Steben - Antibiotic Awareness

antibioticawareness.ca

Steben - Antibiotic Awareness

The Use of Antibiotics in

the Family Physician’s

Office

Antibiotics Awareness Day

Thursday, November 18, 2010

Marc Steben MD

Biological Hazards and Workplace

Health Branch


Presentation Objectives

• Illustration of the challenges of

prescribing antibiotics in family

medicine

– Balancing the pros and cons for our

patients

– Dealing with pressure to prescribe

antibiotics

2


A bit about our practice

• The walk-in context is very different

from appointment-based practice

• It is increasingly difficult to see a

physician, even with an appointment

• There is pressure to provide a quick

and effective solution…the first time!

3


Pressure in the walk-in practice

• We don’t know the patients and

know nothing about their related

medical history

• Most times, we make a presumptive

diagnosis

• We want to avoid patients returning

to the walk-in

• Patients don’t have time to be sick

4


First Truth

Antibiotics have a major impact on

population health

• They are essential medications in

good family medicine practice

5


Second Truth

• Patients see antibiotics as the best

way to cure all ills, even the most

serious!

6


Third Truth

• It takes less time to prescribe an

antibiotic than to educate a patient,

especially when there is a 3-hour

wait in the walk-in clinic!

7


However, it is important to recognize

that antibiotics have short-term term

impacts…

• Side effects

– Diarrhea (D. difficile or other)

– Stomach upset

– Headaches

• Complications

– Flora imbalance

• Vaginal infection or diarrhea

– Allergic reaction

• Simple, such as a skin rash

• Severe, such as an anaphylactic reaction

8


…and long-term impacts

• Antimicrobial resistance

• Molecule sensitization

• Self-medication with leftovers from

previous personal or others’

prescriptions

9


The physician is caught…

• Between patients’ expectations to have

their problems fixed quickly and

effectively

• Between the pressure of salespeople

pushing the foolproof advantages of

their product

• Because of a plethora of guidelines that

are contradictory or at best complicated

and convoluted…

10


The art of prescribing antibiotics

• It is important to recognize that

antibiotics

– Are not cure-alls

– Have short- and long-term impacts

– Must be used wisely and prudently to

be effective

11


The art of prescribing antibiotics

• It is important to recognize

– That for some ailments, some patients

require antibiotics more quickly than

others, e.g.

• Patient with COPD and coughing

• Diabetic patient with a wound

– That some of the broad-spectrum

antibiotics are not for everyone and

everything

12


The art of prescribing antibiotics

13

• It is important to recognize

– That the older antibiotics still have their

place in treatment

Antibiotics can be taken for shorter

periods for some ailments, without loss of

effectiveness

– That before prescribing a long course of

antibiotics, confirmation tests are useful to

guide the decision about whether to

prescribe


In retrospective

• Most respiratory infections are viral

and antibiotics have little effect on

the course of the illness

• Most urinary infections do not

require long-term antibiotics

• The new antibiotics are not

necessarily better than the older ones

14


Knowing how to dose

antibiotics

• A simple urinary infection in a

person with no risk factors can be

treated in 3 days with a less broad-

spectrum antibiotic

• The symptoms of a respiratory

infection without a high fever can be

controlled before starting antibiotics

15


Knowing how to dose

antibiotics

• The simpler the antibiotic

prescription, the better the

compliance

• e.g., single doses in blood-borne and

sexually transmitted infections, for

gonorrhoea, chlamydia or

trichomonas

16


Conclusion

• While antibiotics are invaluable, like

all medications, they are not without

risks

• Knowing how to prescribe

antibiotics is an art that must not be

lost

Antibiotics must not become a

“quick fix” for patients or physicians

17

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