Survey: Internists See Regular Misuse of Antibiotics, Narcotics

Physicians prefer newer, more-costly drugs over generics

Antibiotics and narcotics are often prescribed when they aren’t the best option for patients and may do more harm than good, a survey by the American College of Physicians (ACP) has found. In the survey, 5,000 ACP-member internal medicine physicians were asked to identify two treatments frequently used by internists but unlikely to provide high-value care to patients.

The overuse of antibiotics topped the list, with 27% of doctors identifying it as a common problem.

The overuse of aggressive care in patients with limited life expectancy was identified as a problem by 9% of respondents, making it second only to the overuse of antibiotics. Aggressive care included life-support measures near the end of life, such as feeding tubes, intubation, and resuscitation; treatments to prevent long-term complications in patients with little time left to live, such as dialysis or invasive heart procedures; and chemotherapy for patients with advanced or metastatic cancer.

Prescribing narcotics and opioids for chronic pain was another treatment of limited value, according to 7% of the physicians surveyed.

The findings were published in the Annals of Internal Medicine.

Many current clinical guidelines recommend against the routine use of the treatments identified in the survey, including antibiotics for upper respiratory-tract infections and the use of opioids for chronic pain management.

Despite evidence highlighting the efficacy of generic medications and the lack of evidence supporting the use of newer and more-expensive medications compared with older drugs, physicians continue to prescribe more-costly treatments, the survey found.

“While many current clinical guidelines recommend appropriate care, the results of this survey may reflect intrinsic motivations to err on the side of treatment rather than ‘doing nothing,’” said lead author Amir Qaseem, MD, FACP, PhD. “However, as health care shifts to a value-driven system, this study shows that doctors are willing to critically assess their own clinical practice.”

Earlier this year, the ACP and the Centers for Disease Control and Prevention issued advice for prescribing antibiotics for acute respiratory-tract infections in adults.

Sources: Reuters; December 5, 2016; and EurekAlert; December 5, 2016.