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View Full Version : If the overuse of antibiotics is a problem, why are they still prescribed?


Stainz
01-17-2006, 01:29 PM
I live in British Columbia, Canada and have recently started seeing a lot of PSAs on various Canadian networks about the risks / hazards / results of the overuse of antibiotics.

It's been known for years that this is a problem. But why are physicians still prescribing antibiotics for viral illnesses? Shouldn't they know better?

Why are average people being targeted by these ads? Antibiotics are only available by prescription, so it would seem to me that doctors hold the key to solving this problem. Are they feeling too pressured by their patients for a "quick fix"? Are they too busy to properly diagnose a problem?

I'm hoping this won't become a GD thread, and that there is a straightforward answer or two.

DrDeth
01-17-2006, 01:48 PM
AFAIK, MDs are no longer prescribing antibiotics for viruses. In fact, I doubt if this was ever a significant problem. However, there are three issues with antibiotics, the 1st of which is what I think you are getting:

1. a Flu (virus) is often accompanied by bacteriological infections- Strep throat, ear infections, etc. Strep throat is dangerous- thus Doctors used to oftem give antibiotics "just in case" for those with a Flu (and a few old timers may still do this). Kids get very cranky with ear infections, and Moms badger their kids Doc to do something- thus even today, Doctors will prescribe antibiotics for this MOSTLY harmless infection.

2. Self-medication. Old prescriptions, or Pet antibiotics are often used. Don't do this, it's dangerous (there was an idiot here on the SDMB not too long ago that advocated using fish pills for the antibiotics :rolleyes: )

3. Feed- antibiotics will make certain animals (pigs, steers) put on weight faster. Thus, bad ranchers/farmers will use those antibiotics like crazy to get a few more pounds from their critters when they take them to market. Very bad.

CookingWithGas
01-17-2006, 01:57 PM
Kids get very cranky with ear infections, and Moms badger their kids Doc to do something- thus even today, Doctors will prescribe antibiotics for this MOSTLY harmless infection.IANAD but I am a parent. When my son was younger he had numerous ear infections. It goes beyond cranky. It can be quite painful. I looked to the doctor for help (it's not just the moms). Our pediatrician would routinely prescribe Amoxicillin for ear infections. This is generally a bacterial infection and appropriate to treat with antibiotics. It might be "harmless" in terms of causing permanent damage, but so is a lot of other stuff that people go to doctors for.

(I had an ear infection myself a few years back and first realized it during a transatlantic flight. "Cranky" would be a gross understatement of my demeanor. I was treated with antibiotics and am grateful.)

Kalhoun
01-17-2006, 02:08 PM
IANAD but I am a parent. When my son was younger he had numerous ear infections. It goes beyond cranky. It can be quite painful. I looked to the doctor for help (it's not just the moms). Our pediatrician would routinely prescribe Amoxicillin for ear infections. This is generally a bacterial infection and appropriate to treat with antibiotics. It might be "harmless" in terms of causing permanent damage, but so is a lot of other stuff that people go to doctors for.

(I had an ear infection myself a few years back and first realized it during a transatlantic flight. "Cranky" would be a gross understatement of my demeanor. I was treated with antibiotics and am grateful.)
Ditto. Ear infections can cause serious problems. You need antibiotics when there is an infection present. That's what they're for.

I don't agree with the statement DrDeth made about viruses not often being treated with antibiotics. It was common, expected, and DEMANDED back in the '70s and '80s, even though they knew it was wrong. Beats the hell outta me why they did it.

The reason they are still prescribed is because not everyone abuses antibiotics, and we still need them. The PSA situation is probably more toward letting people know that antibiotics don't fix everything.

And I AM a doctor. No..wait a minute. I'm not. But I did raise a frequently sick kid who benefitted greatly from antibiotics.

CynicalGabe
01-17-2006, 02:10 PM
AFAIK, MDs are no longer prescribing antibiotics for viruses. In fact, I doubt if this was ever a significant problem. However, there are three issues with antibiotics, the 1st of which is what I think you are getting:

I have a few members of my family who work in the medical profession and write prescriptions. I can assure you that this is a problem, and a very widespread one. The problem is that many citizens think if you are sick = you need antibiotics. Many of them will continually pester doctors until they give them what they think they need. The doctors would rather pacify the bitchy patient than waste time trying to explain that the antibiotics wouldn't do any good, and that they will recover in a few days anyway.

WhyNot
01-17-2006, 02:21 PM
AFAIK, MDs are no longer prescribing antibiotics for viruses. In fact, I doubt if this was ever a significant problem. However, there are three issues with antibiotics, the 1st of which is what I think you are getting:

1. a Flu (virus) is often accompanied by bacteriological infections- Strep throat, ear infections, etc. Strep throat is dangerous- thus Doctors used to oftem give antibiotics "just in case" for those with a Flu (and a few old timers may still do this). Kids get very cranky with ear infections, and Moms badger their kids Doc to do something- thus even today, Doctors will prescribe antibiotics for this MOSTLY harmless infection.

