Stop Expecting Antibiotics to Be Handed Out Routinely: Here's Why
| June 10, 2014
For years, my colleagues on the Prepared Patient site have preached the importance of being an advocate for your own care. And they've noted that at times it is necessary to push back against doctors' recommendations if a suggested treatment does not seem right. I just returned from a visit to the U.K., which drove home the importance of that advice. Coming down with a common cold gave me a chance to experience differences in how British and American doctors approach the nasty symptoms of an all-too-common medical problem.
Let's face it. Most of us have been given too many antibiotics for sore throats, coughs, bronchitis, even the flu caused by viruses for which antibiotics are not helpful. As we know, they may be harmful by causing resistance later in life when a serious illness could become tough to cure or even deadly. Last fall, a study found that although growing antibiotic resistance has been known about for a couple of decades, between 1997 and 2010 primary care and emergency room doctors prescribed antibiotics about 60 percent of the time for sore throats.
The lead researcher, Dr. Jeffrey Linder, a primary care physician at Brigham and Women's Hospital in Boston, advised "the right antibiotic prescribing rate for adults with sore throat is probably around 10 percent." That's because only about 10 percent of adults with sore throat actually have strep.
The day after I arrived in London my cold symptoms were quite bothersome, so I made my way to a hospital's A and E department (for accidents and emergencies). The doctor who saw me was more concerned that I might have a blood clot in my legs from the travel the night before. She checked me out and found no signs that would warrant an antibiotic. No fever, no red ears, no red throat and no congestion in my lungs. She talked about the overuse of antibiotics and said studies indicate that cough syrup is also not effective for coughs. She sent me on my way but did warn that a viral infection could turn into a bacterial infection.
That's all that happened. Another week passed, and the cold hung around. This time the symptoms had changed, indicating the infection may have become bacterial. I was in a different English city and checked in at a walk-in clinic. There, a nurse practitioner said I did need antibiotics. My ears and throat were red, and she heard crackly noises in my upper lungs. No pneumonia, though, she advised. She prescribed plain old amoxicillin, not high-powered Cipro or Zithromax.
A week later I was much better even though some symptoms remained. These practitioners in Britain's National Health Service gave the proper care and were in no hurry to send me home with a pill if I didn't need one. I thought of all the times I visited urgent care centers in New York City where doctors often seemed eager to prescribe a Z-Pack (Zithromax). Once a doctor peeked in my ears and said he was prescribing Zithromax because it would take care of the ears, the nose, the throat and the lungs in case I had an infection in any of those places.
In May, while I was still in the U.K., yet another study found that doctors are also overprescribing antibiotics for acute bronchitis. Linder, who was involved in this study too, noted that although more than four decades of research have shown antibiotics are not effective for acute bronchitis, the prescribing rate was between 60 and 80 percent in the U.S.
Linder speculated that some doctors may be responding to patient demands for medications and a desire to do something for patients. In England, I felt I could have stomped my feet and yelled but I still wasn't going to get the drug on that first visit.
This antibiotic business is a two-way street. An educated patient shouldn't demand or expect them unless they are warranted. An educated doctor shouldn't prescribe them.
Says Linder, "The main thing I try to get across to patients is as long as you are feeling better and your cough is slowly, slowly going away, that's how acute bronchitis works and antibiotics won't change it."
