Over Prescription of Antibiotics

Over prescription of antibiotics for sore throats and mild respiratory infections has been a continuous issue in the healthcare community, even after the CDC declared antibiotic resistance as a serious health threat in September and consistent news headlines each week and month thereafter.    Researchers have called for a further intervention to stop unnecessary use of antibiotics, particularly for patients with acute bronchitis or sore throats, who are not likely to benefit from taking them.  Treating these cases with antibiotics increases the prevalence of antibiotic-resistant bacteria, a growing global health concern.

Bacterial or viral infection?

As the names imply, bacterial infections are caused by bacteria and viral infections are caused by viruses.  Without getting into a molecular description of how each differs and causes infection in the body, the most important distinction between the two is that bacterial infections can be treated with antibiotics and viral infections cannot.  In the case of respiratory infections, the journal JAMA internal medicine reported that doctors prescribed antibiotics in 60% of sore throat cases, while only 10% of adults with a sore throat have strep, the bacterial infection requiring antibiotics.  The report also stated that unnecessary antibiotic prescriptions to adults with sore throats cost the US was more than $500 million from 1997-2010.  This estimate did not take into account the expense of dealing with side effects from antibiotics.

Interestingly, a recent study from the CDC (Center for Disease Control) found that the most frequently prescribed antibiotic was azithromycin, or Z-Pak, commonly used for bronchitis symptoms. This poses a problem. Acute bronchitis, a swelling and inflammation of the main air passages (bronchi) in lungs, is most often caused by a virus.  According to research, antibiotics – like azithromycin – should almost never be prescribed for this condition because they do not work against viruses. Despite this fact, patients going to the doctor for this condition are prescribed antibiotics about 73% of the time.  Why?

Part of the problem of overprescribing is patient demand.  Patients go to the doctor with the idea that the solution to their problem comes in the form of a pill.  They ask for antibiotics because they assume they will make them feel better.  Many doctors have also made a habit of prescribing antibiotics because of a lack of knowledge about antibiotic resistance, as well as a precautionary effort to overmedicate, instead of under-medicate their patients.  Antibiotics have been commonly available since the 1940s, and have saved an innumerable amount of patients with infections ranging from pneumonia to sexually transmitted diseases.  It is understandable that patients and doctors continue to turn to them as a solution.

Ultimately, there needs to be better communication between doctor and patient.  U.S. doctors are prescribing enough antibiotics to give them to 4 out of 5 Americans every year.  Overuse is one reason antibiotics are becoming less effective, making infections harder to treat.  The chances of resistance increase when antibiotics are not used long enough or are taken for the wrong reasons, allowing bacteria to survive and adapt. This in turn has given way to an increasing amount of antibiotic resistant strains of bacteria. As a patient, if you have a sore throat, ask your doctor for a strep test.  If your test is negative, chances are you don’t need an antibiotic.

So how exactly can you tell if you are experiencing symptoms of the common cold, acute bronchitis or strep throat? Since symptoms for both viral and bacterial respiratory infections can be quite similar, it is important to track your symptoms.  Viral infections are often characterized by the presence of low grade fever and sore throat.  Bacterial infections on the other hand present with a high fever, and along with the throat being red or swollen, white patches on the tonsils and back of the throat are a clear indicator of strep throat.  If symptoms get worse over the course of a few days, consult your doctor.  Have your physician take a throat culture and check for the type of infection present.  If it is strep, antibiotics are the answer.

If you do not have a bacterial infection like strep, what can you do? Unfortunately the answer is not as simple as a prescription for antibiotics.  The best thing to do is get rest and increase your intake of fluids like water, tea and fresh juices.  Your body will do the rest! You can also focus on eating foods high in vitamin C and zinc, as well as garlic, onions – all known to boost your immune system and your cold fighting power.

David Samadi, MD - Medical Contributor

View posts by David Samadi, MD - Medical Contributor
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team. Learn more at roboticoncology.com. Visit Dr. Samadi's blog at SamadiMD.com. Follow Dr. Samadi on Twitter, Instagram, Pinterest, and Facebook.
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