Various results for oral drugs
The use of oral antibiotics also had various results based on the country. Twelve percent of surgeons in the United States and 13% in Europe used them with patients.
In Europe, no surgeons in France and Germany used them before a procedure, but 42% of surgeons in Italy used them after procedures. The overall usage rate in South America was 37%, with yet another wide swing—no surgeons in Chile used them but 60% of surgeons in Argentina did.
In Asia, the overall rate was 59% for the use of oral antibiotics, with the highest rate in India, at 89%. “I don’t believe that the infection rate is seven times higher in India than in the United States, but clearly the prescribing patterns are responding to something,” Dr. Wladis said.
Colleagues who had practiced or trained in the United States or the United Kingdom were much less likely to use oral antibiotics compared with respondents in India, Southeast Asia, Venezuela, Brazil, and Argentina.
One part of the survey that Dr. Wladis found fascinating was the clinician estimate of complications and its lack of correlation with real-world values. For instance, respondents estimated a 1% risk of infection without the use of antibiotics, a less than 1% risk of allergy with a 1-week course, and a 2% to 10% risk for gastrointestinal issues.
However, the current data show the actual risk for infection is 0.4%, a 25% occurrence of gastrointestinal effects (such as diarrhea), and an 11% risk for allergic reaction.
“Perhaps we’re overtreating the patient,” Dr. Wladis said. “As much as we all care for patients, that doesn’t mean we always have to prescribe antibiotics. I’d encourage some rethinking based on the existing literature.”
The survey results also revealed that the more that surgeons believed that antibiotics would benefit patients, the more likely it was that they would prescribe them. The more they believed in the harmful side effects of antibiotics, the less likely it was that they would prescribe them.
1. Fay A, Nallasamy N, Bernardini F, et al. Multinational comparison of prophylactic antibiotic use for eyelid surgery. JAMA Ophthalmol. 2015;133:778-84.