|Evidence-Based Use of Antibiotics Can Save Your Jail Money!|
|By Jeffrey E. Keller MD|
I suspect that almost every physician in the United States would agree that antibiotics are over-prescribed. Unfortunately, since the total number of antibiotic prescriptions in the United States given to people with “cold” has been estimated at 44 million per year, it would seem that most physicians have not actually decreased their own prescribing habits. I can see how this would be the case. Physicians are stuck in the inertia of “I have always done it this way.” Also, “my patients expect an antibiotic when they come in and they won’t be happy if I don’t prescribe one.” Finally, “The antibiotic can’t hurt and it might help!” Multiply each incident of an unneeded prescription by, oh, a few million, and it adds up.
Of course, inappropriate antibiotic use can and does hurt. It hurts every patient who has an adverse effect from inappropriate antibiotic prescriptions, stuff like diarrhea, yeast infections, nausea or an allergic reaction. It hurts the community by breeding antibiotic resistant bugs. And it hurts because inappropriate antibiotic use is expensive! 40 billion dollars a year expensive! How much of that money is being wasted at your facility?
One of the neatest things that I have discovered about the evidence-based medicine movement is that using evidence-based principles almost always saves money. There is no better example of this than in the area of antibiotic use.
Three years ago, the Centers of Disease Control published evidence-based guidelines for the appropriate use of antibiotics for upper respiratory infections. The guidelines were developed by a panel of experts which included representatives from infectious disease, family practice, emergency medicine, internal medicine and from the CDC itself. The panel used evidence-based principles to review the huge amount of literature on these subjects. In the end, they came up with guidelines entitled “Principles of Appropriate Antibiotic Use for Acute Respiratory Tract Infections in Adults.” The finished guidelines can be found in the March 20, 2001 edition of the Annals of Internal Medicine or online at www.cdc.gov/ncidod/dbmd/antibioticresisance/. The final report included pharyngitis (which I reviewed in the last issue of CorrectCare), acute bronchits, and rhinosinusitis.
Acute Bronchitis: A patient presents to your medical clinic complaining of a cough, productive of green sputum that she has had for three days. She should get an antibiotic, right? Not so fast!
The CDC panel defines acute bronchitis as an acute respiratory tract infection with prominent cough, with or without sputum production. As we all know, complaints of cough that we diagnose as “acute bronchitis” are common. The CDC panel’s recommendations apply to otherwise healthy adults without other complications, such as COPD. In other words, they apply to the vast majority of the patients we see. With that in mind, here is a summary of the CDC’s recommendations regarding bronchitis:
Viruses cause the vast majority of bronchitis. The only significant non-viral causes of bronchitis are Pertussis, Mycoplasma, and Chlamydia.
The CDC panel defines ‘rhinosinusitis” as and inflammation of the mucosa of the sinuses and paranasal structures. Sinusitis involving the maxillary and ethmoid sinuses is usually self limited. However, sinusitis remains the fifth most common diagnosis for which antibiotics are prescribed. The CDC panel makes the following recommendations:
Viruses account for the majority of cases of rhinosinusitis.
Here is the question for your facility: How much money are you paying for antibiotics prescribed for sinusitis, bronchitis and pharyngitis? I recommend that you find out by pulling all of the charts with one of those diagnoses over the past couple of months and adding up the antibiotic costs. Then, I highly recommend that these CDC guidelines be required reading for all the prescribing clinicians in your jail or prison.
Corrections.com author, Jeffrey E. Keller is a Board Certified Emergency Physician with 25 years of practice experience before moving full time into the practice of Correctional Medicine. He is the Medical Director of Badger Medical, which provides medical care to inmates in several jails throughout Idaho. He is also the author of the "Jail Medicine" blog
Other articles by Keller
IN CASE YOU MISSED IT