Q&A: Antibiotic Use
Do You Really Need That Antibiotic?
Antibiotics also are often given when they aren’t needed, according to a recent study.
Since their initial use in the 1940s, antibiotics have greatly reduced death rates from infectious illness—however, according to the Centers for Disease Control and Prevention, up to 50 percent of the time that antibiotics are used they are not optimally prescribed. The wrong drug might be given to a patient, or the drug may be given in the wrong dose, or for the wrong duration. Antibiotics also are often given when they aren’t needed, according to a recent study—moreover, even when these drugs are prescribed correctly, patients often don’t take them as directed.
Antibiotic Resistance a Reality
Our reliance on antibiotics when they aren’t really necessary, along with poor compliance when taking them, is leading to the development of potentially dangerous antibiotic-resistant bacteria. Each year at least two million Americans are infected with these “superbugs,” and at least 23,000 die as a direct result. Experts with the World Health Organization predict that antibiotic resistance will cause up to 10 million deaths per year by 2050.
“Overusing and/or misusing antibiotics limits their efficacy,” confirms Mount Sinai geriatrician Patricia Bloom, MD. “If you use these drugs unnecessarily, and/or fail to complete your prescribed dose, the bacteria in your body may develop resistance to them, a resistance that can be passed on to other bacteria you become infected with. This means that if you develop an infection, the antibiotic of choice may not work—you’ll need different antibiotics that may be less effective, and which also may put you at greater risk for side effects.” Taking antibiotics also raises the risk for serious diarrheal infections caused by Clostridium difficile, which can grow out of control if antibiotics destroy too many of your normal, helpful bacteria while destroying the bacteria that are causing your illness.
Just Say No
With flu season here, you may be tempted to ask your doctor for antibiotics if you develop a sore throat or runny nose—but flu is one of several illnesses that aren’t impacted by antibiotics. Flu, the common cold, and most bronchial and other acute respiratory infections (ARIs) are caused by viruses, not by the bacteria antibiotics are designed to fight.
Even so, many doctors are prescribing antibiotics to treat these infections, according to a recent study (Annals of Internal Medicine). The eight-year study analyzed 1,044,523 patient visits for ARIs, and found that 68 percent resulted in an antibiotic prescription. There also was a 10 percent increase in the proportion of broad-spectrum antibiotics prescribed. These drugs act against a wide range of disease-causing bacteria, but guidelines recommend against using them as a first line of defense for most respiratory infections, since they increase the likelihood of developing resistant organisms.
Dr. Bloom says most doctors are aware of antibiotic prescribing guidelines, but the study highlights a large variation in prescribing. At the lower end of the spectrum, 10 percent of providers prescribed antibiotics during 40 percent or fewer patient visits. However, at the higher end 10 percent of healthcare providers wrote an antibiotic prescription for nearly every patient (95 percent or more) who walked in with a cold, bronchitis, or other ARI. When it comes to these higher-end providers, Dr. Bloom points out that some patients insist they need antibiotics. “It can become a battle,” she says, “and in some cases a doctor may feel it’s easier to give the antibiotic than argue that it isn’t necessary.”
Misdiagnosis May Lead to Unnecessary Prescribing in Hospital
Overprescribing of antibiotics in hospitals may be partly due to misdiagnosis, and/or because the drugs are given before a full diagnostic workup is performed, according to other recent research (Infection Control & Hospital Epidemiology).
Dr. Bloom notes that distinguishing between viral and bacterial infections can be difficult. “Doctors have to rely on symptoms both observed and reported, clinical tests that may take days to return any results, and their professional judgment,” she explains. “The patients they are dealing with may be severely ill, and when time is of the essence, antibiotics may be prescribed as a precaution.” A study reported in PLOS ONE points to a possible solution—a blood test that may distinguish between viral and bacterial infections. In early trials, the test showed promising results, and the researchers say that it could help doctors to tailor treatment quicker when someone with a suspected infection is admitted to hospital. However, randomized trials are needed before the new test can be used in a clinical setting.
Smart Use Is Vital
Scientists are working on developing new antibiotics, but experts predict there will be no new options until 2021–22 at the earliest, since any new drug would require stringent testing before being marketed. In the meantime, Dr. Bloom says that smart use of current antibiotics is the key to controlling the spread of antibiotic resistance. “You should avoid requesting antibiotics for viral infections such as colds and flu, most coughs and bronchitis, and sore throats, unless you have strep throat,” she advises. “If your doctor recommends antibiotics, ask if tests will be done to ensure a drug that specifically treats your illness is used, rather than a broad-spectrum antibiotic. And when taking antibiotics, complete the dose even if you start to feel better—otherwise, any surviving bacteria may become resistant to the drug you were taking.” Finally, don’t forget the most basic precautions against viral illnesses—get your annual flu shot, stay away from people with colds and flu, and wash your hands frequently.
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