Antibiotic overuse: managing uncertainty and mitigating against overtreatment

Antibiotic overuse contributes to the growing threat of antimicrobial resistance (AMR). Despite local, national and global initiatives to target the problem, reducing overuse is challenging. Levels of antibiotic prescribing in hospitals in the UK are still rising year on year.1 Pandolfo et al’s2 study in this issue of BMJ Quality & Safety provides new insights into this problem by studying clinician decision-making about antibiotic prescribing in intensive care units, using a framework from psychology: the Necessity Concerns Framework. They explored how clinicians balanced the perceived necessity of antibiotics to protect the patient from deteriorating or dying from severe infection, against concerns about the actual or potential adverse consequences (including toxicity and the longer-term threat of AMR). Their findings highlight that clinical uncertainty is a complicating factor in this balancing act. When clinicians were unsure about the underlying cause of symptoms, they preferred to ‘err on the side of caution’ and give the patient antibiotics just to be safe. [Opening paragraph]