2. Self-medication. Old prescriptions, or Pet antibiotics are often used. Don't do this, it's dangerous (there was an idiot here on the SDMB not too long ago that advocated using fish pills for the antibiotics :rolleyes: )

3. Feed- antibiotics will make certain animals (pigs, steers) put on weight faster. Thus, bad ranchers/farmers will use those antibiotics like crazy to get a few more pounds from their critters when they take them to market. Very bad.


There's a number four, as well.

4. Misuse of antibiotics. A properly prescribed antibiotic for a real honest-to-gosh bacterial infection needs to be taken as directed. If it says 10 days, that means ten days, even if you feel better after three. Stopiing early means you only kill the weaker bacteria, leaving the stronger ones (which need a longer exposure to kill them) alive and even more able to reproduce (because they're no longer fighting the "weaker" bacteria for resources.) This leads very quickly to colonies of antibiotic resistant bacteria.

It's #4 that is almost entirely in the hand of consumers.

WhyNot
01-17-2006, 02:35 PM
Oh, and I should add that violations of Rule #4 often mean that another round of antibiotics, oftentimes stronger ones, are required to clear up the infection, leading to another chance to mess it up and more of that antibiotic overuse the OP mentions.

Kansas Beekeeper
01-17-2006, 02:48 PM
I have some relatives who go across the border to Mexico and buy and bring back huge bottles of antibiotics, which they then gobble whenever they get the slightest cold. (They insist their doctor told them to do this.) As I understand it from them, pretty much everyone in their retirement community in Arizona does this.

ethelbert
01-17-2006, 03:19 PM
My wife claims that she gets antibiotics from her doctor for 'incidental infections' (the flu/cold supposedly provides a fertile ground for bacterial infection). I have always thought this was a crock, but she clings to it desperately. Complicating the issue is the fact that she always gets better, so it must be the antibiotics.

I have always felt the doctor should give patients placebos in this situation.

Excalibre
01-17-2006, 04:49 PM
I have always felt the doctor should give patients placebos in this situation.
Unfortunately, I think that's considered unethical. It seems reasonable to me.

It astonishes me that there are still people who eat antibiotics like M&Ms.

Anne Neville
01-17-2006, 04:55 PM
there was an idiot here on the SDMB not too long ago that advocated using fish pills for the antibiotics :rolleyes:

I don't doubt you, but... could we have a link? :eek:

4. Misuse of antibiotics. A properly prescribed antibiotic for a real honest-to-gosh bacterial infection needs to be taken as directed. If it says 10 days, that means ten days, even if you feel better after three.

Another result of this is that people have "leftover" antibiotics around, and will sometimes take them in a situation where they shouldn't be.

And then there are the morons who will somehow "stockpile" antibiotics or antivirals in case of something bad happening (the anthrax letters in 2001, or the threat of bird flu now). Then, the next time they get the sniffles, these dimbulbs might use their stockpiled antibiotics/antivirals/whatever, "just in case" it's anthrax/bird flu/whatever, rather than the far more likely cold, regular flu, or allergies. Since they're doing this on their own, without a doctor's advice, they're likely to only take the antibiotics until they feel better, thus creating resistant bacteria or viruses.

I have some relatives who go across the border to Mexico and buy and bring back huge bottles of antibiotics, which they then gobble whenever they get the slightest cold. (They insist their doctor told them to do this.) As I understand it from them, pretty much everyone in their retirement community in Arizona does this.

Do these people not get diarrhea or yeast infections from taking antibiotics willy-nilly? I tend to get yeast infections from antibiotics, and it's certainly unpleasant enough to deter me from taking them if I don't really need them (if that whole antibiotic-resistant bacteria issue weren't enough reason not to).

CookingWithGas
01-17-2006, 05:07 PM
(there was [a member] here on the SDMB not too long ago that advocated using fish pills for the antibiotics )

Hey, Doc, this is not the BBQ pit. Also, if you actually read the post you're talking about you will see that the poster did not advocate using fish pills for antibiotics, he was merely asking for a factual answer triggered by a news story.


I don't doubt you, but... could we have a link?

Can I buy useful prescription antibiotics OTC at a pet store? (http://boards.straightdope.com/sdmb/showthread.php?t=126113&highlight=fish+pills+antibiotics)

Unfortunately the link to the news story is now broken.

Anne Neville
01-17-2006, 05:22 PM
if you actually read the post you're talking about you will see that the poster did not advocate using fish pills for antibiotics, he was merely asking for a factual answer triggered by a news story.

I think he could have been a bit clearer on that point, though. The other posters to that thread certainly had the impression that he did intend to buy fish antibiotics at a pet store and take them himself.

Thanks for the link.

Antigen
01-17-2006, 05:35 PM
Another thing that happens is that you go in with a sore throat and get a culture done. To save you another trip if it does turn out to be strep throat, the doc writes out a prescription and tells you to go get the pills, but only if the clinic calls back to tell you it's strep.

Most people will go get the pills anyway, without waiting for the call, because they figure they'll help.

MLS
01-17-2006, 05:46 PM
Bottom line is that antibiotics are quite valuable when used appropriately. I wish they had been around when my mother was a child, so that she would not have had a mitral valve damaged by infection and would not have died during a second attempt to replace it. The over-use and inappropriate use of meds is another matter entirely, and I despair over the number of people -- including some doctors -- who can't seem to get it.

