Antibiotics have been in use since the 1940’s, and have done much to save lives, improve quality of life and control communicable diseases. In fact, the discovery of antibiotics has been touted as one of the greatest medical advances of the 20th century.
Unfortunately, the past century of benefits realized from antibiotic use are at risk of being reversed, due to increasing prevalence of bacteria that are resistant to antibiotics. Affectionately known as ‘superbugs’, these resistant bacteria are difficult to treat, can cause serious illness and can even be life-threatening. Finger-pointing is a useless exercise in this discussion, as physicians, dentists and patients all bear some responsibility for the current situation.
The conversation about overprescribing of antibiotics by physicians and dentists is not a new one, but it has recently come into focus again in light of studies published by both the American Medical Association and the American Dental Association in 2016. One of these studies suggests that as many as 30 per cent of all antibiotic prescriptions written in North America in 2016 were unnecessary – a staggering number. And although dentists only account for 10 per cent of all antibiotic prescriptions, dentistry is particularly culpable in the area of preventive antibiotics given prior to dental procedures for patients with certain heart conditions and hip and knee replacements. Recent published guidelines advise that preventive antibiotics are no longer necessary for many of these patients, and yet many patients and surgeons still request them.
It is clear that prescribers need to do a much better job in the area of antibiotic stewardship. It is equally clear, however, that the public has a role to play in fixing the problem. The days of paternalistic medicine, where doctor knows best, are long gone. Patients advocate for their own health, and are generally more comfortable in questioning the advice provided by healthcare professionals.
One recent study questioned physicians and dentists about their antibiotic prescribing practices. The study found that in a certain percentage of cases, the prescriber gave a prescription even though they felt it was unnecessary, citing “pressure from the patient.” The authors of the study also point out that it may be more expeditious for a busy practitioner to “write a script” than to take the time to educate the patient.
Ultimately, the responsibility lies with the prescriber, but this revelation at least sheds some light on the complexity of the problem, the role of human behaviour and the desire of health care practitioners to satisfy their patients.
Antibiotics still play a vitally important role in health care. At the very least, however, physicians and dentists and their patients need to have a frank conversation about the pros and cons of antibiotic use before they are prescribed.
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