Mi-marr.org

Avoiding Unnecessary Use of Antibiotics
Common Scenarios
PEARLS Strategy
Description and Helpful Statements
• An antibiotic is the only thing that ever helps.
• Children have 6-8 viral URI per year; adults have 2-3 per year.
• Amoxicillin doesn’t work … I need Biaxin (or other drug) Only 0.5% of viral URI are complicated by bacterial infection.
• But it always settles in my chest/sinuses.
• In uncomplicated colds, cough and nasal discharge may persist for 14 days or more, long after other symptoms have resolved.
Show understanding, put feelings into words • Mucopurulent rhinitis (thick, opaque or discolored nasal • My co-workers/ sent me in to get an antibiotic.
discharge) frequently accompanies viral URI. It is not an • The daycare won’t take her without antibiotics.
indication for antibiotic treatment unless it persists without • Help me to understand what these symptoms are about.
• I have drainage – it’s green/bloody/choking me.
• You look so ill today; it must be so hard to accomplish anything.
• Antibiotics do not effectively prevent subsequent bacterial infection.
Communication Strategies
• Only 15% of pharyngitis is caused by group A strep; most sore for Discussing Viral Illness with Patients
• I’m sorry you’re feeling ill.
• Prominent rhinorrhea, cough, hoarseness, conjunctivitis or Value patient’s choices,traits,behaviors and 2. Comment on pertinent positive and negative physical findings as diarrhea with sore throat suggests viral etiology for pharyngitis.
• I appreciate your decision/action.
• Penicillin is the drug of choice for pharyngitis; no group A s t re p 3. Make reference to popular news articles or other media reports • You did the right thing by coming in today.
about antibiotics assuming patient is aware of their content.
a re resistant to penicillin. Use erythromycin for penicillin-allerg i c 4. Don’t pressure yourself to convince 100% of your patients.
Remember your success in prescribing antibiotics appropriately.
• You may need an antibiotic, but first let’s see what your Keep in mind that many patients will become convinced over time • Bronchitis in children and adults rarely warrants antibiotic • I’m sure you’ve seen reports about bacterial resistance caused 5. For patients who insist on an unnecessary antibiotic, offer the treatment; if non-viral illness is suspected (underlying lung prescription and explain that you care about the patient, but do not disease?), erythromycin or doxycycline can be used.
support using the antibiotic on medical grounds.
• Biaxin (or other drug) is a good antibiotic. It’s very popular 6. For patients whose illness poses diagnostic uncertainty or logistical because it’s been heavily advertised. But I think amoxicillin (or Seven studies have identified recent antibiotic use as a risk factor for concerns (travelling, etc), try these suggestions: other drug) is better for your illness.
development of infection with resistant pneumococci. To pre v e n t • Offer the prescription and provide instructions describing under bacterial resistance, avoid unnecessary use of antibiotics. Plan tre a t - what circumstances it would be appropriate to fill it and initiate L EGITIMATION: Normalize and validate feelings and choices ment of symptoms for your patients presenting with viral illness.
• Anyone would be irritated/miserable with this situation.
• Suggest the patient call your office in a few days if not better or • We’re seeing a lot of this illness (cold, flu, virus) lately.
getting worse. Be sure to provide the patient with an easy • It’s difficult for most people to tell the difference between a OTC Symptom Relief Medications
mechanism for reaching you (voice mail, beeper, specific nurse or cold, flu, sinus infection or an allergy flare.
• I can see how you would feel that way.
• Suggest patient return if not improved in a few days.
• You do have a lot of drainage (or other complaint).
• Promise to call the patient in a few days and DO IT.
7. Make an effort to understand the context of the illness in the patient’s life and how the patient feels the illness will affect • I’ll stick with you as long as necessary.
him/her. This may yield clues for suggesting treatment that does • I’m going to help you manage this.
• Let me offer you some helpful suggestions.
8. Provide education - Explain the natural course of the illness including time markers. Consider showing the patient the CDC symptom v. time graph of upper respiratory infections.

Source: http://mi-marr.org/documents/PEARLS.pdf