Tuesday, March 04, 2008

Dr. Rob’s handout on antibiotic myths

In general, says Dr. Rob, it is inappropriate to “call in” antibiotics for patients. I agree, although there are a few exceptions. Let’s look at some common patient misperceptions cited by Dr. Rob.

If mucous is green, it is time for antibiotics. Agree. That’s a myth.

When a fever starts, it is time for antibiotics. That’s not necessarily a myth. The best answer is “it depends.” What if the patient has a history of splenectomy or is neutropenic? Should you tell the patient to take two aspirin and call you in the morning? You may not get that call! Of course, calling in antibiotics would not be appropriate. That patient needs to go to the ER, pronto.

Sinus pain means you need antibiotics. Yeah, that’s a myth. The patient doesn’t necessarily need antibiotics, at least initially. He/she may ultimately need them, though.

“The last time I had this I needed antibiotics, so I wanted to catch it early this time.” That appeals to patients’ intuition but isn’t necessarily true.

Bronchitis requires antibiotics. NOT a myth, at least according to recent evidence. Popular dogma has taught that it’s inappropriate to treat bronchitis with antibiotics, then along came this study. It provided robust evidence that, at least in the elderly patient with bronchitis, a “preemptive strike” with antibiotics prevents pneumonia with a NNT of only 39. That’s way, way better than adult pneumococcal vaccine!

“I am immune to amoxicillin.” Whatever that means.

“Can I have antibiotics to be on the safe side?” Again, it depends.

“Can you call in an antibiotic?” Doctors in the middle of a busy day are often maneuvered into doing this. Stop and think first.

“When I got an antibiotic last time, I got better. That means the antibiotic made me better.” The post hoc ergo propter hoc fallacy.

Via Kevin M.D.

1 comment:

Rob said...

Thanks for the nod. The truth is that I wrote this to be read by an "average" audience - meaning, mostly-healthy adults. The key to the section on bronchitis is the use of the word "requires." I do not disagree with your points, however.