The People's Perspective on Medicine

How Serious Is the Problem of Inappropriate Antibiotics?

An analysis of patient records demonstrates that perhaps a quarter of antibiotic prescriptions in the US are for inappropriate antibiotics.

Infectious disease experts worry a lot about the problem of bacterial resistance related to inappropriate antibiotics. A study of patient records suggests that doctors in the US may be prescribing antibiotics too often (Chua et al, BMJ, online Jan. 16, 2019).

Who Gets Inappropriate Antibiotics?

The scientists reviewed antibiotic prescriptions from an insurance database with records for 19 million people and examined the diagnostic codes associated with them. About three-fourths of the patients covered by the study were adults; the remaining records belonged to children.

Nearly one fourth of the prescriptions were for common colds or coughs and were therefore inappropriate antibiotics. Another third of the prescriptions might be appropriate  because they were for problems like sore throats or sinusitis. Since these conditions frequently are caused by viral rather than bacterial infections, some or perhaps even many of these prescriptions might also have been inappropriate.

This is not the first study to tackle the problem of inappropriate antibiotics. In fact, researchers have long been concerned about the dilemma of how to handle infections without overusing antibiotics for years. One group of scientists found that taking antibiotics for relatively few days might work just as well as taking them for a week or two, at least for some cases of pneumonia. This would have the advantages of exposing patients to less antibiotics, which results in a lower risk of antibiotic resistance as well as saving money.

Taking Antibiotics for a Week:

For decades, physicians commonly prescribed antibiotics for a week to 10 days. Patients were warned that if they stopped prematurely the infection could return with a vengeance.

A Shorter Course of Antibiotics:

A study in JAMA internal Medicine compared two regimens. Spanish patients hospitalized with pneumonia took the antibiotic they were prescribed for at least five days. Those in the study group discontinued the drug after day five if they no longer had a fever or serious symptoms. The other group continued their antibiotic treatment for the full 10 days. (Uranga et al, JAMA Internal Medicine, Sep. 2016)

Benefits of Less Antibiotics:

The investigators found no difference in outcome and no difference in length of stay in the hospital between the two regimens. Consequently, there was no reason to stick with the longer course. It should be noted that not all the patients randomized to the study group qualified. About 30 percent still had a fever or troublesome symptoms of pneumonia on the fifth day, and those people continued to take the antibiotics their doctors had prescribed.

Other studies have found that urinary tract infections also respond to shorter duration of treatment. It remains to be seen if other infections might benefit from the new mantra: “Shorter is Better.”

What Can You Do?

Can you help reduce the use of inappropriate antibiotics? Perhaps you should make sure to ask if any infection you are suffering is caused by bacteria or virus. Bacterial infections are susceptible to antibiotics, while viral infections are not susceptible to antibiotics, although in some cases antiviral medicines may help. Reducing the use of antibiotics for non-bacterial infections should also cut down on the likelihood of contributing to bacterial resistance.

What About Kids’ Ear Infections?

Parents of young children may also wish to consider whether their youngsters are getting inappropriate antibiotics for ear infections. For decades, children with earaches have been given antibiotics to treat ear infections. Such infections are very common, affecting three-fourths of youngsters by the time they reach their third birthday. But the American Academy of Pediatrics says that antibiotics should not be given routinely. Their guidelines urge doctors to diagnose ear infection only in children whose eardrums are red and bulging. Other children with ear pain should be offered pain relievers, while antibiotics should be reserved for kids who have had pain and swelling for two days or who have a fever over 102.

Pediatricians have been admonished previously to reserve antibiotics for ear infections that really require treatment. In many cases, children recover without such treatment, and antibiotics do have potential side effects. In addition, there is a public health consideration, in that frequent use of antibiotics may lead to the germs developing resistance so that the drugs become less useful when they are really needed. One study of 65,000 children found that antibiotics were being over-prescribed (Hersh et al, Pediatrics, Dec. 2011).

Parents can help by not insisting on antibiotics for every earache. But if the child is quite ill, running a fever, the doctor should be informed. In some cases, parents and doctors might negotiate this by having the doctor give out a prescription that would be filled and used only if the problem persists for at least two days.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I used to get 3 to 4 sinus infections per year, all of which were bacterial as they did not improve with time. Finally, one day I saw a different GP who suggested to me that my real problem was nasal allergies. Apparently, the allergies led to inflamed and swollen nasal tissue which was much more susceptible to bacterial infections. The GP recommended that I take an OTC antihistamine. I have now taken Claritin for years, and have had very few sinus infections in that entire period. What a difference! And, of course, there is the added bonus of not taking all those antibiotics.

I was prescribed a 16-day regimen of Augmenting which I believe resulted in kidney damage,e as my kidney function declined almost immediately after taking the drug.

What about antibiotics for people with hip replacements every time they go to the dentist?

I have been told by the doctor to “quit reading the adverse effects described on the included insert of a prescription! I ignored him and thankfully recognized the bad side effects I was having and discontinued it. It was Macrobid.

I have been on various antibiotics prophylactically. This is for acute and chronic prostate infections. This has been under the direction of an infection control specialist. After Cipro caused problems I was then prescribed nitrofurantoin. My urologist noticed this and then informed me that this medication may rarely cause very serious (possibly fatal) lung problems. Lung problems may occur within the first month of treatment or after long-term use of nitrofurantoin (generally for 6 months or longer), he said. I have idiopathic pulmonary fibrosis, a fatal lung disease. I asked the infection control doctor to find another drug. His response was “all drugs have side effects.” After tossing the ball back and forth finally my pulmonologist said he would prescribe…. Be careful out there. It is a jungle.

One driver of this problem is pharmaceutical companies who in many TV ads say, “Ask this your doctor if this drug is right for you.”

I live in farm country where it is commonly known that farmers have been giving antibiotics to their livestock prophylactically for many decades. This may be an even greater factor in the resistance problem than the above reporting suggests. Corporate mega farm methods are not just polluting ground water and soil but contributing to the contamination of our national food supply. Consumers are part of the experiment on how far corporate farming can push production before causing serious harm to human health and the environment.

I was on antibiotics for several years, at least 5 to 6 times a year for upper respiratory infection. Last year when I started Medicare my primary care physician told me Medicare did not approve over-use of antibiotics. I said okay. It has been 5 months, and I was put on antibiotics before Thanksgiving. I was told to take them for 10 days. I only took for 4 days because the condition cleared up, With it being cold and flu season, I take red marine algae which is a germ fighter and strengthens the immune system, and olive leaf extract which is a natural antibiotic. I am not constantly sick. I feel better than I have in years.

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