December 22, 2014
When to Be Anti-Antibiotics
Be Well

When to Be Anti-Antibiotics

by John Swartzberg, M.D.  |  

‘Tis the season of colds, flus and sore throats. And that means lots of unnecessary prescriptions for antibiotics. For decades antibiotics have frequently been misused to treat such ailments, but I assumed that national campaigns to reduce this had achieved some success. Not much, it turns out, going by a recent report in JAMA Internal Medicine by two Harvard researchers.

The report looked at data representing 92 million American adults treated for sore throat in primary care clinics or emergency rooms between 1996 and 2010. The researchers estimate that just 10 percent of adults seeking medical care for a sore throat have “strep” (caused by a species of streptococcus bacteria), the only common cause that requires antibiotics. Yet they found that 60 percent of people with sore throats were prescribed antibiotics. That would mean the drugs were wrongly prescribed five out of six times. Most sore throats are caused by viruses and thus won’t respond to antibiotics, which treat only infections caused by bacteria.

That’s a small improvement from 1993, when 70 percent of people treated for a sore throat were prescribed antibiotics, but the prescription rate for sore throat has remained around 60 percent since 2000. Looking at the big picture, the Centers for Disease Control and Prevention (CDC) estimates that up to half of antibiotic use in Americans is “unnecessary and inappropriate.”

The report also found that expensive broad-spectrum antibiotics (notably azithromycin) are increasingly being prescribed, rather than penicillin, which (along with amoxicillin) is recommended by medical guidelines for treating strep because it is very effective and inexpensive.

Why is this overuse a problem? Antibiotics can cause adverse effects: diarrhea in 5 to 25 percent of users, and serious reactions in at least 1 in 1,000 of them. What’s more, overuse of the drugs contributes to the development of antibiotic-resistant bacteria, a huge and increasing concern today that puts us all at risk. Antibiotics are a limited resource—the more they are used today, the less likely they’ll be effective in the future. Misuse of these drugs also wastes hundreds of millions of health care dollars.

If testing confirms that you have strep throat, which is often accompanied by fever, you should be given antibiotics. If you also have a runny nose, cough, hoarseness or mouth sores, it’s probably a cold or flu, so you don’t need to see your doctor and don’t need antibiotics. Only in the unlikey event that you develop a bacterial complication would you need antibitiocs. But the drugs won’t prevent such complications.

Why do doctors misguidedly prescribe antibiotics so often? Sometimes it’s just easier for them to write out a prescription “to be on the safe side.” And often patients ask for antibiotics and are happier if their doctors prescribe something rather than tell them to just take it easy and drink plenty of fluids. Taking a pill, even a sugar pill, may make them feel better, too, thanks to the placebo effect—but antibiotics should never knowingly be prescribed as a placebo.

My bottom line: If you’re prescribed an antibiotic for a sore throat, ask if it’s really necessary. Unless you have strep, you’ll get better just as fast without it.