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Beware Unnecessary Antibiotics from Urgent Care Centers

Have you ever been given a prescription for a cold or the flu? Unnecessary antibiotic prescriptions are common, especially at urgent care centers. Read Joe's personal tale of woe and intrigue.
Hospital entrance

Have you ever visited an urgent care center or a retail clinic (like those found in some pharmacies)? Getting a quick doctor’s appointment during flu season can be challenging. It may take a week or longer to be seen. Going to the ER is also problematic. Most people are sick and tired of waiting five to ten hours in an emergency department at their local hospital. People who are feeling sick, especially if they have the flu, may opt for an urgent care center or a retail clinic instead. One big problem with that decision: unnecessary antibiotics.

Why Unnecessary Antibiotics Are a Problem:

Public health authorities and infectious disease experts have been working to reduce inappropriate use of antibiotics. A new study has found, however, that a lot of patients get unnecessary antibiotics in urgent care centers (JAMA Internal Medicine , July 16, 2018).

Antibiotic misuse is associated with bacterial resistance and diminishing value of the antibiotics. It may also lead to infections such as Clostridium difficile, which causes severe diarrhea. There are also side effects associated with some antibiotics, as we wrote about in this post:

What The Researchers Discovered:

The investigators reviewed insurance claims from 2014. This captured data on people under 65 with employer-sponsored insurance. What they found was rather shocking: Almost 40 percent of the 2.7 million urgent care center visits resulted in a prescription for an antibiotic. Approximately 16 percent of the visits to urgent care centers were for problems that shouldn’t be treated with antibiotics, such as colds. Retail clinics were no better.

In fact, 45 percent of the people at urgent care centers who were diagnosed with a problem that doesn’t respond to antibiotics got a prescription for one anyway. That compares to 25 percent of such visits in emergency departments and 17 percent in medical offices.

The authors conclude:

“The finding of the present study that antibiotic prescribing for antibiotic-inappropriate respiratory diagnoses was highest in urgent care centers suggests that unnecessary antibiotic prescribing nationally in all outpatient settings may be higher than the estimated 30%.”

“Antibiotic stewardship interventions could help reduce unnecessary antibiotic prescriptions in all ambulatory settings, and efforts targeting urgent care centers are urgently needed.”

A Personal Story About Unnecessary Antibiotics:

Over a decade ago I caught a nasty upper respiratory tract infection. It left me with a lingering cough that would not quit. The cough was especially bad at night.

I realized on a Friday afternoon that we had a big fund-raiser radio show coming up the next morning. I knew that talking on the radio would be a challenge. That afternoon I decided to head to an urgent care center. BIG MISTAKE!

  1. there was a surprisingly long wait.
  2. the clinician insisted that I needed a chest X-ray. The X-ray technician couldn’t seem to get the image right and took a whole bunch of unnecessary X-rays.
  3. the clinician determined that the X-rays did not show I had pneumonia. She prescribed an antibiotic anyway, which I was pretty sure would be useless. Unnecessary antibiotics at an urgent center, just like the new research estabished.
  4. the clinician administered a bronchodilator using an aerosol inhalator device. It didn’t help much, if at all.
  5. I got a call the following Monday that a radiologist had double-checked my chest X-rays and saw a spot on my lungs that worried him. I was told to come in for more X-rays. Needless to say, that totally freaked me out!
  6. I went to the radiology clinic and got more chest X-rays, scans and continuous radiation than I would ever want in a lifetime. At the end of the process the radiologist said he couldn’t tell what the spot was and I should come back in six months and repeat the entire process to see if the spot had grown.

Instead I opted for a CT scan at another radiology center. The radiologist there said it was a calcium deposit on a rib and nothing to worry about. Of course the CT scan meant a LOT more ionizing radiation.

My Perspective on Unnecessary Antibiotics:

My visit to the urgent care center resulted in a prescription for unnecessary antibiotics. The medicine wouldn’t have done anything for my cough. As a bonus, I got a lung-cancer scare and way more ionizing radiation than I needed. All this to determine that my “spot” was nothing to worry about.

I am sure that there are great urgent care centers and doctors who do not prescribe unnecessary antibiotics. But judging from the latest research, far too many are.

