When someone is not feeling well, it is common to seek help
from a primary care provider (PCP) and request an antibiotic. Unfortunately,
some of these individuals do not require an antibiotic and this can cause
health issues within the community. Vinnard et al. (2013) indicate prescribing
antibiotics when not needed can cause the individual to develop a resistance to
certain antibiotics, as well as adverse drug reactions and unnecessary cost.
Vinnard et al. (2013) found that providing patient education about their
expectation of antibiotics in unnecessary cases, coupled with provider
educational mailings, helped decrease antibiotic prescribing for URIs from 23.6%
to 12.8%. The goal of this blog is to provide some input into when symptoms may
indicate the need for an antibiotic and when they may just be the common cold
or bronchitis (which are both viral).
Viral URI is caused by a virus and does NOT require an
antibiotic.
Symptoms Include:
- A dry cough or with white/clear sputum likely caused by postnasal drip
- Runny nose (rhinorrhea)
- Sneezing
- General tiredness (fatigue)
- Symptoms less than 5 days
- Sore throat
Bacterial URI is caused by bacteria and may require
antibiotics.
Symptoms Include:
- A productive cough or coughing up colored sputum (yellow or green)
- Fever
- Increasing tiredness (fatigue)
- Last 5 days or more
- Change in appetite
- Shortness of breath
- Decreased appetite
Source: Parolini, E. (N.d.). Retrieved from cartoonstock.com
Recommended Treatment
Viral URI
- Over the counter cold, allergy, or sinus medications
- Rest (plenty of sleep)
- Stay hydrated with plenty of water
- Vitamin C
Bacterial URI
- See your health care provider for evaluation and more than likely an antibiotic, which covers most bacterial infections.
- Rest (plenty of sleep)
- Stay hydrated with plenty of water
- If symptoms worsen, go to the emergency room or return to your PCP as instructed.
Reference
Vinnard, C., Linkin, J. R., Localio, A. R., Leonard, C. E.,
Teal, V. L., Fishman, N. O., & Hennessy,
S. (2013). Effectiveness of interventions in reducing antibiotic use for upper respiratory infections in ambulatory
care practices. Population Health
Management, 16(1), 22-27.
http://dx.doi.org/10.1089/pop.2012.0025
Kiesha,
ReplyDeleteYour blog is outstanding. It is easy to follow and is amendable to your patient population. I do hope your blog attracts much engagement and interaction from your patients and your colleagues! Dr. D
Thank you Dr. D! I really enjoyed this assignment! I was not sure if we could ask "others" to visit the blog for input and dialogue, so now I will let my patients and colleagues know to gain some input. I really hope everyone enjoys it!
DeleteGreat information!
ReplyDeleteThanks Nikeyia, let me know if you need any further information or have any other questions.
ReplyDeleteThis is great information, especially as antibiotic (AB) resistance is on the rise. Many physicians and ARNPs have found themselves prescribing ABs to assuage worried parents and we've seen dangerous consequences in hospital settings. Aziz (2013) wrote of hospitals developing antibiotic committees to review how health care providers are prescribing and recommending ABs. With population health the way of the American future, family physicians will feel increased pressure to keep patients out of the hospital, and judicious and appropriate use of ABs is certainly one tool in the box, so to speak. I think it would be fascinating for those hospital-based committees to share their strategies and findings with family care providers, so the information could be disseminated to patients and raise awareness about what is happening due to over-prescribing.
ReplyDeleteReferences
Aziz, A. (2013). The role of healthcare strategies in controlling antibiotic resistance. British Journal Of Nursing, 22(18), 1066-1074.
Hi Beck,
DeleteThank you for contributing to my post. As indicated in the referenced article by Vinnard et al. (2013), great progress was made with educating both patients and providers about antibiotic usage. I have seen providers prescribe antibiotics just to appease patients; however, I practice with the best interest of the patient. Providers must always do what is right for the patient and realize that if an antibiotic becomes resistant in a community, simple infections can mutate and will be more difficult to treat in an outpatient setting.
Kiesha
Kiesha,
ReplyDeleteThanks for addressing this issue. Not a day goes by where I don't have to explain to patient that their viral URI doesn't require antibiotics. Their response, usually "I got better on a Z-pack last time," just goes to show how often patients are over-prescribed antibiotics. It's important that patients understand their illnesses, have realistic expectations on how the illness will progress/resolve, and the indications for antibiotic use.
It's good to provide as much information to our patients as possible to help them understands the issues with inappropriate antibiotic use. Along with breeding resistance, there are costs associated with prescribing antibiotics when not indicated or necessary. One study, published in the American Journal of Managed Care (2011), investigated the inappropriate use of antibiotics in patients diagnosed with influenza (Mirsurski, Lipson, & Changolkar, 2011). The study showed antibiotics were inappropriately prescribed in over 21% of the cases, estimating the costs at over $211 million in the United States annually (Mirsurski, Lipson, & Changolkar, 2011).
Providers need to continue to educate their patients and prescribe antibiotics appropriately. Over time, we can mitigate the effect on bacterial resistance and decrease health care costs.
References
Mirsurski, D., Lipson, D., & Changolkar, A. (2011). Inappropriate antibiotic prescribing in managed care subjects with influenza [Abstract]. American Journal of Managed Care, 17(9), 601-608.
Hi Paul,
DeleteThank you for contributing to the discussion. I agree with your post. I see many angry patients after they are seen in the ER and diagnosed with viral syndrome. Sometimes the patients feel that if they do not receive an antibiotic then they were not treated correctly. Attempting to educate patients about the difference between a virus and a bacterial infection is sometimes difficult, but providers must take the time to thorough explain this distinction and not cave in to pressure to write an unnecessary antibiotic prescription.
Kiesha
This information is good to know as these two are very common diagnosis. I especially loved the illustrations. It is amazing how many diagnosis share very similar symptoms. This makes me interested in seeing the breakdown of bronchitis vs. pneumonia which also seem very common, yet often misdiagnosed.
ReplyDeleteAlishia,
DeleteI am glad you enjoyed the post. Similar symptoms can make diagnosis difficult, but clinicians are trained to look for key elements to distinguish one diagnosis from another. Sears (2014) provides a couple keys points between pneumonia and bronchitis is bronchitis is inflammation in the upper airway, can last several weeks, most causes are viral and should not be treated with antibiotics. Pneumonia is an infection in the lower airways, the person usually feels horrible, and most causes are bacterial and require an antibiotic. I hope this helps.
Kiesha
Reference:
Sears, B. (2014). Pneumonia or bronchitis? Retrieved from healthylivingmadesimple.com/pneumonia-or-bronchitis