Study: Doctors are overprescribing antibiotics

By Brenda C. Coleman, Associated Press, 09/16/97

CHICAGO (AP) Doctors wrote 12 million antibiotic
prescriptions in a single year for colds, bronchitis and other respiratory
infections against which
the drugs are almost always useless, a study found.

Such indiscriminate use of antibiotics has contributed to
the emergence of drugresistant bacteria, a growing problem in the United
States, the
researchers said.

More than 90 percent of upper respiratory infections,
including bronchitis and colds, are caused by a virus and are therefore
impervious to antibiotics, researchers noted in Wednesday's Journal of the
American Medical
Association.

Doctors usually know this, but studies have suggested
they may yield to pressure from patients or what they perceive to be the
patients'
expectations to prescribe a drug, even if it is unlikely to help.

``Every time we use an antibiotic, we run the risk of
promoting antibiotic resistance, or drug resistance, by bacteria,'' said
the lead author, Dr. Ralph Gonzales of the University of Colorado Health
Sciences Center in Denver.

In the past 10 to 15 years, doctors have seen an epidemic
of Streptococcus pneumoniae that is resistant to penicillin and penicillin
derivatives, Gonzales said. The strain of bacteria is a leading cause of
ear and sinus infections,
meningitis and other common and potentially serious illnesses.

Drug resistance has been blamed on overuse of antibiotics
and the failure of some patients to take their medicine properly. Some
patients stop taking
their medication once they feel better but before the infection has been
knocked out, enabling the hardiest germs to survive and multiply.

In 1992, doctors prescribed antibiotics to twothirds of
bronchitis sufferers who visited them in their offices and half of
commoncold sufferers and
patients with other upper respiratory infections, the researchers found.
respiratory infections, the researchers found.

That amounted to 12 million prescriptions, or one in
every five antibiotic prescriptions written for adults that year, the
researchers said.

The 1992 figures were the latest available for the study,
but the 1995 numbers have since become available and are similar, Gonzales
said.

Doctors have been prescribing antibiotics for upper
respiratory infections because until recently they thought that it wouldn't
hurt, and that a very small chance existed that it might help, Gonzales said.

In an accompanying editorial, Dr. Benjamin Schwartz of
the Centers for Disease Control and Prevention said ``an immediate and
aggressive response'' is needed to combat inappropriate prescribing of
antibiotics.

``We encourage all physicians to examine their own
practices and identify where they can decrease unnecessary antimicrobial
use,'' he said.

Patients can take the pressure off their doctors by
putting up with the coughs that follow upper respiratory infections and can
last for three weeks,
Gonzales said.

``Give your body's own immune system enough time to clear
the infection,'' he said. Also, any patient prescribed an antibiotic should
consider asking the doctor: ``Do you really think I need this?''

In the study, rural doctors were about twice as likely as
urban ones to prescribe an antibiotic for a cold, bronchitis or other upper
respiratory
infection, all other factors being equal.

Gonzales speculated that because people in rural areas
often travel far to see doctors, the physicians may be trying to head off
bacterial complications that could occur when the patients are back home.

Also, he said, rural practices tend to be much busier
because doctors are in short supply, so these physicians may feel too
rushed to explain to patients why antibiotics are unnecessary.