Antibiotics Aren’t Always the Answer

Al-Azhar Park in Cairo, Egypt. (Dr. Noorali Bharwani)
Al-Azhar Park in Cairo, Egypt. (Dr. Noorali Bharwani)

Are we prescribing too many unnecessary antibiotics for cold, cough and sinusitis? Yes, says an article in the Journal of the American Medical Association (Internal Medicine: May 3, 2016).

The article is titled, “Prevalence of Inappropriate Antibiotic Prescriptions Among U.S. Ambulatory Care Visits, 2010-2011,” by Fleming-Dutra, Hersh and others.

The research comes amid ongoing concern about antibiotic resistance, which has been blamed for at least two million illnesses and 23,000 deaths annually, according to the US Centers for Disease Control and Prevention (CDC).

People with sore throats, ear infections and sinus infections get the wrong antibiotic at least half the time. When that happens patients are not cured and it helps drug-resistant “superbugs” evolve, says the article.

What is the most commonly misused drug?

Zithromax, also known as “Z-Pack” or azithromycin. “Z-Pack” is a name easy to remember, so patients ask for it.

“Overall, only 52 per cent of patients treated with antibiotics for sinus infections, middle ear infections and pharyngitis (sore throat) received the first-line treatments recommended by prescribing guidelines,” Dr. David Hyun, an infectious disease specialist at the Pew Charitable Trusts, told NBC News.

Research also shows at least a third of people who get antibiotics don’t even need them. There is lot of bad prescribing of antibiotics. Ear infections, sore throats and sinus infections generate 44 million antibiotic prescriptions a year.

Antibiotics are essential to treat certain conditions. Strep throat is easily treated with antibiotics, and if a child with a middle ear infection has pus oozing out, a pediatrician will usually give an antibiotic. Sinus infections that linger may be helped with antibiotics. Experts do not disagree on that.

Quite often infection is caused by viruses. In that situation, antibiotics will not help. When an antibiotic is called for, it should be a basic one – usually amoxicillin, according to Pew researchers. However, that’s not what people usually get.

If you are allergic to penicillin and have pharyngitis then Zithromax should be tried. But Zithromax is not recommended for sinus or middle ear infection.

The reason doctors end up prescribing Zithromax is because of the pressure from patients and the convenient dosage. Not to mention sleek packaging.

To prevent misuse of antibiotics, doctors and patients should ask whether antibiotics are really necessary and if yes then what is the correct antibiotic. Medical experts have been complaining about the misuse of antibiotics for two decades, but the message still is not getting through, says one of the experts.

“Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said CDC Director Dr. Tom Frieden.

Sinusitis was the single diagnosis associated with the most antibiotic prescriptions. Drugs are not usually needed to treat sinus infections, which are often caused by fungi that are not affected by antibiotics. Up to 70 per cent of people with acute sinusitis recover without any prescribed medications, the American Academy of Allergy, Asthma and Immunology says on its website.

The point is we should use antibiotics only when we really need it. Otherwise it’s just a waste of money. And dangerous to our health.

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