Empiric Treatment and Antibiotic Overuse

Belinda Ostrowsky, MD, MPH, Health Systems Director of Epidemiology, Antimicrobial Stewardship & Infection Prevention, Montefiore Medical Center, and Associate Professor of Clinical Medicine, Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, explains how empiric treatment can lead to antibiotic overuse.

Interview Transcript (slightly modified for readability)

“The question relates to empiric treatment. I think it would depend [on] what the infection is, but we know, especially in the ambulatory setting (where there is a little bit of a mismatch) that many of the programs for [antibiotic] stewardship have really grown up in the inpatient setting.

That’s largely because that’s where your sickest patients are and where there’s a potential for them to transmit [infection] to other patients that are very close in the environment. But truthfully, the majority of [antibiotic] overuse is in the ambulatory setting, and in that setting, I think it’s less that the choice is wrong or that it’s too broad, it’s that many conditions require no antibiotics at all.

So, I think that there’s a lack of understanding for some clinicians, but [there’s also] a push [from] the patient asking for antibiotics [for] most conditions, especially acute respiratory infections, [which] are viral, where no antibiotic would be needed. Even when it’s something like bronchitis, only a small percentage of infections are [from] a bacterial condition that would require any antibiotics at all, let alone broad ones.”