By UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE
A study of primary care doctors found that, on the basis of a single positive urine sample, an estimated 70% of them would still recommend antibiotics to treat asymptomatic infections. According to a study recently published in the journal JAMA Network Open, this is despite long-standing medical standards that advise against this practice. Researchers from the University of Maryland School of Medicine (UMSOM) directed the study.
Medical associations have opposed the regular use of antibiotics for individuals with bacteria found in a urine culture but no signs of a urinary tract infection (UTI), such as burning or frequent urination, since 2005. Overwhelming evidence suggests that the drugs are ineffective for asymptomatic patients and can instead cause side effects such as diarrhea, vomiting, rashes, and yeast infections. In rare instances, antibiotics can even result in death due to an excess of the harmful bacteria C. difficile in the colon. The overuse of these medications has also led to an increase in bacterial infections that are difficult to treat and sometimes fatal due to their resistance to antibiotics.
In the study, 723 primary care professionals from Texas, the Mid-Atlantic, and the Pacific Northwest were questioned about how they would treat a fictitious patient with asymptomatic bacteriuria, which is when bacteria are detected in the urine of a patient who has no signs of a urinary tract infection. They discovered that, despite doing so going against the recommended guidelines, 392 out of the 551 physicians who responded to the study (71%) would choose to treat such a patient with antibiotics.
“Our study suggests that primary care clinicians do not follow widely accepted recommendations against prescribing antibiotics for asymptomatic bacteriuria,” said lead author Jonathan Baghdadi, MD, Ph.D., Assistant Professor of Epidemiology & Public Health at UMSOM. “Some primary care clinicians may be unaware of these recommendations, but a culture of inappropriate prescribing is also likely a contributing factor.”
Compared to other specialties, family medicine doctors were more likely to give unnecessary antibiotic prescriptions. Physicians in residency or living in the Pacific Northwest were less likely to administer antibiotics.
“We found other factors also played a role in prescribing like whether a physician had a stronger preference in favor of over-treating a condition and fear of missing a diagnosis; that person was more likely to favor prescribing antibiotics compared to a physician who felt more comfortable with uncertainty in practicing medicine,” said study leader Daniel Morgan, MD, MS, Professor of Epidemiology & Public Health at UMSOM.
One strategy to change practice could be an education program targeting physicians who place a high priority on treating just to make sure they do not miss a possible infection, the researchers said in the conclusion section of the article. For example, reframing “unnecessary treatment” with antibiotics as “potentially harmful” treatment with antibiotics could help curb the tendency toward overprescribing.
UMSOM faculty and staff Lisa Pineles, MA, Alison Lydecker, MPH, Larry Magder, Ph.D., and Deborah Stevens, LCSW-C, MPH, were study co-authors. Researchers from the University of Colorado School of Medicine and the Memorial Sloan Kettering Cancer Center also contributed to this study.
The research was funded by the New Innovator Award from the National Institutes of Health and the University of Maryland, Baltimore Institute for Clinical & Translational Research/Clinical and Translational Science Award.
“This is an important finding that points to the importance of continuing medical education to help change lingering attitudes towards antibiotics that are out of date with the current guidelines,” said E. Albert Reece, MD, Ph.D., MBA, Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. “Physicians are taught to first do no harm, and now we know that overtreatment with antibiotics could lead to real harm.”
Reference: “Exploration of Primary Care Clinician Attitudes and Cognitive Characteristics Associated With Prescribing Antibiotics for Asymptomatic Bacteriuria” by Jonathan D. Baghdadi, MD, Ph.D., Deborah Korenstein, MD, Lisa Pineles, MA, Laura D. Scherer, Ph.D., Alison D. Lydecker, MPH, Larry Magder, Ph.D., Deborah N. Stevens, LCSW-C, MPH and Daniel J. Morgan, MD, MS, 27 May 2022, JAMA Network Open.