When Levaquin fails....

[anh06005, MSN, APRN, NP]

As I'm gaining experience and seeing how other providers practice I have some concerns. I do try to explain viral vs. bacterial etiology when it comes to sinus infections, colds, bronchitis, etc. and many patients I can make a deal with: "I'll write in my note that if you're not better in a few days we can call in this antibiotic. All you have to do is call...not come in again." I am concerned, though, how some seem to hand out IM Rocephin and Levaquin like candy to otherwise healthy individuals with green snot since this morning.

What will happen, though, when critters develop resistance? I try to follow protocols and reserve quinolones for patients with respiratory infections and comorbidities or if there is treatment failure. One of these providers has told me they go ahead and treat even mild symptoms so the patient doesn't have to come back.

I think I never realized how prevalent this issue is because my doctor keeps current with guidelines and is happy to explain that it he won't be giving someone antibiotics for their sinus symptoms x 3 days. I know better than to go to him until I hit the 10-ish days.

[TakeTwoAspirin, MSN, RN, APRN]

It's a big issue, because the people who own the practice want you to keep the patient happy - at all costs. If they want antibiotics and it makes them happy, why not? Except, as you note, we are running out of antibiotics. Do what you have to do to make sure at least you are practicing in the patient's best interest on a case by case. Educate. Educate.