Is Your Doctor Prescribing Antibiotics You Don't Need?

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."

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.

See Also: Antibiotic Misuse Is Putting Increasing Number Of Patients At Risk

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.

Delayed Prescription: Getting Just The Antibiotics You Really Need

Overuse of antibiotics creates antibiotic-infections that eventually make them useless. But people sometimes don't have the time off work to stay at home and see if they get better or the money to pay for laboratory tests and repeated doctor visits and they want their antibiotics now. Delayed prescriptions are one way of dealing with the need for possible need for antibiotics when testing isn't practical.

What Is a Delayed Prescription?

Delayed prescriptions, or delayed prescribing, are the practice of giving the patient a postdated prescription for an antibiotic to be filled 3 to 7 days after an office visit if symptoms have not improved.

A study published in Cochrane Reviews found that this is the only method of offering patients prescriptions for antibiotics that eliminates the cost of additional office visits while avoiding the creating of antibiotic-resistant strains of bacteria.

Only about half of doctors surveyed, however, offer delayed prescriptions, and fewer than one-quarter of patients surveyed by WebMD and Medscape reported they had ever received a delayed prescription.

And What Do Patients Do with Delayed Prescriptions?

While delayed prescribing is the best way of dealing with the need to treat without running labs to identify the bacterium causing the infection, it is not a perfect system. The WebMD-Medscape survey found that of the patients surveyed:

• 2.0% filled the prescription immediately and took it against doctor's orders.
• 2.8% weren't sure what they did with delayed prescriptions.
• 9.7% filled the prescription immediately "just in case."
• 11.7% filled the prescription for the next time they got sick, so they would not have to go to the doctor's office at all, or so they could give the prescription to a friend or family member.
• 36.8% generally did not fill the prescription and just
• 36.8% filled them on the date indicated.

What More Could You Expect from Your Doctor?

If your doctor accommodates your financial restraints by offering you a delayed prescription, it is still a good idea to ask if other patients have run into problems with the antibiotic you are taking. Make sure that you take the entire prescription if you start it. What you do not want to to do is to kill some of the bacteria that are making you sick only to have the "meanest" bacteria in your body to spring into action when you stop taking your medicine too soon.

It also helps to know that sometimes an antibiotic just is not going to make you better.

See Also: Persistent Bacterial Infections And Resistance To Antibiotics

All the antibiotic will do is to kill the probiotic, friendly bacteria your body needs for making vitamins, for regulating your mood and your immune system, and regulating your digestive tract. Don't take antibiotics you don't need, and always take the full course of antibiotics you do need.