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Not What the Doctor Ordered

Medical groups warn consumers against taking too many drugs during cold and flu season

First of two parts

SATURDAY, Nov. 3, 2001 (HealthDayNews) -- Sneezing? Freezing? Or maybe you've got a sore throat coupled with a hacking cough? Well, don't call your doctor -- if your only goal is to get an antibiotic prescription for that nasty cold or flu.

As we brace for another blustery season of sniffles, the medical community is once again warning patients -- and reprimanding doctors -- about the overuse of antibiotics.

"Consumers must get the message that most colds and flu are caused by a virus, and antibiotics are just not going to help," says Dr. Ronald Davis, a spokesman for the American Medical Association (AMA) and director of the Center for Health Promotion and Disease Prevention at the Henry Ford Health System in Detroit.

Antibiotics are quite useful against bacterial infections, like strep throat or pneumonia.

Most often, says Davis, viral symptoms -- including sore throat and respiratory distress -- will subside on their own. Allowing that to happen, he adds, is not only better for the patient, but also good for the planet.

The reason is antibiotic resistance -- the creation of strains of bacteria called "super bugs" that grow stronger and more resistant in response to continued exposure to certain antibiotics. About 70 percent of bacteria that cause infections in hospitals are resistant to at least one of the drugs most commonly used to treat infections, the Food and Drug Administration says.

"It's no longer just a threat; antibiotic resistance is here. And it grows more real with every unnecessary prescription that's written," says Dr. Joseph Stavola, director of pediatric infectious diseases at New York Weill Cornell Medical Center.

In what has fast become a game of pharmaceutical "Survivor," experts say bacteria are now mutating to outwit, outsmart and outlast even the most advanced drugs developed to kill them. And the bugs are well on their way to winning.

A recent statement by the World Health Organization (WHO) cautioned that much of the $17 billion spent by the United States in the last five years to research and develop new antibiotics could be lost to germs that will become more powerful than their cures.

In an effort to keep that from happening, WHO recently launched a world-wide campaign to convince doctors, hospitals and consumers to curb antibiotic use.

"Our strategy is designed to promote the wise use of drugs, so that resistance is minimized and effective treatment can continue for generations to come," says Dr. David Heymann, WHO's Executive Director for Communicable Diseases.

The AMA was quick to issue a statement of support.

"If we are going to control this problem, it has got to be a cooperative effort. Patients have got to stop pushing their doctor for drugs, and doctors have to stop giving in to the demand," Davis says.

But some doctors report it's often difficult to say "no" -- particularly when parents are rallying on behalf of a sick child.

"We tell a parent, 'Let's wait and see.' But their response is inevitably, 'Why wait for things to get worse?' And sometimes it's a logic that's difficult to defy," Stavola says.

Indeed, in a survey published in the journal Pediatrics, 600 doctors reported feeling pressured by parents to prescribe antibiotics, and one-third relented, even when they felt the medications weren't necessary.

And the problem appears to be only getting worse.

In 1980, doctors wrote about 900,000 prescriptions for the antibiotic cephalosporin, commonly used to treat ear infections in children. By 1992, the number of those prescriptions climbed to almost 7 million -- an increase of 680 percent. Prescriptions for an equally powerful antibiotic -- amoxicillin -- have increased by 200 percent, according to researchers at Yale University School of Medicine.

And a recent report released by the U.S. National Ambulatory Medical Care Survey revealed that, between 1989 and 1999, approximately 73 percent of patients with sore throats asked for -- and received -- unnecessary antibiotics.

So, when do you -- or your child -- really need those drugs, and when can you get by with a little chicken soup and a hug? For the most part, say experts, the soup and the hug will work just fine 90 percent of the time.

"Rather than asking your doctor for a pill, try asking for a test -- a throat culture for example -- to see if you really do need medication," says Stavola. "Then wait for the result before you take anything."

That said, there are times when antibiotics are necessary to combat a bacterial infection. Experts say look for these symptoms and talk to your doctor about a possible prescription if you or your child have:

  • Fever above 101 degrees in adults ( longer than a day or two), or above 103 degrees in children;
  • Severe headache, or stiff neck, particularly in conjunction with a high fever;
  • Difficulty breathing, or extreme shortness of breath after coughing;
  • Green mucus from the nose or throat -- usually thick;
  • Swollen lymph nodes, particularly in the neck;
  • Pus on the tonsils;
  • Any symptoms that continue to grow worse after three or four days, or don't get significantly better in seven to 10 days.

In the final analysis, however, experts say listen to your doctor's advice.

"If they say you don't need medication, they are probably right," says Davis. If you do get a prescription, experts say to make sure you finish it, and never share medication with anyone, even if the symptoms seem identical.

What to Do: For more information on antibiotic resistance, visit this FDA site. Or check out the new fact sheet from the National Institutes of Health. To learn more about predictions for the approaching flu season, visit this Centers for Disease Control and Prevention Web site.

Tomorrow: Some proven home remedies to fight colds and the flu.

SOURCES: Interviews with Ronald Davis, M.D., trustee and spokesman, American Medical Association, and director, Center for Health Promotion and Disease Prevention, Henry Ford Health System, Detroit; Joseph Stavola, M.D., director of pediatric infectious diseases, New York Weill Cornell Medical Center, New York City; David Heymann, M.D., executive director of communicable diseases, World Health Organization
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