Accounting for variation in and overuse of antibiotics among humans

Abstract

Worldwide, antibiotic use is increasing, but many infections against which antibiotics are applied are not even caused by bacteria. Over‐the‐counter and internet sales preclude physician oversight. Regional differences, between and within countries highlight many potential factors influencing antibiotic use. Taking a systems perspective that considers pharmaceutical commodity chains, we examine antibiotic overuse from the vantage point of both sides of the therapeutic relationship. We examine patterns and expectations of practitioners and patients, institutional policies and pressures, the business strategies of pharmaceutical companies and distributors, and cultural drivers of variation. Solutions to improve antibiotic stewardship include practitioners taking greater responsibility for their antibiotic prescribing, increasing the role of caregivers as diagnosticians rather than medicine providers, improving their communication to patients about antibiotic treatment consequences, lessening the economic influences on prescribing, and identifying antibiotic alternatives.

From idioms of distress, concern, and care to moral distress leading to moral injury in the time of Covid

“…I also observed routine prescription practice and was struck by the way medicines served as a symbol of quality of care, even when not needed as per evidence-based medicine guidelines. When a practitioner felt that medications like an antibiotic were expected although not warranted, patients were prescribed medicines “just in case” to maintain patient trust and as an expression of care (Blaser et al, 2021). I further observed medicine-focused discourse used as an idiom of control by family members through “take your meds” messages when a chronically ill patient acted defiant or confrontational, and as a threat used in hospitals as a means of control.…”

Editorial: Emerging Ototoxic Medications and Their Role in Cochlear and Vestibular Disorders

“…Rybak et al call our attention to the "Ototoxicity of Non-aminoglycoside Antibiotics." This is a timely and fundamental subject because the widespread global use of antibiotics in humans and animals has created multidrug resistance among several microbial species (4), and the use of antibiotics continues to increase (5). The authors thoroughly review the field and present the evidence for ototoxicity of capreomycin, erythromycin, azithromycin, clarithromycin, vancomycin, and chloramphenicol.…”

Association of area-level education with the regional growth trajectories of rates of antibacterial dispensing to patients under 3 years in Norway: a longitudinal retrospective study

“…Education is associated with the awareness and proper use of antibacterials 14–16 and with the individual capacity to obtain, process and understand health information, 17 18 and cultural factors, such as individual versus collective value systems, and future-oriented behaviour have also been associated with prescription patterns at multiple levels. 19 …”