Antibiotics Anonymous Redux1

special report

By Stan Deresinski, MD, FACP

The problem of antibiotic resistance continues to worsen. An important contribution to this problem is the inappropriate prescription of antibiotics by physicians. For example, excess prescription of antibiotics for respiratory tract infections, particularly in children, has been identified as an important factor in the emergence of penicillin-resistant Streptococcus pneumoniae. Indeed, it has been suggested that some physicians have lost control over their antibiotic prescribing—that they have become, in effect, antibiotic dependent. I have, as a consequence, devised a questionnaire for the diagnosis of this dreaded addiction afflicting practicing physicians. If the answer to one or more of these questions is yes, you have a problem!

Are you antibiotic dependent?

1. Do you prescribe antibiotics to relieve tension?

2. Do you prescribe antibiotics more than other physicians but are able to hide it?

3. Do you sometimes feel guilty about the way you prescribe antibiotics?

4. Do you have a strong urge to prescribe antibiotics at a particular time of day?

5. Have you lost ambition since you began prescribing antibiotics in this way?

6. Has another physician advised you to stop or cut down your prescribing?

7. Are you harder to get along with when you are heavily prescribing?

8. Have you ever tried to cut back?

9. Do you have difficulty sleeping a full night?

10. Have you ever been in trouble with the antibiotic police?

11. Have you ever done anything while prescribing that you don’t remember (have a blackout)?

12. Have you ever promised yourself you would cut back on your prescribing and then broken that promise?

13. Have you ever tried to convince people that you were not prescribing antibiotics when you were?

14. Do you wish people would mind their own business about your antibiotic prescribing—that they stop telling you what to do?

15. Have you ever switched from one kind of antibiotic to another in the hope that this would keep you from going over the edge?

16. Have you had to have an eye-opener, i.e., prescribed an antibiotic immediately upon awakening, in the last year?

17. Do you envy people who can prescribe antibiotics without getting into trouble?

For those who have answered yes to one or more of these questions, I have begun the development of a 12-step program. Unfortunately, I have only been able to develop half of a 12-step program.

1. You must admit that you are powerless over your antibiotic prescribing.

2. You must believe that a power (an antibiotic guru) greater than yourself can restore you to sanity.

3. You must make a decision to turn your will and life over to the care of that power.

4. You must make a searching and fearless moral inventory of yourself.

5. You must admit to the power and to yourself the exact nature of your misprescribing.

6. You must humbly ask the power to remove your antibiotic shortcomings.

Reference

1. Lockwood WR. N Engl J Med 1974;290:465-466.