The scale of antibiotic misuse raises concerns not only about antimicrobial resistance but also about the damage that unnecessary prescriptions can do to trust between patients and clinicians. Professor Linder argues that doctors should focus on whether an antibiotic is likely to help or harm an individual patient, while Thorpe and colleagues call for better communication to address why patients may misrepresent their symptoms or request inappropriate treatment.
The risks of unnecessary antibiotics
Illicitly obtained antibiotics could contribute to the rise of antibiotic-resistant infections. The World Health Organization notes that antibiotic misuse and overuse facilitate the development and spread of drug resistance. This week, the Centers for Disease Control and Prevention announced that its latest report on the threat of antimicrobial resistance found that drug-resistant bacteria and fungi cause 9.7 million infections and 50,800 deaths in the United States each year.
In an accompanying commentary, Linder said that an even more concerning consequence could be a “deterioration of trust” between clinicians and patients. He acknowledged that drug resistance is a concern, but said that, for an individual patient, the development of resistance is “probably irrelevant” in most clinical situations.
Instead, Linder said doctors should ask: “Is this prescription likely to help the patient or is it likely to harm the patient?” In many cases, unnecessary antibiotics offer no benefit while creating risks that include adverse events, allergic reactions, and disruption of the healthy microbiome. They can also create opportunities for harmful organisms such as Clostridioides difficile to cause infection. The CDC classifies C. difficile as a “significant threat” in its newly updated Antimicrobial Resistance Threat Report.
Trust between doctors and patients
“Prescribing antibiotics for diagnoses for which these antibiotics are not appropriate is medically wrong and may itself be considered a form of dishonesty or a lie primarily to reassure the patient,” Linder wrote. He said such dishonesty is corrosive, quoting the philosopher Sisera Bok, who has written extensively about lying and medical ethics.
In 1978, Bok observed that antibiotics “are sometimes used as placebos” and that many parents “have come to believe that they must request a prescription for an antibiotic every time their child has a fever or cold.” Bok argued that these “dishonest practices” threaten “the entire medical establishment” when clinicians prescribe drugs likely to cause more harm than good.
Linder concluded by emphasizing that “a physician’s duty is to act in the patient’s best interest, even if the patient wants us to do something different, even if the patient doesn’t like it, or even if the patient is lying about his symptoms.”
Thorpe and colleagues, meanwhile, argue that healthcare providers must address why patients lie in the first place. They concluded that “strategies to improve communication about antibiotics are needed to address patient concerns, support understanding of appropriate antibiotic use, and strengthen the patient-physician relationship.”
Source: arstechnica.com
