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Volume 20, Number 12—December 2014

Effects of Knowledge, Attitudes, and Practices of Primary Care Providers on Antibiotic Selection, United States

Guillermo V. SanchezComments to Author , Rebecca M. Roberts, Alison P. Albert, Darcia D. Johnson, and Lauri A. Hicks
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Main Article

Table 2

Topics and quotations from in-depth interviews with primary care providers regarding antibiotic therapy and antibiotic resistance, United States

Topic Quotation
Antibiotic selection “We as doctors are business people. We’re no different than running a shoe store. If somebody comes in and wants black shoes, you don’t sell them white shoes. And if you do, they get upset. You can convince a patient, look if I were you I wouldn’t take this antibiotic… but patients in general don’t understand that concept of not taking it if you don’t need it… [and] if you don’t give it to them, they don’t come back to you.”
“The patient [may] call you up and… tell you … call me in some X, Y or Z because everybody wants to hurry up and get better faster. Sometimes [you worry] about 1-800 call you-know-lawyer. [Maybe] you don’t have a standing relationship with the patient and you don’t know [if they will] come back if they are not getting better. All of those things [affect antibiotic selection]. But if you are pretty comfortable and have a good relationship [with a patient], you [may] not necessarily go straight to a broad-spectrum antibiotic.”
“[Broad-spectrum antibiotics] take the thinking out of it for me so that I am not trying to figure out what the organism is and [which] particular antibiotic treats the organism.”

“It’s very simple. Patients come to the doctor and they want an antibiotic. If they don’t get better, they get upset… I had a patient who came to me who had bronchitis and I started her on azithromycin… however, she did not get better. She came to see my colleague and [he] did not change the antibiotic, but gave her Prednisone and that got her better within 24 hours. She was mad at me, because I apparently did not give her ‘the right antibiotic’ and my partner did.”
Broad- and narrow-spectrum definitions
“If it’s narrow, it [covers] one particular class of organism like gram-negative. If it’s broad, it’s going to be different types like gram-negative, gram-positive, anaerobes to treat a wider spectrum of infections.”
“The more bacteria the antibiotic works …against, you call it broader. If this antibiotic only works against one or two types of bacteria, then that is a narrow-spectrum [antibiotic].”
“The one thing no one’s going to argue about is penicillin being narrow-spectrum.”
“Amoxicillin is a great example of a very broad-spectrum antibiotic.”
“I guess it is pretty subjective, the definition [of broad- versus narrow-spectrum antibiotics].”
Education and resources for antibiotic treatment
“During residency…when you see patients with different conditions and decide how you want to treat them and see how the attending… chooses to treat them, I think that's when you learn the most.”
“I think there needs to be more education to providers about the real dangers of antibiotic resistance. You get taught that in school and … you don't ever hear about it again, and you get busy in your practice, it's not your number one priority. And you… get to where you really don't think about it, but it is a huge issue.”
“I think [focusing education efforts only on students and residents] would be a mistake. I think that’s the conclusion you would draw if you assume the rest of the system stayed unchanged. If you just focus on the young doctors you're still going to wait 15 years for that change to take place.”
Changing prescribing habits “Habits are hard to change. I will say that. So if someone’s used to writing Zithromax… they’re not going to stop because it’s easy, patients want it, and they want the patients to go away and be happy. But I think pushing the knowledge is helpful, and change takes time.”
“[Physicians] tend to be rigid. That’s it, really; a new generation that has learned its own rigid rules that come in and replace the previous… It’s not that any new crop of doctors is any more malleable, it’s the fact that everybody’s not malleable… [they] resort to the way they were during residency.”

“Patients don’t realize [antibiotic resistance could affect them] and some of them don’t even care. You can say ‘one day you’re going to [have a resistant infection]’ and they’ll say ‘oh, they’ll make more [drugs]’.”
Antibiotic resistance “It is very scary because we are seeing increasingly resistant germs. We had a lady in the office the other day [with] a urinary infection [resistant to] every single oral antibiotic on the entire list of the culture and sensitivity report. There wasn’t a single oral medicine that could be used... It was resistant to everything.”
“We haven’t had a new antibiotic for at least 10 years and something is going to happen one of these days. We are going to get a big, big multi-drug resistant bacteria and we are going to end up with nothing to treat this thing… and then we are going to be in trouble. That is my main concern.”
“I had a patient with an abscess on his nose, and [a dermatologist] agreed with the Bactrim I started, I see the patient today, looks 100% better, but needs to stay on the antibiotics. “Well, I want to stop,” [the patient said]. Why? “I’m worried about antibiotic resistance,” which is a fair assessment.”

Main Article

Page created: November 18, 2014
Page updated: November 18, 2014
Page reviewed: November 18, 2014
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.