Overprescibing Antibiotics: Patient Satisfaction Vs. Medical Necessity

According to the Centers for Disease Control and Prevention (2019a), “2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result.”  Antibiotic resistance continues to be a serious issue, and the general population does not seem to fully grasp the seriousness of this evolving issue. There are many individuals who search the internet for medical answers and are convinced they know better than physicians. Frequently, patients arrive in medical offices and urgent cares requesting a “Z-pack” or other type of antibiotic for viruses and the common cold. When they feel better in a few days, they attribute their improvement to these medications that do not actually treat viruses.

While these offices are also businesses, prescriptions may be given for patient satisfaction purposes instead of medical necessity. A research study by Martinez et al. (2018) found that patients rated their satisfaction highest when receiving a prescription for an antibiotic. 66% of individuals who received the antibiotic did not have a bacterial infection diagnosis. Martinez (2018) stated, “It is very problematic because it creates an incentive for physicians to do things that are not medical necessary in order to drive up their satisfaction ratings.” It is also important to note that this study involved telemedicine patients who are getting prescribed antibiotics over the phone, without a proper physical examination.

There are several reasons why microbes become resistant to drugs that are intended to eradicate them. The National Institute for Allergy and Infectious Diseases (2011) summarized the reasons why this phenomenon is growing at a rapid pace. Bacteria and microbes not killed by antimicrobials/antibiotics adapt and mutate leading to microbe replication. New bacteria forms and carries the mutated genes which fight the antibiotic at the next exposure. Inappropriate frequent use of prescription antibiotics allow these bacterial cells to adapt and mutate into stronger microbes. Prescribing antibiotics prophylactically is also part of the problem. Intensive use of antibiotics in the hospital setting is resulting in the formation of multiple resistant organisms which can spread between patients when carried by hospital staff. New research is also being done on the use of antibiotics in agricultural feed and how that can contribute to multi-drug resistant organisms.

Current data evaluates microbes and their drug resistance and categorizes five bacteria and fungi as urgent threats, eleven as serious, two as concerning, and three have been placed on the watch list (CDC, 2019a).  Although antibiotic-resistant microbes remain a continued threat, there has been a significant improvement within hospitals to contain and limit the spread of resistant germs. There has been a 28% decrease in deaths between 2012 and 2017 (CDC, 2019b) from multi-drug resistant organisms. Rapid detection and prevention strategies such as the CDC (2019a) Containment Strategy have assisted in this decrease.  Some of the strategies include screening for at-risk patients, encouraging patients to receive recommended vaccinations, educating patients in regards to preventing the spread of infection, and following antibiotic prescribing guidelines (CDC, 2019c). To fully address the growth of multi-drug resistance organisms, improvement must also be made outside the hospital setting to prevent the rampant overprescribing of antibiotics in primary/urgent care settings.




Centers for Disease Control and Prevention. (2019a).  Biggest Threats and Data.  Retrieved from https://www.cdc.gov/drugresistance/biggest-threats.html

Centers for Disease Control and Prevention. (2019b). More People in the United States Dying from Antibiotic-Resistant Infections than Previously Estimated.  Retrieved from https://www.cdc.gov/media/releases/2019/p1113-antibiotic-resistant.html

Centers for Disease Control and Prevention. (2019c). Protecting Patients and Stopping Outbreaks.  Retrieved from https://www.cdc.gov/drugresistance/protecting_patients.html

Martinez, K. A., Rood, M., Jhangiani, N., Kou, L., Boissy, A., & Rothberg, M. B. (2018). Association Between Antibiotic Prescribing for Respiratory Tract Infections and Patient Satisfaction in Direct-to-Consumer Telemedicine. JAMA Internal Medicine, 178(11), 1558. doi: 10.1001/jamainternmed.2018.4318

The National Institute for Allergy and Infectious Diseases. (2011). Causes of Antimicrobial (Drug) Resistance. Retrieved from https://www.niaid.nih.gov/research/antimicrobial-resistance-causes