TUESDAY, Nov. 8, 2005 (HealthDay News) -- Despite widespread concern about the growing problem of antibiotic resistance, too many people are still receiving prescriptions for antibiotics they don't need.
The use of a clinical decision-making tool for physicians and the consistent use of strep testing might help cut down on the number of inappropriate antibiotic prescriptions, according to two studies in the Nov. 9 issue of the Journal of the American Medical Association.
"In the United States about 150 million prescriptions are written each year and 60 percent of those are for antibiotics," said Philip Tierno, director of clinical microbiology and immunology at New York University Medical Center. "So, about 90 million antibiotic prescriptions are written and about half of those are either unnecessary or inappropriate, which is the leading cause of antibiotic resistance in this country. These [JAMA] articles represent a beginning effort in trying to break the cycle of inappropriate antibiotic use," he said.
One study examined the rate of antibiotic prescriptions for children with sore throats. According to the study, most sore throats aren't caused by bacteria but by viruses. Only 15 percent to 36 percent of all sore throats are caused by the streptococcus (strep) bacteria.
For those infections caused by strep, the antibiotics penicillin or amoxicillin are the recommended first-line treatments. For patients allergic to penicillin, erythromycin and some cephalosporin medications are recommended, according to the study.
The study included 4,158 American children between the ages of 3 and 17 seen in a physician's office, hospital outpatient department or emergency room for a sore throat.
The data came from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey and included information from 1995 through 2003.
Overall, 53 percent of the children seen were tested for strep. Of those who received an antibiotic prescription, 51 percent received the strep test.
"Almost 100 percent of these kids should have had the strep test," said study author Dr. Jeffrey Linder, an associate physician at Brigham and Women's Hospital and an instructor in medicine at Harvard University Medical School in Boston.
"That was surprising. This is an example where there's a good test available and what you should do is pretty clear," Linder said.
While only about 35 percent -- at most -- of the children would be expected to have strep, more than 50 percent were given antibiotics, the study found. The good news is that number is down by 12 percent since 1995. The bad news is that almost one in five of these prescriptions is probably unnecessary, the researchers said.
The use of non-recommended antibiotics remained stable over the study period, at about 27 percent.
Linder said that, concern over antibiotic resistance aside, parents should be leery about giving children unnecessary medications because all drugs, including antibiotics, have risks.
"Exposing kids to medicine they don't need may not help them and exposes them to all the risks of the drug," he said.
The second study included 334 primary-care doctors from 12 rural areas in Idaho and Utah. Half of the communities received community intervention, which included press releases, educational materials, and a direct mailing to parents with children under 6 about the appropriate use of antibiotics.
The other communities received community intervention, but doctors were also given a clinical decision support system (CDSS), which was either a paper system or a program for a hand-held computer. The CDSS is a step-by-step guide for the appropriate diagnosis and treatment of acute respiratory infections.
The antibiotic prescription rate dropped by nearly 10 percent in the CDSS group and went up slightly in the community intervention-only group. Antibiotic prescriptions deemed "never indicated" by study guidelines dropped 32 percent in the CDSS group, but only 5 percent in the community intervention-only group.
Tierno, the author of The Secret Life of Germs, said physician over-prescription of antibiotics isn't the only problem; antibiotic use in animals is also a big concern.
"Three million pounds of antibiotics are produced for [human] disease, and 25 million pounds are produced for the agriculture industry," he said.
Europe is working on eliminating antibiotics in animal feed, he said, and leaders there have already taken steps to help reduce antibiotic resistance in humans. "The U.S. is far behind Europe in trying to cut out agriculture industry use. We should be at the front of the charge; instead we lag behind," Tierno said.
"It's difficult to change, but we need a paradigm change," he added. "We are in trouble if we don't make a change in the way we do business."
More information
For advice on when antibiotic use is appropriate, visit the American Academy of Family Physicians.
