spectrum drugs would be sufficient remains a serious worldwide problem.
Strategies to combat the growing problem of antibiotic resistance emphasize treatment only for illnesses in which antibiotic use has proven to be beneficial and prescription of drugs with the narrowest reasonable range of activity. Reductions in rates of antimicrobial resistance have been shown after policy changes or other interventions leading to reduced rates of antibiotic usage. Resident education during ambulatory training is theoretically important in establishing a basis for appropriate antibiotic use in the future.
We posed the following question: Do internal medicine residents prescribe antibiotics for acute sinusitis in a pattern similar to that of their general medical staff, or do they form prescribing practices based on other information (ie, subspecialty staff, pharmaceutical representatives, or journal advertisements)? We hypothesized that residents prescribe newer, broader spectrum antibiotics more frequently than do staff physicians and that they learn more appropriate prescribing practices from staff physicians in the ambulatory setting and incorporate this knowledge into their practice as their level of training advances.
We chose to evaluate the influence of teaching on prescribing of antibiotics for acute sinusitis because we thought that physicians who entered this billing diagnosis believed strongly that the patient had a disorder requiring the use of antibiotics. Published guidelines and a recent meta-analysis support the use of a narrow spectrum agent such as amoxicillin or a folate inhibitor as the best initial therapeutic choice, reserving broader spectrum agents for treatment failures and more serious illness. The setting was ideal for our study because residents and staff work in the same environment, see a similar patient population, and have similar support mechanisms (nurses, front desk, etc).