Pharmacy Times

Inappropriate Prescribing, Penicillin Resistance: Causes and Remedies

Author: Jeannette Y. Wick, RPh, MBA, FASCP

A recent paper sheds light on the causes of inappropriate antibiotic prescribing and misconceptions about infectious disease that can lead to it.

Inappropriate antibiotic prescribing—prescribing antibiotics for viruses or self-limiting bacterial infections—is a common problem. Despite aggressive, very public efforts to reduce this problem, it continues. The primary diagnoses associated with inappropriate prescribing are all upper respiratory in nature: the common cold, rhinosinusitis, pharyngitis, acute bronchitis, and acute otitis media.
 
Resistance to common antibiotics goes hand-in-hand with inappropriate antibiotic prescribing. The Center for Disease Dynamics, Economics, and Policy indicates that Streptococcus pneumoniae, which causes community-acquired pneumonia and bacterial meningitis, has become alarmingly resistant to narrow spectrum antibiotics such as penicillin. The center predicts that 8 of every 10 infected patients will be unresponsive to first-line, narrow spectrum antibiotics in the near future.
 
A paper by Michelle Froh, a candidate for a Masters in Nursing at Washington State University, sheds light on causes of inappropriate prescribing and misconceptions about infectious disease that can lead to inappropriate prescribing. Froh reviews a number of key facts about inappropriate prescribing and covers mechanisms that can address perceived problems.
The author stresses that many evidence-based treatment guidelines are available and can help PCPs differentiate between conditions that need treatment with an antibiotic and those that don’t. Appropriate mechanisms in lieu of immediate antibiotics include giving parents a safety-net prescription when recommending observation alone, although this approach requires educating the parents about when and why to fill the prescription. Penicillin treatment failure in patients with pharyngitis is approximately 30%, and patients who fail penicillin treatment will generally need cephalosporins.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.