Share your own story about unnecessary antibiotics in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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My husband was in such good health that he did not even have a primary care doctor. In the fall of 2014,after a cold seemed to be getting worse after about a month, he went to a local urgent care center. After getting a chest x-ray that didn’t show an infiltration, he walked out with a prescription for Levaquin. I did not think he should take it, after researching the drug on-line, but he was concerned about the severity of his symptoms. He took it for 2 days then stopped due to severe muscle and joint pains, along with other symptoms. He became worse over the next several months, requiring 6 hospitalizations in 2015. He continues to suffer with severe peripheral neuropathy requiring several pain medications, along with many other medical problems. He is unable to work, drive or do much of anything.These drugs are HORRIBLE and should be banned!

I have COPD. Had been seeing a lung doctor. One day I had a real problem breathing, called the office, talked to the nurse. Next thing, I’m getting a call from my pharmacy, two prescriptions are ready for me. I asked what they were for–one was a Z-pak and another. Called the drs. office to see why I was given an antibiotic. He said there was a virus going around, and he assumed I had it. Now get this, I NEVER saw nor talked to this man, and he just assumed!! Needless to day, I canceled all my appointments with him and told them never to call me again. Doesn’t he know antibiotics don’t work on viruses?

As a provider myself I see where there is also a need to continue educating patients. Two comments here mentioned 1) providers prescribing antibiotics so that the patient feels like they “got something” from the visit and 2) desperate patients. I see this all the time. Patients are upset if they think they have a UTI or a “sinus infection,” and they don’t walk out with an antibiotic. They feel they “know” their body and they have paid a co-pay – sometimes as much as $50. And no one wants to wait for a culture over a weekend when they have already felt bad for 5 days (sometimes with as little as 1 day of symptoms they show up). People need to know they can get over a UTI or a cold without antibiotics but it takes a tincture of time, some rest and comfort measures. We are the culture of immediate gratification, and healthcare is no exception.

I routinely deal with irate patients who insist they need an antibiotic and will write scathing reviews of my “poor” care on the internet if they don’t get what they want. That’s just not right either.

UTIs at clinics are only diagnosed using a urine sample for a white blood cell count, that if high, confirm an infection for them…..without actually doing a culture and seeing if an infection grows, identify it and match it to an antibiotic that will kill it. BUT high white blood cells also indicate inflammation such as in the bladder or urethra that feels like a UTI but with no infection, and that will not respond to antibiotics. I have been misdiagnosed so often, and almost given a family of antibiotics that I have been severely damaged by, based on a white blood cell count that would a few days later not show any infection. Fluoroquinolones are suppose to be a last line of defence when nothing else works because they are so damaging to our mitachondria DNA. Resulting in permanent disabling bodywide damage. They are handed out without thought of the consequences for the patient. If I had mistakenly taken Cipro a second time, it would have killed me! Despite it being on my file as,an allergy, and the first thing out of my mouth at every doctor visit, vigilance is always necessary at every medical visit.

Newest data out was that Cipro may cause Aortic Dissection and/or aneurysm. In 1995 my husband died of a dissection after a polypectomy and taking antibiotics. I have warned my kids not to take this very dangerous drug.

Cheryl, that is quite startling. I just learned from you that fluoroquinolones damages your DNA. I am awaiting test results from my Ancestry testing so that may mean that my test results will be flawed. I was on fluoroquinolones for two days until I read an article advising against it. The article also said it can cause your tendons to tear. I showed the article to the doctor and he took me off that medication and put me on something else.

How do I change the shipping charge from $11.00 to the $3. mentioned when I buy this book?

Another explanation that may not have occurred to many, but that has been brought to my attention by a close relative that is a primary care physician. Antibiotics are often prescribed when not necessary for the sole purpose of having the patient feel like they “got something out of the visit and it wasn’t just a waste of time and a co-pay.”

While the close relative provides explanations to patients just like your great article does and refuses to provide unnecessary antibiotics, she said the majority of her partners in their private practice primary care group do the same thing as the urgent care centers and just prescribe a low does antibiotic so that patient feels like they got something out of the visit and paying the co-pay.

For patients who have to take time off of work and pay for a babysitter just to get to the doctor or urgent care center, they don’t want to be told it’s something that just requires rest while it runs its course. Apparently they fail to see the value in the check up and advice of a well educated physician without a prescription in hand. Sad.

Another problem with, at least, our urgent care center is their refusal to use alcohol for minor scrapes. They would only use Hydrogen Peroxide which resulted in the scrape getting infected and instead of opening it and using alcohol, they prescribed an antibiotic. Is there any chance that they profit from prescriptions?

