On Twitter a couple weeks back, in response to my plea to reduce empiric macrolide use for benign clinical syndromes, there was an allusion suggesting Pediatricians were the culprits of a poor antibiotic stewardship.
Of course, that’s clearly not the case. And, while we all envision Urgent Cares and customer-service medicine contributing to the over-prescription of antibiotics, it’s happening in our academic medical centers, as this article indicates. This is a retrospective chart review from San Diego that evaluated 836 patients receiving a diagnosis of “acute bronchitis”, a typically self-limited disease that evolves into pneumonia only in a minority of cases in elderly patients or patients with significant pulmonary comorbidities.
The average age was 46, 10% had comorbid COPD noted, 17% asthma, 8% diabetes, and 4% HIV/AIDS. All told, 74% were prescribed antibiotics – 50% received a macrolide, 15% a tetracycline, 6% a fluoroquinolone, along with a few others.
Unfortunate.
And certainly not just the Pediatricians.
“Antibiotic and bronchodilator prescribing for acute bronchitis in the Emergency Department.”
http://www.ncbi.nlm.nih.gov/pubmed/22341759