Medical care is based on science, but science guides day-to-day clinical decision making less than you might think.
Jeffrey Gerber and colleagues report on "Variability in Antibiotic Use at Children’s Hospitals" (Pediatrics, 2010;126;1067-1073). The title is a bit dry, but the problem is important, because
The inappropriately excessive use of antimicrobial agents, particularly systemic antibiotic agents, is a major public health and patient safety issue. Most hospitalized patients receive antibiotics, and roughly one-half of all antibiotic use is unnecessary. Antibiotic overuse promotes the emergence and expansion of antibiotic-resistant organisms, and infections caused by resistant pathogens have a significant impact on patient morbidity and mortality, with an estimated cost of $4 billion to $5 billion annually.
Studying more than half a million patients and 40 children's hospitals, Gerber et al. find that
[T]he proportion of inpatients who received at least 1 dose of an antibiotic agent during their hospitalization demonstrated a range across hospitals of 44.4% to 73.6%.
This is an extraordinary range of variation for an ostensibly science-driven process. When people think about clinical research, I expect they often think about efforts to develop new drugs. However, there is much to be learned about the best ways to use existing drugs.
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