Fewer antibiotic prescriptions are issued for acute respiratory infections when doctors share decision making with patients, according to a review published by the Cochrane Library
on 12 November 2015.
The findings may help in the fight against antibiotic resistance, say the reviewers, although the data only shed light on short-term antibiotic prescribing.
“It’s important that health professionals and patients are supported to have quality conversations about the use of antibiotics so that informed decisions can be made,” says Tammy Hoffmann, lead author of the review and professor of clinical epidemiology at the Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia.
In total, ten studies (nine trials and one follow-up study) involving over 1,100 primary care doctors and around 492,000 patients were included in the review. Based on the analysis of data from eight of the trials, 29% of patients who shared decision making with their doctors were given a prescription for antibiotics, compared with 47% of patients who did not share the decision.
“It would be interesting to know if this information is remembered by the patient in the long term,” says Colin Garner, chief executive of charity Antibiotic Research UK, who was not involved in the review.
Acute respiratory infections (such as an acute cough, middle ear infection or sore throat) are among the most common reasons to see a health professional, and antibiotics are often prescribed despite evidence that they have little benefit for these conditions, write the authors of the Cochrane review. Any decision to prescribe an antibiotic should take into account the balance between possible benefits, the risk of common side effects (such as rash and stomach upset) and the contribution to antibiotic resistance — now a major threat to human health, the authors add.
Antibiotic Research UK recently released its own research findings showing that doctors in the UK prescribe 59% more antibiotics in December than they do in August, despite the fact that many of the illnesses treated by antibiotics are not seasonal.
The charity’s mission is to educate the public and professionals about antibiotic resistance, conduct research into developing new antibiotic therapies and provide patient support. “Doctors engaging with their patients about antibiotic use results in fewer prescriptions, which is something all those involved with antibiotic stewardship, including ourselves, would endorse,” Garner says.
However, while the review provides clear evidence for short-term effects on antibiotic prescribing, the long-term effects were not measured.
 Coxeter P, Del Mar CB, McGregor L et al. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. The Cochrane Library 2015. doi:10.1002/14651858.CD010907.pub2