Pushy Patients, Pushover Doctors

Maryam Henein experienced repeated urinary tract infections on and off for more than a decade. As a result of taking antibiotics to treat them, the 43-year-old Los Angeles resident developed allergies to Cipro and sulfa-based antibiotics. They even caused her to develop canker sores in her mouth — she couldn’t eat for weeks.

“Doctors don’t always make fully rational choices,” said one expert. “This is especially true as the day wears on.”

“It was hell,” Henein said. “And the doctors had no idea what was going on. When I had to go to the hospital because I was suffering from the sores, they told me I had herpes — which I certainly didn’t have.”

It’s been three years since she’s taken antibiotics. Instead, she’s now turned to colloidal silver, which is said to kill bacteria and viruses.

Strolling out of the pharmacy with antibiotics in hand remains an all-too-common occurrence in America today, even though we know the drugs can be dangerous. So why is over-prescribing antibiotics still an issue, even as more superbugs emerge?

At least 30 percent of antibiotic prescriptions in the U.S. are unnecessary, according to a report in the Journal of the American Medical Association. Looking at data from 2010 to 2011, researchers found that the majority of unnecessary drugs are issued for viral respiratory conditions such as colds, ear infections, and sore throats. Viral conditions do not respond to antibiotics — so anyone taking them is needlessly building up resistance to the drugs. When these patients need antibiotics, it has to be a stronger one because of that resistance.

“It’s a big problem,” Dr. John Meigs, an Alabama-based family care physician and president-elect of the American Academy of Family Physicians, said. “It makes patients harder to treat.”

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Those unneeded prescriptions — 47 million of them are prescribed each year — also put patients at risk for allergic reactions or sometimes deadly diarrhea.

“Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said  the Centers for Disease Control and Prevention Director Dr. Tom Frieden in a statement.

Battling the Resistance
In 2015, the White House released the National Action Plan for Combating Antibiotic-Resistant Bacteria, which aims to reduce inappropriate outpatient antibiotic use by at least half by 2020.

The initiative takes place as another recent report in The Lancet Infectious Diseases found that up to half of infections after surgery and over a quarter of infections after chemotherapy are caused by organisms already resistant to preventative antibiotics. Those antibiotics are given to patients to avert infection and death.

A 30-percent reduction in the efficacy of preventive antibiotics could result in 120,000 more infections and 6,300 infection-related deaths in the U.S. each year, the report found.

Meigs said many family doctors are aware of the problem, and they take continuing education courses on the topic. Patients and doctors are both responsible for this ongoing issue, he said.

In many cases, doctors are just trying to help patients when they prescribe an antibiotic. In other cases, the doctor will prescribe an antibiotic during the initial visit, instructing the patient not to take it unless they don’t see improvements in a few days. That way, the patient does not have to return and pay for a second visit. Other patients insist on an antibiotic the minute they see the doctor, he said.

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“Sometimes you take the easiest way out instead of the best way out,” Meigs said. “We need to remember that we [the doctors] are causing harm — harm to the system and potential harm to the patient.”

Jason N. Doctor, an associate professor at the University of Southern California, said doctors know they are not supposed to prescribe antibiotics for colds and the flu.

“Often, though, they do anyway — they overestimate the risk that the patient might have a bacterial infection, or it is easier to prescribe than to explain to a patient why they do not need an antibiotic.”

He added, “We’re learning doctors don’t always make fully rational choices. This is especially true as the day wears on, when they are tired or fatigued.”

In his research, he found that doctors who committed publicly to being judicious in prescribing antibiotics — and displayed a signed letter to their patient as a framed poster in their office — reduced inappropriate prescribing by 20 percent.