I'm not any kind of medical professional, but this is a major peeve of mine. When my kids were little, their pediatrician prescribed antibiotics in only 2 situations: When he had clear indication of a bacterial infection, such as a positive strep test, or when he could see an ear infection. Anything else that was most likely viral got supportive care.

However, I seem to encounter a lot of otherwise healthy adults who insist on taking these meds for viral things. Or stopping the meds too soon. A few years ago, my younger daughter had a bad cold of some sort, and an actual physician told her "It's a virus. Here, take these antibiotics." :rolleyes:

DrDeth
01-17-2006, 05:51 PM
Hey, Doc, this is not the BBQ pit. Also, if you actually read the post you're talking about you will see that the poster did not advocate using fish pills for antibiotics, he was merely asking for a factual answer triggered by a news story.


No, the thread I am talking about was several/many months ago, and "the poster with the idiotic idea" (I retract calling the poster an idiot, that was wrong of me- but his idea is idiotic nevertheless) actually said he did so, and suggested it. I called him on it, and a Mod stepped in also and castigated the poster for it.

I can't find the thread with a casual search. It isn't impossible that his post was removed or edited by a Mod, or that it's too far back for my search to find.

Yes, I know that sometimes antibiotics are the right course of treatment for ear infections. Sometimes. It depends.

Kansas Beekeeper
01-17-2006, 06:01 PM
I don't doubt you, but... could we have a link? :eek:


Do these people not get diarrhea or yeast infections from taking antibiotics willy-nilly?

Yes, at least as to the yeast infections. She complains of them constantly.

Qadgop the Mercotan
01-17-2006, 07:46 PM
Ditto. Ear infections can cause serious problems. You need antibiotics when there is an infection present. That's what they're for.
Sorry, no. Most run of the mill ear infections are actually viral, not bacterial. Recent studies have shown that kids get better just as fast with treatment for the pain and fever as they do when given antibiotics and decongestants.

Now complicated or chronic/recurrent ear infections may be a different matter. If the kid is having those, they need antibiotics. And they may need them for weeks or months at a time. I've had ENT specialists go so far as to obtain samples of the pus behind the ear drum so they can culture it and find out which bugs are growing there. I've done the same if the eardrum has spontaneously ruptured from the pressure of the infection. It's a golden opportunity to identify what's really in there.

Otherwise, doctors still prescribe waaaaaaaaaaaaaaaaaay too many antibiotics for things that don't need antibiotics, especially colds, bronchitis, the "flu" (whatever that is), and icky looking urine samples on people who have no signs or symptoms of bladder infections.

As for sore throat: strep throats need to be treated, but strep throats heal just about as rapidly without antibiotics as with antibiotics. Treatment is needed to prevent the small but real possibility of rheumatic fever or strep nephritis, and treatment within a week or so of sore throat symptom onset is sufficient. So the doc should culture or run a rapid strep test if the suspicion is that high, and only treat (in most cases) once a positive test is obtained. NB: Mono pharyingitis looks and smells just like strep pharyngitis, but giving amoxicillin to someone with mono can make them sicker, not better.

Do you Dopers know the most common reason for prescribing amoxicillin? To get the patient out of your office! :eek: (I kid, but not much, frankly)

QtM, MD (who incidentally saw about a dozen patients today and didn't write for a single antibiotic) :D

flodnak
01-18-2006, 08:18 AM
For what it's worth, we here at Casaflodnak have had kids in the ear infection age for the last decade. Every pain in the ear has been met with the same advice, from half a dozen different doctors: give painkillers, nose spray, and sympathy for 24 hours, and see how things develop. Most of the time, they have felt much better the next day, and no further treatment was necessary. Between them, they've had three courses of antibiotics.

When young totnak got an eye infection, we stumbled across another reason for those prescriptions. The doctor bluntly said that the eye would get better on its own with a little TLC, but if he needed to return to daycare, said doctor could prescribe an antibiotic goo for use in the eye. Daycares generally don't allow kids with "pink eye" to attend, regardless of the cause, unless they have a doctor's note saying it's okay, Junior's using the prescription goo. The prevailing belief is that pink eye is always bacterial and always spreads like wildfire, see. And even if the daycare teachers know that's not true, try explaining that to twenty-odd worried parents. We were lucky enough that I was at home and he was in a part-time preschool, so he could just stay home, and thus we avoided not only unnecessary meds but also having to hog-tie a toddler to put something in his uncooperating eye. After three days his eye was all clear and he was back in preschool.

CookingWithGas
01-18-2006, 10:24 AM
Most run of the mill ear infections are actually viral, not bacterial. Recent studies have shown that kids get better just as fast with treatment for the pain and fever as they do when given antibiotics and decongestants.Well, I stand corrected. I have never lurched into the doctor's office and demanded antibiotics. When I brought my child in for ear infections, they just always prescribed. I didn't ask for a prescription, just asked to see what was wrong. The infections were recurring. (In our case an ENT recommended and performed intubation.)

The doctor, in all those visits, never said that the ear infections might be viral.