Overuse of antibiotics – doctors, not patients, to blame?


Women consulting their GP with symptoms of urinary tract infections are often happy to delay antibiotic treatment when their GP requests it. This intriguingly suggests that patients are much more open to reducing unnecessary antibiotic use then is often thought.


The rise of antibiotic resistant bacteria poses one of the biggest threats to human health. The UKs chief medical officer, in a report on the threat of increasing bacterial resistance, described it ‘as big a risk as terrorism’.

A number of factors contribute to this problem, such as the lack of financial incentives for drug companies to develop new antibiotics (see Gerard Wright’s recent Q&A article in BMC Biology for more on this), but there is no doubt that the biggest reason is the misuse and overuse of antibiotics. In some countries (especially in the developing world) antibiotics are available ‘over the counter’ without a prescription, inevitably leading to their indiscriminate use. However even in countries where antibiotics are only available from a doctor, over-prescribing and unnecessary use are still all too common.

iStockPhotoThis raises the question of who is responsible for this over-prescribing – the doctor, or the patient? The general consensus is that patients are mostly to blame (see here for an example); they demand access to antibiotics even when advised against this by their physician, placing doctors under pressure to prescribe the drugs even when they think it unnecessary.

It was this assumption that a new study, published today in BMC Family Practice, set out to test. Carried out by Bart Knottnerus and colleagues at the University of Amsterdam, the study tested women’s willingness to delay antibiotic use when consulting their doctor with symptoms of urinary tract infections.

Urinary tract infections (UTIs) are a good focus for this type of study. A common condition in women, it is not a serious infection, but symptoms are bothersome and can reduce quality of life. Guidelines often recommend immediate treatment with antibiotics for any patient presenting with UTI symptoms. However, past studies have shown that in 25-50% of women symptoms will disappear by themselves within a week. This then, seems to be a textbook case of antibiotic overuse; patients, many of whom will recover without treatment, being prescribed antibiotics regardless. The question then: is it true that patients with UTI symptoms expect and demand treatment with antibiotics?

To find the answer, Knottnerus and colleagues recruited a number of General Practitioners (GPs) in the Amsterdam region to take part in their study. They requested that these GPs ask patients presenting with typical UTI symptoms to delay antibiotic treatment for one week; more than a third of patients were prepared to do so. Over 70% of patients delaying treatment had improved symptoms after a week; that it to say, prescribing antibiotics to these women would have been unnecessary and wasteful.

NIH.govThese results suggest that the common perception that patients demand immediate treatment is not always correct. Instead, perhaps it is this perception among doctors that is sometimes to blame for unnecessary antibiotic prescriptions. It is notable that one of the doctors recruited into this study refused, as a point of principle, to ask his patients to delay treatment. Might results from studies such as this encourage GPs to be a bit more trusting of their patients when it comes to using antibiotics responsibly?

Of course one should not overstate these results. After all, almost two thirds of women preferred to begin treatment immediately, even when the reasons why a short delay might be beneficial were explained by their doctor. In addition, almost half of the women who initially agreed to delay treatment did in fact use antibiotics before the week was out; evidently some patients will feel the need for immediate relief from their uncomfortable symptoms, even when they appreciate the good reasons why they should delay treatment.

Even with these caveats, there is no doubt that this study makes an important contribution to the debate on reducing unnecessary use of antibiotics. Perhaps one of the biggest contributions GPs can make is to put a bit more trust in their patients to do the right thing.

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BMC Series blog Highlights of the BMC-series: May 2013

[…] Over a third of women presenting with urinary tract infection symptoms are happy to delay antibiotic treatment when asked by their GP, with the majority of these patients showing an improvement in symptoms without the need for further treatment. This intriguingly suggests that patients are much more open to reducing unnecessary antibiotic use than is often thought. More on this study over on our blog. […]

Samantha Bodan

I find that a big problem with the overuse of antibiotics is the patients demanding and bullying doctors to give them the drugs. Everyone just wants a quick fix without trying. It is seen all time these days, with weight loss and a number of other things. Let’s just fix this little problem and avoid the bigger issue on hand. I found it interesting that many patients would actually listen to their doctors and delay antibiotic treatment when actually having a conversation with their physician.

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