Research shows doctors prescribe antibiotics too often

Thursday , March 06, 2014 - 1:02 PM

Jamie Lampros

SALT LAKE CITY — Researchers at the University of Utah School of Medicine have found doctors are prescribing some of the strongest antibiotics to people when they don’t even need an antibiotic at all.

More than 60 percent of the time, doctors choose broad spectrum antibiotics for their patients. These medications are capable of killing multiple kinds of bacteria. In more than 25 percent of cases studied, the researchers found the antibiotics useless because the infection stems from a virus, which cannot be treated with antibiotics.

This overuse of antibiotics can cause a number of problems, including a growth of antibiotic-resistant bacteria, according to Dr. Adam L. Hersh, senior author of the study, published July 29 in the Journal of Antimicrobial Chemotherapy.

Hersh, who is also assistant professor of pediatrics at the U of U School of Medicine and an infectious disease expert, said discerning whether an infection is viral or bacterial can be tricky, which probably accounts for the overuse of antibiotics.

“It seems that the natural bias, when there is uncertainty about an infection’s cause, is to err on the side of prescribing antibiotics,” he said in a news release. “Our study found that the majority of prescriptions are antibiotics that kill a wider range of bacteria, and that they are most likely to be given when not needed, such as in cases of viral infections.”

This means the bacteria that live in our bodies can become resistant to antibiotics so when we need them they will not work as well. Hersh said with mild illnesses, doctors should hold off prescribing antibiotics to see if the body can heal on its own.

Dr. Nadim Bikhazi, Ogden Clinic board president and an ear, nose and throat specialist, said there is no question there is continued use of antibiotics for many infections that do not need them, and the consequences of taking them when not needed can cause super-resistant bacteria to invade, such as Methicillin resistance Staphylococcus aureus (MRSA) and Pseudomonas to develop in the community.

Bikhazi said when health care providers choose to treat with antibiotics, they generally tend to be broad spectrum, which may adversely affect the entire patient in an effort to eradicate the infection. While this on first glance appears wrong, he said it may not necessarily be.

“In a perfect world, the clinician would culture and target the exact bacteria that are causing the infection and prescribe culture directed antibiotic therapy versus broach spectrum therapy,” he said. “Unfortunately, most of the time we do not know the exact bacteria. If the physician uses a limited or narrow spectrum antibiotic, it may not treat the infection adequately and may promote resistance, so the physician is caught in a catch 22 — an antibiotic that is not broad enough results in failure to cure the infection and too broad a choice results in too many side effects.”

Bikhazi said even in cases where antibiotics are warranted, people often will not take the full course prescribed, which can also lead to resistance. Taking too many antibiotics in a given year can also increase resistance.

Dr. Kelly R. Amann, a family physician at Ogden Clinic, said the U of U study is compelling and demonstrates a problem which many physicians encounter within the medical community.

“Taking antibiotics comes with risks. Risks include antibiotic-induced diarrhea from a reduction of our bodies’ normal bacteria. One such antibiotic-induced illness is a condition call C. difficile infection, which can be severe,” Amann said. “Some can have an allergic reaction to an antibiotic, which can also be severe and even lethal. Medication side effects may also include nausea, headaches, dizziness and muscle weakness.”

Amann said quite often, patients are unhappy when they leave the doctor’s office without a prescription.

“When a patient has a viral infection there is not a treatment available outside of symptomatic relief. Most viral infections last more than five days and many people do not want to wait for that time to pass to see if the symptoms will resolve on their own,” he said. “They cannot take time off work or school and they want to feel better quickly.”

Amann said the perception in the population is that antibiotics will always make an illness or cold go away faster, when in reality, if it’s viral, the illness will resolve on its own despite the antibiotic.

“Patients should trust their medical provider as they practice under strict guidelines designed to optimize health and treat illness,” he said. “Everyone wants value for their money, but with the office visit co-pay becoming so common, many people feel they are not getting value if they walk out of the medical office without an antibiotic prescription in hand in exchange for that co-pay visit. People should recognize that they are seeing a provider for their expert opinion and appropriate treatment for an illness, not just to get an antibiotic.”

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