Wednesday, April 23, 2014

Doctors often prescribe more powerful antibiotics than necessary

Imagine asking your doctor if you could have something “weaker.”

New research suggests you should question your doctor about what antibiotics you’re getting. When U.S. physicians prescribe antibiotics, they choose the most powerful type of a drug 60 percent of the time, even though that’s often not needed.

Those “broad-spectrum” drugs, so-called because they’re capable of killing a number of different types of bacteria, are supposed to be reserved for use against germs that are resistant to simpler drugs.

Scientists at the University of Utah School of Medicine found that doctors generally chose stronger antibiotics for problems such as respiratory, skin and urinary tract infections, which frequently are better treated by less complex drugs.

Moreover, about a quarter of antibiotic prescriptions are futile because they’re given for infections caused by viruses, which can’t be killed by antibiotics.

Dr. Adam Hersh, an infectious disease specialist who led the study, said even when an antibiotic should be given, such as for an ear infection or strep throat, doctors often prescribe a broader-spectrum drug like azithromycin rather than a narrow-spectrum antibiotic like amoxicillin.

The researchers looked at a sample of 238,624 visits by patients 18 and older to doctor’s offices, hospital-based clinics and emergency rooms nationwide between 2005 and 2007. Based on that sample, they estimate that there were an average of 985 million ambulatory care visits each year, with antibiotics prescribed in 101 million of those visits; broad-spectrum scripts were given for 62 million of those visits.

The antibiotic overload described July 29 in the Journal of Antimicrobial Chemotherapy has a number of downsides: It can cause unwanted destruction of beneficial bacteria in the gut, skin and elsewhere that can cause side effects, and contribute to the growth of bacteria that are resistant to more advanced antibiotics.

Bacteria always have evolved naturally to avoid toxins released by fungus and other microorganisms, but the pace of genetic mutations has become much more rapid in many strains since antibiotics have become commonplace in medicine over the past 70 years.

The researchers said many doctors choose more powerful antibiotics because they’re unsure of what’s causing an infection and want to avoid repeat visits from unhappy patients, but also because many people expect to leave the doctor with a prescription, no matter what the doctor suspects is wrong with them.

A number of efforts in the past several years by the Centers for Disease Control and Prevention, the World Health Organization and private organizations aim to educate consumers about the dangers of antibiotic resistance, inform them when the drugs are likely to work and encourage them talk to their doctors about other options.

At the same time, the Food and Drug Administration and National Institutes of Health have taken steps to speed up development of new antibiotics to combat resistance.

But a new commentary slated to appear in an upcoming issue of the same journal contends that effort is not enough and that antibiotic resistance among hospital-acquired infections is at “crisis levels.”

It’s estimated that more than 2 million Americans are infected with antibiotic-resistant bacteria each year, and more than 100,000 die from those infections.

Researchers that include Dr. Brad Spellburg of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center analyzed three common types of hospital-acquired infections and found evidence that the rise in incidence of all of them are much greater than has been reported by CDC studies using older data.

In particular, they looked at resistance to a class of high-end drugs called carbapenems, last-resort drugs with a structure that makes them difficult for bacteria to evade, and found that resistance has been growing steadily in several strains that are responsible for many hospital infections.

— By Lee Bowman,

Scripps Howard News Service


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