March 2000 • Volume 6 • Number 3
Deadly risks of antibiotic overuse warrant widespread education
BY SHARON DENT
Green mucus implies a bacterial infection. ... If a cold lasts a week, you should consult a physician. ... Antibiotics might not help you get better, but they can't hurt.
Right?
Wrong! Physicians involved in curbing the excessive and inappropriate use of antibiotics insist misinformation is the main culprit.
Education for physicians, office staff and patients would go a long way in preventing antibiotic resistance, said family physician John Hickner, M.D., who serves on a CDC panel developing principles for the judicious use of antibiotics for respiratory infections in adults.
According to him, green mucus isn't a good indicator that antibiotics are needed. Research shows cold symptoms commonly last longer than a week. And the misuse of antibiotics leads to strains of bacteria developing resistance to drugs. Misinformation, such as these commonly held beliefs, results in many patients prematurely visiting their physicians and expecting a prescription for antibiotics. Too frequently, the physicians comply, Hickner said.
"When you look at well-designed studies of antibiotics for bronchitis or sinusitis, for example, there's no evidence of any clinically significant benefit, just very marginal benefits," said Hickner, professor of family practice at Michigan State University College of Human Medicine in East Lansing. "Nearly all people get better from bronchitis and sinusitis on their own without the use of antibiotics. But doctors are a little uncertain about that."
About 70 percent of patients diagnosed with bronchitis and more than 90 percent of those with sinusitis are prescribed antibiotics, he said. "There is still some belief that antibiotics are effective enough to be used in those cases, but the data just don't bear that out."
And the consequences are serious.
Drugs that once guaranteed eradication of bacterial diseases are suddenly up against strains that don't respond as predictably. These bacteria have developed resistance in part because of overuse and misuse of the drugs, often in ambulatory settings. As a result, patients are getting sicker, and death rates for some communicable diseases, such as tuberculosis and malaria, are on the rise in regions where such diseases had been under control.
"Some doctors think of antibiotics as harmless placebos," said William Hueston, M.D., family medicine department chair at the Medical University of South Carolina in Charleston. "You risk not only harming the patient when you prescribe unnecessary antibiotics, but also harming the community."
Although doctors should refresh their knowledge and get up to speed on issues surrounding antibiotic use, patient education also is key.
The January Family Medicine details research conducted by Hueston with his university colleague Arch Mainous, Ph.D., to assess the use of two interventions aimed at reducing the rate of antibiotic prescribing for pediatric upper respiratory infections. The interventions -- (1) providing feedback about the physicians' antibiotic prescribing habits and (2) providing physicians with patient education materials on antibiotic use -- had little overall effect. However, providing patient education materials to physicians did seem to have a slight positive impact on antibiotic prescribing.
The study notes that "providing them with tools for educating patients may be a good way to help physicians change prescribing practices, and thereby confront the public health problem of antibiotic resistance."
If physicians don't have time to do it, nurses or other staff members could be trained to teach patients the facts about antibiotics, said Hueston. The CDC offers a plethora of resources on the topic, including a handy Q&A sheet for patients (see "A pill that cures every ill?").
"One of the biggest ways we can help patients gets back to why we're family physicians," Hueston said. "Let's talk to our patients. If we take the time to educate patients, we'll save them money and keep them healthier in the long run."
Better telephone triage also helps by teaching patients to know when an office visit is warranted. If patients get good counseling from staff, they won't head to the office for a prescription and therefore won't misuse an antibiotic, said Hueston.
Hickner said that overall, he's optimistic about the situation. "For example, physicians have dramatically decreased antibiotic prescriptions for adults with upper respiratory infections," he said. "For the common cold, antibiotic prescriptions have gone way down. It's now around 20-30 percent, and most of those patients probably have something else, too. I think we're moving in the right direction."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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