It’s the rare person who hasn’t crawled into their doctor’s office or even an emergency room, seeking help from the congested-crud of some respiratory nastiness. Some of us may have left that office with a prescription for an antibiotic, those seemingly magic infection-fighting pills that doctors credit with savings countless numbers of lives since coming into widespread use last century.
Unfortunately, some of those outpatient antibiotic prescriptions —actually nearly one-third or about 47 million scripts overall — may be doing absolutely nothing to help you feel better and may be further contributing to a host of problems like drug interactions, nasty side effects like diarrhea and rashes, and the ever-growing problem of antibiotic resistance, according to a new study published today in JAMA.
In the study, researchers from the CDC and Pew Charitable Trusts, among others, looked at outpatient antibiotic prescribing information from 2010 to 2011 from two large data sets, the National Ambulatory Medical Survey and National Hospital Ambulatory Medical Care Survey. These surveys include outpatient prescribing patterns from doctors’ offices, emergency departments, and hospital specialty clinics for a host of problems such as respiratory issues, urinary tract infections and other conditions.
According to their data, about 13 percent of all outpatient office visits in the United States, or about 154 million visits annually, result in an antibiotic prescription. Unfortunately, about 30 percent of these prescriptions, totaling about 47 million, may be unnecessary, researchers say.
The biggest swath of prescriptions is for respiratory issues, with 44 percent of all outpatient antibiotic prescriptions being written to treat patients with acute conditions like middle-ear infections, viral upper respiratory infections (also known as the “common cold”), bronchitis, and the flu among others.
The researchers found nearly half of these prescriptions are unnecessary, since many of these conditions are viral and antibiotics simply don’t help and should only be given when a bacterial infection is certain or suspected.
“The common cold, acute bronchitis, some sinusitis and others don’t need to be treated with antibiotics,” says says author Dr. Katherine Fleming-Dutra of the CDC’s Division of Healthcare Quality Promotion, a medical epidemiologist and pediatrician. “Most clinicians know what they are supposed to be doing (in terms of prescribing), but sometimes there are communication issues.”
Doctors may feel pressured to provide antibiotics, believing it's what we want, explains JAMA co-author Dr. David Hyun, a pediatric infectious disease physician and senior officer at The Pew Charitable Trusts.
“What’s clear is that there is sometimes a communication gap between patients and doctors and there needs to be a more open dialogue as to whether antibiotics are needed or not,” he says.
When you (probably) don't need an antibiotic
Take, for example, sinus infections.
According to the study data, sinus miseries are the most common reason that antibiotics are prescribed to outpatients, accounting for more than 17 million prescriptions annually, with the majority being written for adults ages 20-64.
About 6 million of these prescriptions are unnecessary, say researchers.
That’s because sinus infections can be either bacterial or viral, and doctors rarely use an invasive diagnostic test to determine the exact cause of the problem. Rather, they rely on length of time of symptoms and other clinical signs.
So, before demanding an antibiotic, ask your doctor whether it's a bacterial or viral infection. A viral sinus infection isn't helped by antibiotics.
But not all infections and not all patients are created equal.
“In some instances, if someone has severe sinus symptoms or some underlying problem making them less able to fight off an infection, antibiotics could absolutely be appropriate,” says Dr. Frank Esper of University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, Ohio.
The most important aspect, he believes, is for patients and doctors to really talk about the need for antibiotics on a case-by-case basis to avoid unnecessary prescribing and potential antibiotic resistance.
Ear infections — to treat or not?
As a pediatric provider, Esper feels for parents who must provide care for a child with a middle-ear infection who have to wait a few days to see if the condition improves before antibiotics are provided.
In 2013, the American Academy of Pediatrics recommended that doctors hold off prescribing antibiotics for ear infections in children older than six months.
A child over six months with an ear infection should be given antibiotics if:
- They have a history of frequent ear infections
- Their fever is higher than 102.2
- Their pain lasts longer than 2 days
- They have a bulging ear drum
“It can be tough for parents if they have a child who is miserable and they have to take off work to care for that child,” Esper says. “It’s a domino effect, but we need to educate parents as well as the doctors so they conform to standard practices.”