When to be Anti-Antibiotics


In spite of professional guidelines and educational campaigns to reduce the overprescribing of antibiotics, the problem is still widespread. It’s estimated that at least one-third of prescriptions for antibiotics given in U.S. outpatient settings are inappropriate. The biggest misuse: antibiotics given for viral respiratory infections, such as colds and flu. Antibiotics can treat only bacterial infections. Overuse of the drugs contributes to the development of antibiotic-resistant bacteria, which cause an estimated 2 million illnesses and 23,000 deaths in the U.S. each year. Here are three recent pieces of evidence.

  • In a study of 15,000 people who went to outpatient clinics with acute respiratory symptoms during flu season, 41 percent were prescribed antibiotics. Of these, four out of 10 had diagnoses for which antibiotics are inappropriate, primarily viral upper respiratory infections or acute bronchitis. In addition, three out of 10 people with the flu got antibiotics, as did four out of 10 people who had sinusitis for three days or less and no indication for antibiotic treatment. The study was in JAMA Network Open.
  • Urgent care centers, which account for a growing proportion of antibiotic use, have a particularly high rate of inappropriate prescribing, according to a study in JAMA Internal Medicine. It looked at millions of outpatient claims and found that 46 percent of visits to urgent care centers for “antibiotic-inappropriate” respiratory diagnoses resulted in antibiotic prescriptions, as did 25 percent of visits to emergency rooms, 17 percent of visits to medical offices, and 14 percent of visits to retail clinics (as in some pharmacies and big-box stores). As the accompanying commentary pointed out, “incentives may not be aligned to decrease antibiotic use” in urgent care centers, in that people may go to them specifically because they desire antibiotics, and staff there may worry that patients won’t return if their expectations aren’t met.
  • It’s a problem in Canada, too. Over the course of one year, nearly half of 185,000 people, ages 66 and over, who went to primary-care doctors in Ontario for probable nonbacterial upper respiratory infections were inappropriately prescribed antibiotics, according to a study in the Annals of Internal Medicine last year. Most of them had colds, and the rest had bronchitis, sinusitis, or laryngitis for less than 30 days-almost always viral infections. And two out of three people prescribed antibiotics got broad-spectrum types, which are more likely to produce side effects and contribute to the development of drug-resistant bacteria.

Words to the wise

Why do doctors misguidedly prescribe antibiotics so often? Sometimes it’s just easier for them to write out a prescription “to be on the safe side.” And often patients ask for antibiotics and are happier if their doctors prescribe something rather than tell them to just take it easy and drink plenty of fluids. Taking a pill (even a sugar pill) may make them feel better, too, thanks to the placebo effect-but antibiotics should never knowingly be prescribed as a placebo. If you’re prescribed an antibiotic for a sore throat, ask if it’s really necessary. Unless you have strep throat (which is bacterial), you’ll get better just as fast without it.