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Every year just in the USA, the Centers for Disease Control estimate, two million people develop infections that antibiotics can no longer treat and 23,000 die. Antibiotics that used to work have stopped working because they are over prescribed.

For conditions from acne to MRSA, antibiotics that doctors once expected to control infections simply don't work any more.

Dr. Tom Frieden, director of the Centers for Disease Control (CDC), says ""It's clear that we're approaching a cliff with antibiotic resistance. But it's not too late. Clinicians and healthcare systems need to improve prescribing practices. And patients need to recognize that there are both risks and benefits to antibiotics — more medicine isn't best; the right medicine at the right time is best."

 

When doctors prescribe the same antibiotics too many times, or when patients don't take all the antibiotics they are prescribed, a small number of bacteria survive.

These germs inherit genetic mutations that make them resistant to the antibiotic. When patients stop taking antibiotics because they feel better or their infections seem to have cleared up, those antibiotic-resistant bacteria are free to multiply, this time without competition from other germs. And when those antibiotic-resistant bacteria are transmitted to another person, an antibiotic-resistant infection becomes established in the community.

How Often Do Doctors Prescribe Antibiotics Irresponsibly?

Doctors have known for decades that both underuse and overuse of antibiotics make them less effective. But that doesn't mean that all doctors prescribe antibiotics responsibly.

In June of 2014 WebMD and Medscape polled 407 doctors (MDs and ODs), 200 nurse practitioners (NPs), and 189 physician assistants (PAs), in family medicine, emergency medicine, internal medicine, pediatrics, and women's health. They also surveyed 1,178 patients, 71% of them women, about their attitudes on the use of antibiotics.

Health professionals reported that they sometimes prescribe antibiotics when they aren't sure they are necessary.

  • Only 5% of health professionals surveyed reported that they never prescribed antibiotics unless they were sure they were needed.
  • 20% of MDs and osteopaths sometimes prescribed antibiotics they were not sure were necessary.
  • 25% of physician assistants sometimes prescribed antibiotics they were not sure were necessary.
Emergency room doctors were more likely to prescribe antibiotics without being sure they were necessary, while pediatricians and gynecologists were the least likely to give their patients antibiotics without a definitive diagnosis.

There are reasons doctors give out germ killing drugs without a definitive diagnosis. They may be concerned that lab results to identify the specific bacterium for the specific, best treatment may take too long. They may be concerned that their patient can't afford the testing needed to determine the best antibiotic. They may be concerned about malpractice, or their patients may ask for the antibiotics.

How Often Do Patients Ask for Antibiotics?

In the Medscape-WebMD survey, only 22% responded that they ask their doctors for antibiotics. Usually patients are concerned about spending too much time off work, wanting an antibiotic "just in case" they have a bacterial infection (for which some antibiotics may work) rather than a viral infection or some other illness (against which antibiotics are useless). On rare occasions, about 4% of the time, patients ask for antibiotics for their children. Usually requests are on the lines of "I've got to get back to work, Doc," and concern for the cost of coming back to the doctor too many times.

And 25% of patients didn't know that antibiotics don't always work.

Continue reading after recommendations

  • de la Poza Abad M, Mas Dalmau G, Moreno Bakedano M, González González AI, Canellas Criado Y, Hernández Anadón S, Rotaeche del Campo R, Torán Monserrat P, Negrete Palma A, Pera G, Borrell Thió E, Llor C, Little P, Alonso Coello P
  • Delayed Antibiotic Prescription (DAP) Working Group. Rationale, design and organization of the delayed antibiotic prescription (DAP) trial: a randomized controlled trial of the efficacy and safety of delayed antibiotic prescribing strategies in the non-complicated acute respiratory tract infections in general practice. BMC Fam Pract. 2013 May 19
  • 14:63. doi: 10.1186/1471-2296-14-63.
  • Mindmap by steadyhealth.com
  • Photo courtesy of e-Magine Art by Flickr: www.flickr.com/photos/emagineart/4742089272

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