Antibiotic overuse: Still a lot of room for improvement

The Pediatric Insider

© 2016 Roy Benaroch, MD

We’ve heard it before: antibiotics just don’t work for viral infections. Docs know this, and I think most patients know this, but it’s an addiction we’ve had a hard time shaking.

Docs overprescribe because it’s fast, it’s easy, and it (might) increase patient satisfaction and return visits. That’s led to a cycle of reinforcing expectations from patients – who, after all, keep feeling better after the antibiotics. Of course they do. The minor viral infections that have been treated would have gotten better anyway. Still, it’s hard to shake that impression that it was the drug that made the illness go away. So next time, the patient expects and antibiotic, and doc is even quicker to prescribe it.

What’s the harm? Briefly: we’re encouraging the emergence of super-resistant super-bugs that, to put it bluntly, might just kill us all.

A study from 2015 illustrates some of the craziness and superstition that still guides a whole lot of antibiotic use:

The most-popular, most-prescribed antibiotic in the USA is “azithromycin”, known commonly as Zithromax. This top antibiotic is not recommended, first-line for ANY common infection—it’s not a good choice for ear infections, strep throat, or sinusitis. Not recommended for the top 3 reasons for antibiotic use, yet it’s still the top antibiotic*. Crazy.

Antibiotic prescribing varies tremendously by state. In Alaska, 348 scripts per 1000 patients per year; in Kentucky, it’s about four times that. Do they get four times as many bacterial infections in Kentucky? I don’t think so. Antibiotics, overall, are much more commonly prescribed in the southern states.

Another factor: counties with the most doctors – or the highest “per capita” number of people licensed to prescribe meds – have the highest rate of prescriptions. More docs doesn’t mean more preventive care, more access to good medical information, or better health. It does mean more prescriptions for antibiotics. (Why? I’d guess because it makes a practice more competitive and increases repeat business to write a lot of scripts.)

Current data shows that about 58% of antibiotic prescriptions handed out to human patients are for viral respiratory infections, including common colds or “upper respiratory infections”, viral sore throats, or ordinary “bronchitis”. None of these benefit from antibiotics in any way. Perhaps now’s a good time to revive the “Just say no” campaign.

There is some good news. There’s been about a 25% drop in antibiotic use since the 1990s, and I’m hearing from more and more patients who say right up front “we don’t want an antibiotic if we don’t need it.” That’s a very powerful message, and it’s something you ought to think about saying to your own doctor. You might think we’d only prescribe antibiotics if we genuinely thought they’d help… but the question is, who are they really helping? Probably not you.

*If you’re curious – why is Zithromax so popular, even though it doesn’t work well for any common infection? I think it’s because it can be prescribed with a very quick wave of the hand as a “Z Pak take as directed”. It’s so quick to write! So easy! Other meds need milligrams and instructions and things like “once a day” – who’s got time for that?! It also has a cool name. ZITH. Ro. Max! You may think I’m joking, but I’m not.

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4 Comments on “Antibiotic overuse: Still a lot of room for improvement”

  1. Sheri Says:

    I was at your office last week and my son was diagnosed with swimmer’s ear along with an inner ear infection. I was surprised that the doctor prescribed antibiotics. I was under the impression it’s a good idea to wait and see if it got better on its own. He had no fever. I should have questioned it. what are your thoughts?

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  2. Dr. Roy Says:

    Sheri, with a swimmer’s ear + an inner ear infection, I’d typically prescribe antibiotics. Those can be very painful. A swimmer’s ear alone is typically treated w/ topical drops. An uncomplicated, ordinary “inner ear infection” (which is actually a middle ear infection, or otitis media) can be observed without antibiotics if non-severe and in a child typically older than two.

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  3. Sheri Says:

    Thank you! You’ve trained me to always question antibiotics!! 😉

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  4. Sherry Says:

    My youngest kid and I get z-packs for strep. Because we’re allergic to penicillin and sulfa.

    Last month, for the first time ever, I turned into one of those moms and demanded antibiotics for my oldest when the strep test came back negative. Six others in the household with confirmed strep, all the exact same systems, and a history of weird presentations of strep for this child… Maybe it was coincidence that the illness went away in 24-48 hours, but neither science nor medicine is perfect. I honestly think that test was off for some reason.

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