Many years ago, I went to my primary Dr’s office with a painful sore throat. I wasn’t seen by my Dr, I was seen by a P.A. He did a throat culture, which came back negative for strep. Then he started writing an antibiotic order. Why, I asked. Is there another bacteria that could be causing my sore throat? No, it’s probably a virus, he said. Then why the antibiotic? To take care of any bacterial infection that might develop.

So, I refused. He was incensed and implied what’s the big deal. I gave him a short lesson on the dangers of overuse of antibiotics and left with no medications.

I wonder if some medical folks just feel the need to take some action to placate their sick patient or if they just don’t stay abreast of the literature.

Something I haven’t seen anywhere is the mention of some dentists prescribing antibiotics. I was prescribed round after round of powerful antibiotics from a seemingly competent dentist. Cipro was the worst one. I developed IBS which became debilitating to the point that I had to quit my job before retirement. After I switched dentist (a very competent and experienced older dentist) said that the former dentist should never have treated me with such powerful antibiotics. I have been virtually handicapped because of ulcerative colitis. I wish I could have my life back.

In the past, I, too have been prescribed Cipro several times, even though it was for a UTI . My doctor said it was probably better and I may have built up immunity for other antibiotics Have not had another UTI since I bought a couple of (TOTO brand) Washlett toilet seats – NOT Bidets, and I once had UTIs frequently – never found out why. Now, after reading the comments above, I’m wondering if the use of Cipro on several UTIs could have caused my Colon Cancer and continuous intestinal problems now.

s could by why I’ve had so much problems with my “gut”, including Colon cancer.

About 2 years ago I went into a CVS Minute Clinic just to see if they prescribe Cipro for a UTI since the FDA came out with new warnings NOT to give these out for uncomplicated UTIs. The nurse said yes we do. I asked how can you prescribe such a potent dangerous drug for a UTI when it may not even be bacterial since you didn’t get the results of the culture if you do one at all. She replied that it will help get rid of the infection and we wouldn’t want you to suffer until the culture comes back!

Why would you highlight a story from a decade ago? Obviously antibiotic misuse is a problem sometimes, but is way more known about and urgent care doctors as well as doctors in general are committed to preventing use of antibiotics for no reason. Geez. Lots of care standards have changed in 10 years!!

I think they would highlight a ten-year old story because it has gotten worse and The People’s Pharmacy cares and wants the public to know, and they have many new newsletter subscribers than a decade ago. I appreciate the People’s Pharmacy and all the work they do and all the information they share with us at no cost!

Thank you so much for sharing this!!! Levaquin ruined my life over 5 years ago and I’ve been battling debilitating health issues ever since including nerve damage, neuropathy, tremors, Gastrointestinal issues, joint pain, tendinitis, tinnitus, ear pressure/pain, to name a few! Most doctors are very uninformed about the dangerous adverse side effects. I confronted my Dr. with the blackbox warning concerns I had and she assured me it was rare and nothing would happen to me because I was young and that it only happened to the elderly. After 2 days, I could barely walk and was in severe pain with a plethora of other problems.

I must tell you, Terry & Joe, that stories such as this are welcomed and long overdue by the medical establishment & advertisers. Imagine the rush to get Rx items inundating our TV & smart phone screens ‘all’ the time. Of course, it is unrealistic to expect any self-restraint from media, but doctors should be the first defense with informed and discerning individuals- second. It is a cultural phenomenon resembling herds that rush to clinics, ER’s and druggists demanding antibiotics & OTC treatments that contravene more reasonable and/or natural approaches…j

I was given Cipro at an Urgent Care Center for a UTI. When the culture came back 3 days later, it was negative. I was told I had to complete taking the Cipro and I was lucky not to have any residual effects from the antibiotic. BUT, in the future, I will never again take an antibiotic before a culture report determines I actually need one.

Elderly are given antibiotics like candy

I’ve been to an urgent care clinic twice and both times I got sick with respiratory issues, once a cold and the other a sinus infection. I had neither before the visit but after sitting in a waiting room crowded with sick people and children with runny noses, it wasn’t long before I was stuffed up and sneezing myself. I find it appalling that today’s corporate “health care system” seems to be set up solely for the convenience of the “health care” providers who don’t seem to get the irony of mostly healthy people leaving urgent care sicker than when they came in. Urgent care is like the rest of “health care”: lots of prescriptions, lots of medical supplies, lots of medical students, interns, residents, nurses and Physician Assistants providing the vast majority of patient care. Where are the actual doctors? Where are the diagnostic skills? Where is all the money going? Navigating health has gotten to be big business because it’s so complex. It’s miserable enough for a healthy person, ridiculous for a person who is sick or old.

