There is too little results in avoiding unnecessary antibiotic use,
despite that antibiotic resistance is an important public health concern
and that antibiotics are one of the most commonly prescribed drug classes
worldwide.
For urinary tract infection in primary care, Mangin rightly focused on
providing treatment guidelines and decision support to physicians but he
evoked confusing notions such as “therapeutic influence” and “placebo
effect”. We believe he simply missed the overestimation of the benefit
.(1)
Overestimation of the benefit is well characterized for cancer screening
programs: people overestimated the mortality reduction from screening by
at least one order of magnitude and health pamphlets tended to increase
rather than reduce overestimation.(2) We will not discuss overestimation
by doctors.
France, which had the highest rates of antibiotic use and pneumococcal
resistance in Europe, developed a sustained and multifaceted campaign. It
used mass media (the message was that “Antibiotics are not automatic”) as
well as targeting physicians (one-on-one educational sessions known as
“academic detailing” and promotion of the streptococcal rapid antigen test
plus treatment guidelines for viral respiratory tract infections).
Antibiotics prescriptions decreased by 27 %.(3) This confirmed previous
campaigns in others counties (eg. Belgium).
Physicians develop mindlines and citiszen have perceptions. Well-
coordinated national efforts are mandatory to get rid of them and avoid
unnecessary treatments.
1 Mangin D. Urinary tract infection in primary care. BMJ
2010;340:c657
2 Gigerenzer G, Mata J, Frank R Public knowledge of benefits of
breast and prostate cancer screening in Europe. J Natl Cancer Inst
2009;101:1216-20
3 Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle P-Y
et al. Significant reduction of antibiotic use in the community after a
nationwide campaign in France, 2002–2007. PLoS Med 2009;6:e1000084.
Rapid Response:
Antibiotics overuse: mindlines and perceptions
There is too little results in avoiding unnecessary antibiotic use,
despite that antibiotic resistance is an important public health concern
and that antibiotics are one of the most commonly prescribed drug classes
worldwide.
For urinary tract infection in primary care, Mangin rightly focused on
providing treatment guidelines and decision support to physicians but he
evoked confusing notions such as “therapeutic influence” and “placebo
effect”. We believe he simply missed the overestimation of the benefit
.(1)
Overestimation of the benefit is well characterized for cancer screening
programs: people overestimated the mortality reduction from screening by
at least one order of magnitude and health pamphlets tended to increase
rather than reduce overestimation.(2) We will not discuss overestimation
by doctors.
France, which had the highest rates of antibiotic use and pneumococcal
resistance in Europe, developed a sustained and multifaceted campaign. It
used mass media (the message was that “Antibiotics are not automatic”) as
well as targeting physicians (one-on-one educational sessions known as
“academic detailing” and promotion of the streptococcal rapid antigen test
plus treatment guidelines for viral respiratory tract infections).
Antibiotics prescriptions decreased by 27 %.(3) This confirmed previous
campaigns in others counties (eg. Belgium).
Physicians develop mindlines and citiszen have perceptions. Well-
coordinated national efforts are mandatory to get rid of them and avoid
unnecessary treatments.
1 Mangin D. Urinary tract infection in primary care. BMJ
2010;340:c657
2 Gigerenzer G, Mata J, Frank R Public knowledge of benefits of
breast and prostate cancer screening in Europe. J Natl Cancer Inst
2009;101:1216-20
3 Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle P-Y
et al. Significant reduction of antibiotic use in the community after a
nationwide campaign in France, 2002–2007. PLoS Med 2009;6:e1000084.
Competing interests:
None declared
Competing interests: No competing interests