DOES YOUR PATIENT REALLY NEED
AN ANTIBIOTIC?
Dr Roshini Moodley Naidoo,
Head of Risk Management
and Quality of Care
at Discovery Health
Partnering with patients this flu season to preserve antibiotics through smart choices.
"Antibiotic resistance is growing,
and we are fast running out of
treatment options. If we leave it
to market forces alone, the new
antibiotics we most urgently need
are not going to be developed in
time." Dr Marie-Paule Kieny,
Assistant Director-General for Health
Systems and Innovation. World
Health Organisation.
These words accompanied
publication, in late February 2017, of
the WHO’s first-ever list of antibiotic-
resistant "priority pathogens", the 12
families of bacteria that currently pose
the greatest threat to human health.
We are well aware of the imminent
global health crisis presented by
anti-microbial resistance. The solution
to this problem is multifaceted and
receiving priority on public health
agendas throughout the world,
including in South Africa through the
Department of Health’s framework for
antibiotic stewardship. There remains
one important key stakeholder not
as yet meaningfully engaged in the
medical profession’s efforts to preserve
the efficacy of antibiotics - our patients.
Antibiotic resistance
is growing, and we
are fast running out of
treatment options. If we
leave it to market forces
alone, the new antibiotics
we most urgently need
are not going to be
developed in time
We often engage with patients who:
• Apply pressure in consultations
to access antibiotics we deem
unnecessary
• Use antibiotics left over from previous
prescriptions without consultation
• Ignore our instructions for how to use
an antibiotic.
Many of these patient behaviours are
inadvertently driven by misperceptions
of the usefulness of antibiotics. The
need for antimicrobial stewardship
has not as yet mainstreamed into the
public space. Patients lack information
of thepressing nature of the issue at
hand, and are not empowered with
6 MAY 2017 | MEDICAL CHRONICLE
In initiating antibiotic-related conversations with patients and families,
consider applying these four principles to the discussion to guide the
right choice:
1.
2.
What does current evidence say
about the use of antibiotics in
general? Studies show that up
to 50% of antibiotics prescribed
are not really necessary. Inform
patients of the societal implications
of antibiotic resistance and the
universal trend to use these
medicines sparingly and only
when appropriate.
Is antibiotic the best
course of treatment for
you? Patients may demand
antibiotics for infections
caused by viruses. Discuss
alternative treatments and
also treatments that can
relieve symptoms.
3.
You may need specific tests before
an antibiotic is prescribed: Engage
patients meaningfully on required
tests,, remembering to tap into the
patient’s existing health records for
tests that may have already been
completed. Use the Discovery Health
ID app for access to the patient’s
complete electronic health record.
knowledge of the required solutions.. It
is essential that the medical profession
take the message of antimicrobial
stewardship to the bedside, informing
and educating patients and families of
the dilemma we jointly face, and what is
needed to reverse the current trend.
These discussions can be difficult
especially when engaging a patient
seeking empathy from the doctor-
patient relationship through a script
for an antibioticWorse is a demanding
patient insisting on the ‘cure’ of an
antibiotic for whatever the presenting
illness is. These are universal dilemmas
from which we cannot and should not
step away. Finding an effective way to
broker a meaningful discussion on the
appropriate use of an antibiotic within a
trusted doctor-patient partnership, can
4.
Is your treatment free from harm?
Empower patients with knowledge
pertaining to unpleasant side effects
and the potential of exposure to
more serious antibiotics, if the first
line medicine is used incorrectly or
too early.
go a long way to preserving these
vital medicines.
It is firmly the view of Discovery
Health that a patient-centred
healthcare system lowers healthcare
costs, improves health outcomes,
enhances patient sentiment and
improves the experience and well-
being of healthcare providers. Patients
have to be our partners in antibiotic
stewardship efforts. Flu season is
rapidly approaching. This winter, we
have a tangibleopportunity to have
our patients meaningfully join our
efforts to stem the tide of antibiotic
resistance.