Broad-spectrum badness

Here is another report describing high rates of inappropriate antibiotic use, this time in outpatient dialysis centers. Fully 30% of the antibiotic prescriptions written were inappropriate, usually because criteria for infection were not met, or because a broad-spectrum antibiotic was used when a narrow-spectrum antibiotic was the better choice.

In an earlier post I made the point that developing broad-spectrum antibiotics is not necessarily a good thing. The rationale here is that such antibiotics, while providing some therapeutic benefit, are usually not optimal. Narrow-spectrum antibiotics are preferred when the identity and antibiotic susceptibilities of the infecting bug are known, from the standpoint both of patient benefit and antimicrobial stewardship.

Broad-spectrum antibiotics thus enable second-best prescribing practices - they allow doctors to treat patients without ordering a microbiology report, or allow them to fail to follow up on the report. Broad-spectrum antibiotics such as vancomycin are valuable medicines - but is apparent that they also can be used as a crutch to support inferior medical practices.

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