A prescription for disaster

Monday, June 21, 1999

SECOND OF FIVE PARTS

Doctors often give antibiotics under pressure from patients

By Ron Sylvester
News-Leader

Not all patients subscribe to the adage that doctors know best, and even the most respected practitioners can cave in to a client clamoring for antibiotics.

“I’m as guilty as anybody,” said Dr. Wolfe Gerecht of Cox Health Systems, a leading infectious disease specialist in Springfield.

“But it’s hard when patients call up and want that, and if we don’t give it to them they are angry and frustrated or feel somehow you are practicing bad medicine.”

The scenario is so common, the U.S. Centers for Disease Control and Prevention estimates that the nation’s doctors write 50 million unnecessary prescriptions for antibiotics each year.

The result of this perilous practice is an explosive growth of disease-causing germs that are becoming increasingly immune to antibiotics.

The actions of doctors allowing patients to diagnose and treat themselves might surprise those who look to their physicians for guidance.

“Nobody would prescribe a heart pill over the phone to someone having a heart attack,” said Dr. Alastair Haddow, infectious disease physician with St. John’s Health System. “The response would be to call 911 and get to the emergency department.”

Bacterial infections, which can be just as threatening, shouldn’t be treated by phone, either.

“The policy at our clinic is we do not call out antibiotics,” said Dr. Diane Nitta of Springfield’s Pediatric Center. “Our license prohibits that, unless we see the patient.”

Once patients get their medicine, they sometimes fail to follow directions. Doctors may prescribe a 10-day course of antibiotics, but the patient takes the medicine until symptoms let up, then stops.

Antibiotics need time to halt bacterial growth and prevent more serious complications.

“We don’t give antibiotics for strep throat to make people well faster,” Gerecht said. “We give the antibiotic to prevent rheumatic fever. The antibiotic makes them feel better no more than 24 hours quicker. No more.”

By not taking antibiotics correctly, by not finishing the medicine or by sharing it with others, people unwittingly breed bugs that become immune to the drugs. They kill off only the weakest germs and leave the stronger ones that can fight off the prescription.

Within hours, these new, stronger bacteria have multiplied by the millions. Then the new strains get passed on to someone else.

Some in the medical and science communities have known about the threat of antibiotic resistance for years. But the public is only now beginning to hear about it.

Until recently, such cases were isolated enough they didn’t pose a threat to the general public.

When penicillin emerged as a “miracle drug” in the 1940s, however, it took only a few years for some staph infections to become immune to it.

By the 1960s, doctors found new arsenals of antibiotics including methicillin, which seemed to vanquish staph infections. Scientists figured it was just a matter of time until they conquered the microbes.

“The time has come to close the book on infectious diseases,” U.S. Surgeon General William Stewart said in 1969.

Within 10 years, there were strains of staph that could fight off methicillin and gonorrhea that could kick penicillin.

By the 1980s, the emergence of deadly AIDS killed dreams of eradicating infectious diseases. And with AIDS came a slew of new drug-resistant infections, most notably tuberculosis.

Still, many could say it wasn’t their problem.

Then everything changed in the 1990s, when a bug called strep pneumoniae started fighting off a battery of antibiotics.

Such pneumococcal bacteria are the most common cause of ear infections, sinus infections, pneumonia and, in rare cases, can lead to blood poisoning and meningitis.

Ten years ago, only about 5 percent of pneumococci could defeat penicillin, the first drug doctors reached for to treat it. By 1995, 20 percent to 25 percent were resistant.

“In the medical world, we knew this stuff was around, but everyone was kind of like, `Oh, it’s not affecting my patients,’” said Dr. Bernadette Albanese of Johns Hopkins University in Baltimore. “Well, now it’s affecting everyone’s patients.”

Doctors say their first responsibility is treating individuals, not watching out for the health of the larger community.

Others say that’s a cop-out.

“You are putting the individual at risk first and foremost by giving them antibiotics when they don’t need it,” Albanese said. “Then you allow that individual to communicate with other people. Now they’re at risk. It starts with families and siblings, then it moves to child-care centers and schools.”

Yet doctors keep writing prescriptions.

“Many doctors will read this and say all this is true, and then they’ll say, `But that’s not the way I prescribe antibiotics,’” said Springfield pediatrician Robert Steele. “They won’t see themselves as the culprits.”

But using antibiotics more responsibly also falls on the patients who pressure doctors to write the prescriptions.

“Patients need to be educated not to insist on antibiotic therapy, but to be open-minded,” said Scott Kaufman, assistant professor of physician assistant studies at Southwest MIssouri State University.

“They may have a virus and just need something that will help symptoms, like antihistamines or decongestants to help them get through it.”


Unnecessary antibiotic prescriptions

The total number of prescriptions written by doctors each year for major afflications and the percent for each that may not be necessary, according to the Centers for Disease Control.

Ear infection 23 million prescriptions issued/ 30 percent unnecessary
Common cold 18 million / 100 percent unnecessary
Bronchitis 16 million / 80 percent
Sore throat 13 million / 50 percent
Sinusitis 13 million / 50 percent

Source: Centers for Disease Control News-Leader

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