I have been to different urgent care office five times in the past several years. I have also had three appointments with my podiatrist who shares a waiting room with an urgent care office. I have never gotten sick or sicker because I was sitting in an urgent care waiting room. I have also never have had medicine inappropriately given to me by urgent care but I have had medicine proscribed from a regular doctor that was inappropriate. So not all urgent care places are bad.

Right on Linda of Madison, Wisconsin. Yours and millions of others holding a mirror up to the medical establishment will in time catch the eye of some entrepreneur thinking: ‘yeah, let’s build a francize around providing safe, cheaper and patient focus care–not a practice that churns money at the expense of caring’.

Everyone with commonsense knows when and when not to take certain medication but if you’ve ever been desperate most people would choose what’s on offer especially if feeling unwell.

I was prescribed Cipro for what was probably a viral respiratory infection in June of 2007 and it didn’t help. a month later the hardware for my broken ankle twisted and snapped as the connective tissue in my ankle began to come apart. During the surgery to drill the broken pieces out I got a hospital acquired MRSA infection and was given Keflex and Levaquin.

I had a HORRIFIC adverse reaction to the Levaquin with spontaneous tendon ruptures, cartilage lesions requiring a transplant from a dead child, torn lumbar muscle, umbilical hernia, collapsed lung, 6 bulging discs when I was an extreme snowboarder months before, blood clots, broken blood vessels, bloated purple failing veins carved from 13 entry points so far, stomach problems, loss of bladder control, chronic diarrhea, anxiety and panic attacks over nothing, pulmonary edema, crumbling teeth, hair and nail loss, visual and auditory disturbances, cognitive and emotional difficulties, nosebleeds, dry mouth, nose and eyes, photosensitivity, disorientation, depersonalization and psychoses and a hundred other health issues ranging from mildly annoying to life threatening and disabling.

I believe that I would not have been hit by the Levaquin nearly as hard as I was if I had not been given Cipro needlessly or at best inappropriately a couple of months before.

I urge everyone to read your excellent articles about the dangers of fluoroquinolones, or FQs. This class of drugs is normally used for chemo treatments so you can get an idea of just how incredibly toxic they really are. The problem is that most doctors have no clue they are not just traditional antibiotics like penicillin so they often increase the dose or duration and they also prescribe them in conjunction with other drugs that are contraindicated, meaning they cause a toxic reaction when combined.

My idiot doctors did all three, so even though the Levaquin probably saved my life, it also wrecked it. My doctor doubled the dose and tripled the duration and didn’t bother to take me off of any of the numerous drugs he should have. worse yet, when what should have been immediately recognized as an adverse drug reaction (ADR) set in, instead of discontinuing the FQ and the drugs interacting with them, they instead doubled and then tripled down on the deal by adding more and more and more toxic drugs.

Soon, I was on umpteen drugs and when I asked about it they just said “You’re getting older and will probably need them from now on”. I knew it was something else but it took me 3 1/2 years to figure it out when I came across an article that left no doubt in my mind what had happened to me. Now, over a decade later, I have had dozens and dozens of doctors of every sort and I have yet to be able to convince any of them that this is what actually happened to me. I am like the poster-boy for FQ associated disability, or FQAD, and have spoken about it in front of panels of prestigious doctors from both FDA and CDC, but my doctors don’t believe me.

It is incredibly hard to convince a doctor that he, she, or one of their colleagues wrecked your life with a wonderful amazing FDA approved antibiotic. Doctors are absurdly and insanely over-confident in all drugs, but the disparity between what they think is happening and what I really going on is widest with this class of drugs. This is why you need to look into it further!

Mark A G
Fluoroquinolone Toxicity Advocate

Mark, I sincerely hope you are getting better. It’s so sad that most medical care has become just another business, at least here in the U. S. Greed is truly taking over the world, and medical care and drugs are no exception, in many cases. I do trust the People’s Pharmacy. They do not seem to have the greed problem that so many businesses now have.

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