Every primary care physician , urgent care doctor , emergency room physician and many specialists face the pressure of patients and parents to prescribe antibiotics . In the early days of antibiotics , the general feeling among many medical professionals was that faced with an infection , it was better to prescribe an antibiotic in case the infection was bacterial , but if it turned out to be viral then there would be no harm . It took years of over-prescribing before the harm was recognized with resistance ( methicillin-resistant Staphylococcus aureus , vancomycin-resistant enterococci , etc .) or antibiotic associated diarrhea or the emergence of “ superbugs .” Despite multiple efforts by the Centers for Disease Control and Prevention ( CDC ), professional societies and individual physicians , the experience and belief structures of Americans and , too , that of our global neighbors , is that an infection requires a prescription for an antibiotic . This is a pervasive urban legend that is the kudzu of medical misinformation .
Appropriate antibiotic use across the Commonwealth is being driven by Bethany Wattles , PharmD , a senior pharmacist at the Department of Pediatrics at University of Louisville with a number of significant partners . Physicians ’ participation in Antibiotic Stewardship programs can make a difference in changing cultural expectations for antibiotics . Nationally , the Antibiotic Pledge is a useful tool to show patients that physicians are serious about the appropriate use of antibiotics , not just giving in to unfounded demands and threats .
All physicians deal with medical urban legends . Some of them may have some grain of truth behind them . As long as the patient also follows evidence-based medicine , attacking such legends may be futile and a source of friction in the doctor-patient relationship . But others are frankly dangerous . Those are the ones that physicians need to address directly in accordance with our Oath of Hippocrates . Today , there are renewed efforts to improve the decline of immunizations caused by COVID-19 and the “ anti-vax ” movement . Physicians are trying a variety of strategies to get patients immunized including “ Shot Days ,” use of drive-by immunizations clinics and referrals to pharmacists .
Individually and together , physicians can evaluate and dispel inappropriate urban legends .
References
Ileal-lymphoid-nodular hyperplasia , non-specific colitis , and pervasive developmental disorder in children . Wakefield AJ , Murch SH , Anthony A , et al . Lancet .
1998 ; 351:637 – 641
URBAN LEGENDS IN MEDICINE
Retraction--Ileal-lymphoid-nodular hyperplasia , non-specific colitis , and pervasive developmental disorder in children [ retraction of : Wakefield AJ , Murch SH , Anthony A , Linnell J , Casson DM , Malik M , Berelowitz M , Dhillon AP , Thomson MA , Harvey P , Valentine A , Davies SE , Walker-Smith JA . Lancet . 1998 Feb 28 ; 351 ( 9103 ): 637-41 ]. Lancet . 2010 ; 375 ( 9713 ): 445 .
Norris P , Chamberlain K , Dew K , Gabe J , Hodgetts D , Madden H . Public Beliefs about Antibiotics , Infection and Resistance : A Qualitative Study . Antibiotics ( Basel ). 2013 ; 2 ( 4 ): 465-476 . Published 2013 Nov 5 . Broom A , Kirby E , Gibson AF , Post JJ , Broom J . Myth , Manners , and Medical Ritual : Defensive Medicine and the Fetish of Antibiotics . Qual Health Res .
2017 ; 27 ( 13 ): 1994-2005 .
Dr . James is an internal medicine-pediatrics physician in Louisville .
https :// www . nfid . org / antibiotic-resistance /
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