Do We Write Antibiotic Rx Because It's Just Easier?

Written by Clay Smith

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It took an extra 67 seconds when not prescribing an antibiotic to patients with acute respiratory infection compared to visits in which an antibiotic was prescribed.

Why does this matter?
Antibiotic stewardship is key to retaining the usefulness of current drugs and curtailing antibiotic resistance. This study is important because it is one of the first to confirm our anecdotal sense that it would just be quicker to prescribe an antibiotic. This perceived time pressure may be a driver of inappropriate antibiotic use.

If I write this script, can I leave?
This was an analysis of telemedicine encounters for respiratory tract infections. Telemedicine encounter duration can be measured with exact precision. Using this clever retrospective design, they measured the time of encounters for which an antibiotic was prescribed, no medication was prescribed, and no antibiotic was prescribed. They found, on adjusted analysis, that visits for which no antibiotic was prescribed took 1.12 minutes longer than visits in which an antibiotic was prescribed; that’s 67 seconds longer. It seems worth taking an extra minute to explain why an antibiotic isn’t best for a patient’s URI. In fairness, in a busy retail clinic with 25 or more patients, that adds up to an extra 28 minutes per day. Still, with growing antibiotic resistance, NNT for antibiotic use in sinusitis of 18, and NNH of just 8, it seems worth the effort.

Source
Antibiotic Prescribing for Respiratory Tract Infections and Encounter Length: An Observational Study of Telemedicine. Ann Intern Med. 2018 Oct 2. doi: 10.7326/M18-2042. [Epub ahead of print]

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