Most doctors still believe in prescribing unnecessary antibiotics to treat asymptomatic infections, study suggests

An estimated 70 percent of primary care physicians reported in a survey that they would still prescribe antibiotics to treat asymptomatic infections based solely on a positive urine specimen. This is despite long-held medical guidelines recommending against this practice, according to a new study published in JAMA Network Open, which was led by University of Maryland School of Medicine (UMSOM) researchers.

Since 2005, medical organizations have been advocating against the routine use of antibiotics to treat patients who have bacteria detected in a urine culture but no symptoms of a urinary tract infection (UTI) like burning or frequent urination. Overwhelming evidence indicates that the medications are not helpful for asymptomatic patients and could lead to adverse health effects like diarrhea, vomiting, rashes, and yeast infections. Antibiotics can, in rare cases, cause death due to an overgrowth the dangerous bacteria C. difficile in the colon. Overuse of these drugs has also contributed to the rise of antibiotic-resistant bacterial infections that are difficult to treat and sometimes deadly.

In the study, the UMSOM researchers surveyed 723 primary care clinicians from Texas, the Mid-Atlantic, and the Pacific Northwest regarding their approach to a hypothetical patient with asymptomatic bacteriuria; this is a condition where bacteria are detected in the urine of a patient without any UTI symptoms. They found 71 percent of clinicians, 392 out of the 551 who completed the survey, would opt to treat such a patient with antibiotics even though such treatment goes against the recommended guidelines.

“Our study suggests that primary care clinicians do not follow widely accepted recommendations against prescribing antibiotics for asymptomatic bacteriuria,” said lead author Jonathan Baghdadi, MD, PhD, Assistant Professor of Epidemiology & Public Health at UMSOM. “Some primary care clinicians may be unaware of these recommendations, but a culture of inappropriate prescribing is also likely a contributing factor.”

Family medicine physicians were more likely to prescribe antibiotics unnecessarily compared to other specialties. Physicians who were in residency training or who resided in the Pacific Northwest were less likely to prescribe antibiotics.

“We found other factors also played a role in prescribing like whether a physician had a stronger preference in favor of over-treating a condition and fear of missing a diagnosis; that person was more likely to favor prescribing antibiotics compared to a physician who felt more comfortable with uncertainty in practicing medicine,” said study leader Daniel Morgan, MD, MS, Professor of Epidemiology & Public Health at UMSOM.

One strategy to change practice could be an education program targeting physicians who place a high priority on treating just to make sure they do not miss a possible infection, the researchers said in the conclusion section of the article. For example, reframing “unnecessary treatment” with antibiotics as “potentially harmful” treatment with antibiotics could help curb the tendency towards overprescribing.

UMSOM faculty and staff Lisa Pineles, MA, Alison Lydecker, MPH, Larry Magder, PhD, and Deborah Stevens, LCSW-C, MPH, were study co-authors. Researchers from the University of Colorado School of Medicine and the Memorial Sloan Kettering Cancer Center also contributed to this study.

The research was funded by the New Innovator Award from the National Institutes of Health and the University of Maryland, Baltimore Institute for Clinical & Translational Research/Clinical and Translational Science Award.

“This is an important finding that points to the importance of continuing medical education to help change lingering attitudes towards antibiotics that are out of date with the current guidelines,” said E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. “Physicians are taught to first do no harm, and now we know that overtreatment with antibiotics could lead to real harm."

About the University of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world -- with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research.  With an operating budget of more than $1.2 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic and clinically based care for nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding.  As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The combined School of Medicine and Medical System (“University of Maryland Medicine”) has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies.  In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent (#27) of all 192 public and private U.S. medical schools.  The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu