When Antibiotics Work…and Don’t

A new survey conducted by the CDC and reported in the Morbidity and Mortality Weekly Report has found that misconceptions about antibiotics are widespread.

The survey detailed not just patient misunderstandings of antibiotic efficacy, but gaps in physicians’ attitudes of patient expectations and opinions about when antibiotics are effective—and so when they expect to be prescribed them.

Many—more than half of, in fact—doctors and other healthcare providers believe patients expect antibiotics during a visit for a viral illness, whereas only about a quarter of consumers actually expect them, according to survey results in MMWR.

The survey included responses from roughly 7,500 consumers in the general U.S. population and 1,500 healthcare providers. Hispanics were more likely than all consumers to expect antibiotics (41% vs. 26%) during a visit for a cough or cold and to think antibiotics would speed recovery and prevent serious illness.

What’s more, close to half of Hispanic consumers and 20% of all consumers obtained antibiotics from a source other than their doctor or clinic, most often grocery stores, friends and family, or leftovers from a previous illness.

Antibiotics are ineffective against viruses and colds
Colds are caused by viruses, and antibiotics only treat an infection that's brought on by bacteria. Antibiotics cannot fight viruses.

The report explains, “Health care providers face ongoing challenges in responding to patient expectations regarding antibiotic use. Provider perception of patient expectations for an antibiotic is important, because it has been shown to be a reliable predictor of overprescribing, which might contribute to preventable side effects, adverse drug events and antibiotic resistance.”

Why taking antibiotics for a cold can be a problem
When people take antibiotics when they don't have to, over time, the medicine becomes less effective. This poses a great problem when someday you really need the antibiotic because you've got an illness caused by a bacteria, but it won't work.

When bacteria come into contact over and over with antibiotics, they may change in order to survive. These new strains are resistant to some types of antibiotics, and so you may find your doctor trying many different medications to fight the infection until finding one that works. You could get a lot sicker while you wait for the one that can treat you.

Making matters worse
Another study found that antibiotics are often overprescribed for acute respiratory infections at VA centers. In more than two-thirds of visits for acute respiratory infections at these centers, antibiotics were prescribed.

Researchers examined health records for over one million visits to VA centers that resulted in acute respiratory infection diagnoses from 2005 to 2012. Antibiotics were prescribed more frequently for sinusitis or bronchitis, when high fever was present, and in urgent care settings.
 
And finally, children may be getting overprescribed these drugs. Antimicrobial drugs are prescribed almost twice as often as expected to pediatric outpatients presenting with acute respiratory tract infections in the U.S., according to a Pediatrics study.

The overall estimated bacteria prevalence in the meta-analysis (which should predict expected antimicrobial prescribing rate) was 27%. However, a retrospective cohort analysis of children in ambulatory clinics found that antimicrobials were prescribed in 57% of visits.

The authors estimate that there are 11.4 million potentially avoidable prescriptions for antibiotics every year for acute respiratory infections.

When antibiotics can help
When they're used the right way, antibiotics can save lives. For example, they can treat bronchitis, pneumonia, strep throat, ear infection, and pinkeye—as long as they're caused by bacteria. Other times, you get infected with a bacterium after you've got a cold. Some signs of this are pain around your face and eyes that may get worse when you bend over. You might also cough up thick, yellow or green mucus.

If these symptoms last more than a week or are severe, you may have a bacterial infection and need antibiotics. Yet always keep in mind that only your doctor can prescribe them.

MMWR, 2015, Vol. 64, No. 28, pp. 767-770, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6428a5.htm?s_cid=mm6428a5_w

WebMD, Cold, Flu, & Cough Health Center, http://www.webmd.com/cold-and-flu/cold-guide/antibiotics-colds

Annals of Internal Medicine, 2015, Vol. 163, No. 2, http://annals.org/article.aspx?articleid=2397690

Pediatrics, 2014, http://pediatrics.aappublications.org/content/early/2014/09/09/peds.2014-0605.abstract

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