5 ways to reduce uneccessary antibiotic prescribing


Not ordering unnecessary tests is one of the ways to reduce inappropriate antibiotic use, according to the Australasian Society for Infectious Diseases.

The Society nominated the prescription of antibiotics for asymptomatic bacteriuria as one of five low value interventions, in a Perspective piece in The MJA.

However in order to reduce prescriptions, clinicians should avoid ordering urine microscopy and culture in asymptomatic patients including those with indwelling catheters.

“Because a positive urine culture from an asymptomatic patients may trigger a decision to prescribe unnecessary antibiotic therapy, not ordering the test is the best way to avoid this situation,” they wrote.

The few situations where antibiotics may be warranted for asymptomatic bacteriuria include pregnancy and pre-operatively before some urological procedures.

Other low value interventions identified by the Society, as part of the Royal Australasian College of Physicians’ Evolve initiative, were also related to the inappropriate use of antibiotics. They were:

  • Taking a swab of a leg ulcer without signs of clinical infection and treating the patient with antibiotics against the identified bacteria
  • Treating upper respiratory tract infections with antibiotics
  • Investigation for faecal pathogens in the absence of diarrhoea or other gastrointestinal symptoms.

A fifth low value intervention was ordering multiple serological investigations for patients with fatigue without a clinical indication or relevant epidemiology.

They said serological testing for infections such as brucellosis, Q fever, rickettsial disease or syphilis was ‘notoriously non-specific’ and unlikely to identify an underlying cause of fatigue in most patients especially those reporting prolonged fatigue.

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