TUESDAY, Feb. 11, 2003 (HealthDayNews) -- A new study has uncovered two troubling trends in antibiotic use: Not only are doctors still over-prescribing these drugs, but prescribing patterns vary greatly depending on geography and other factors.
The study reports that physicians seem to be scribbling prescriptions for antibiotics -- particularly the newer, more potent "broad-spectrum" versions -- for colds and other conditions for which the drugs are useless. Doctors in the Northeast and South were more likely than those in the West to be prescribing the broad-spectrum drugs, the study found.
Broad-spectrum antibiotics, such as Cipro, are popular because they kill a wide variety of bacteria, as opposed to older "narrow-spectrum" drugs, such as early versions of penicillin. The broad-spectrum medicines are also preferred because they are new and, therefore, perceived by some as better, the study says.
The study, led by a researcher at the San Francisco VA Medical Center, appears in the Feb. 12 issue of the Journal of the American Medical Association.
Over-prescribing antibiotics, which work only against bacteria, not viruses, is a widely recognized problem. Not only does over-prescribing inflate health-care costs, it also promotes the development of "super-bacteria" that are resistant to antibiotics.
The U.S. government estimates that half of the 100 million antibiotic prescriptions written each year are unnecessary, a statistic that prompted the U.S. Food and Drug Administration last week to announce that all antibiotics are now to carry warnings that overuse reduces their effectiveness.
The latest study analyzed data on almost 2,000 adults collected between 1997 and 1999 as part of the National Ambulatory Medical Care Survey (NAMCS). These adults had gone to their doctors with common colds and other upper respiratory tract infections, such as sinusitis, bronchitis, ear aches and sore throats that may, or may not, have required antibiotics.
Antibiotics were prescribed to 63 percent of patients with an acute respiratory tract infections, 46 percent of patients with the common cold or nonspecific upper respiratory tract infections, and 69 percent of patients with acute sinusitis.
Of those patients who received antibiotics, broad-spectrum drugs were assigned in 54 percent of the total cases. More specifically, the broad-spectrum drugs were prescribed to 51 percent of patients with the common cold and nonspecific upper respiratory tract infections, 53 percent of individuals with acute sinusitis, 62 percent of those with acute bronchitis, and 65 percent of those with ear infections.
According to the study authors, the common cold and acute bronchitis do not require antibiotics while ear infections and acute sinusitis may respond to the drugs. Even when there is a benefit, however, broad-spectrum drugs are not necessarily the best choice.
Internal medicine specialists were substantially more likely to choose the broad-spectrum agents. More than three-quarters of antibiotic regimens prescribed by internal medicine physicians in the Northeast and South were broad-spectrum.
Why the variation?
"We suspect that a variety of factors are all coming together that make the local culture of doctors in those regions more likely to turn to newer, more expensive, more powerful and more heavily promoted antibiotics," explains Dr. Michael Steinman, lead author of the study and a fellow in geriatrics at the San Francisco VA Medical Center.
"It may have to do with the influence of drug industry advertising, differing patient expectations or just different attitudes toward new, cutting-edge therapies," Steinman says. "That's not necessarily always the right thing. Are you always trying the latest new thing or are you the kind of doctor who tends to stick with things that are tried and true? There's a time and place for both of those things."
Adds Marc Gillespie, professor in the department of pharmaceutical sciences at St. John's University in New York City: "It [the use of broad-spectrum antibiotics] kind of points to a practice of doing things quicker rather than later. Unfortunately, that's a tough interface between the patient and the doctor. The patient really wants solutions right away."
Dr. Kurt Krause, an associate professor of biology and biochemistry at the University of Houston, says there are bad reasons for prescribing antibiotics, but also good ones.
Antibiotics are, literally, lifesavers for people who have weakened immune systems, such as HIV patients, or people who have diabetes, he points out. And doctors may be turning to the broad-spectrum drugs first because resistance has already rendered some narrow-spectrum drugs less potent.
Certainly more patient and physician education is needed, Steinman says.
However, continuing improvements in the ability to diagnose viral infections may also brighten the picture, especially when it comes to demanding patients.
"A diagnosis is better than no diagnosis," Steinman says.
If patients leave the doctor's office armed with the knowledge [as opposed to supposition] that they have a viral infection, they may be more accepting of the fact that they're going home empty-handed, Steinman says.
More information
For more on antibiotic resistance, visit the U.S. Food and Drug Administration or the Alliance for the Prudent Use of Antibiotics.
