Patients' expectations impact antibiotic prescription, study finds

When patients expect an antibiotic, physicians are more likely to prescribe them one, regardless of if their infection would benefit from antibiotic treatment, according to a study published by the American Psychological Association.

"Much effort has been spent encouraging physicians to adhere to clinical guidelines when prescribing antibiotics. However, with few notable exceptions, these efforts rarely address the nonclinical factors, such as how to tackle patients' expectations," said Miroslav Sirota, PhD, the study's lead author.

Researchers conducted two experiments for the study. In the first, practicing family physicians in the United Kingdom filled out a questionnaire about one of several different stories involving a 15-year-old girl visiting the office with an ear infection and fever. In some versions, the mother pressures the physician to help her daughter heal quickly, and in other versions, there is no such pressure.

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Physicians who read the story in which the mother put pressure on the physician were more likely to prescribe antibiotics even though they were no more likely than other physicians to believe the infection was bacterial.

The other experiment surveyed physicians about a hypothetical visit from an adult patient with an ear infection, with similar pressure scenarios as the first experiment. In this experiment, 52 percent of physicians prescribed antibiotics and were more likely to do so if the patient expected the drugs. In a third story involving an adult patient with a cold, just 12 percent of physicians said they would prescribe antibiotics even though the patient expected them, since colds are not treatable with antibiotics.

"We do not intend our study to criticize physicians and how they prescribe antibiotics," said Dr. Sirota. "Rather, we want to point out that the over prescribing of antibiotics is a serious systemic issue: We should all work together — from patients having more realistic expectations about antibiotic effectiveness to physicians managing patients' expectations when contradicting clinical guidelines — to tackle its multiple facets."

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