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Editor's Note
January 2014

Choosing Wisely, and Soon

JAMA Intern Med. 2014;174(1):140. doi:10.1001/jamainternmed.2013.11672

Barnett and Linder report the sobering news that despite valiant efforts by the Centers for Disease Control and Prevention and others to reduce inappropriate prescription of antibiotics for sore throats in the last 20 years, little to no progress has been made. Even though only about 10% of sore throats are due to group A Streptococcus (GAS) infection, 60% of patients with sore throats were treated with antibiotics. And instead of narrowing the antibiotic spectrum, the use of azithromycin grew, while the use of penicillin declined since 1998.

On an individual level, use of antibiotics for patients without GAS infection exposes them to adverse effects without any benefit. On a societal level, the increase in the use of antibiotics, particularly the broader-spectrum ones, accelerates the development of resistant organisms. Hopefully, implementation of the principles of Choosing Wisely, where in 2011 the pediatricians admonished not to use antibiotics in the absence of a confirmed diagnosis of strep, will start to lower inappropriate use soon.1

Good Stewardship Working Group.  The “top 5” lists in primary care: meeting the responsibility of professionalism.  Arch Intern Med. 2011;171(15):1385-1390.PubMedGoogle ScholarCrossref