Antibiotics Weblog

Colds and Bronchitis

Two recently published studies ("Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians." and "Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis." from Journal of the American Medical Association by Gonzales R, Steiner JF, Sande MA.), based on nationwide data from office visits for children and adults, have decisively documented the expensive and dangerous massive overprescribing of antibiotics for conditions that, because of their viral origin, do not respond to these drugs. Forty-four percent of children under 18 years old were given antibiotics for treatment of a cold and 75% for treatment of bronchitis. Similarly, 51% of people 18 or older were treated with antibiotics for colds and 66% for bronchitis. Despite the lack of evidence of any benefit for most people from these treatments, more than 23 million prescriptions a year were written for colds, bronchitis, and upper respiratory infections. This accounted for approximately one-fifth of all prescriptions for antibiotics written for children or adults.

Sore Throats

Sore throats are one of the leading causes of visits to doctors, with more than 10 million such visits a year. The only kind of sore throat that merits treatment with an antibiotic is a bacterial sore throat caused by group A beta-hemolytic streptococci, the so-called strep throat. Although only approximately 10% of adults seen by a doctor for a sore throat actually have a strep throat, 75% of patients with sore throats seen by doctors are prescribed an antibiotic. Though the likelihood that a sore throat in a child is a strep throat is somewhat higher, perhaps 25%, the majority of children are also treated with antibiotics.

Bladder Infections

In a recent study of more than 13,000 women going to a doctor because of a bladder infection, more than 95% of whom had an acute bladder infection, not a recurrent one, only 37% were prescribed the preferred treatment for this condition, the combination antibiotic trimethoprim/sulfamethoxazole (sometimes prescribed by the brand name Bactrim or Septra. Almost as many (32%) were prescribed one of the heavily promoted fluoroquinolones such as ciprofloxacin (CIPRO), which are not the first-choice drug for bladder infections. Using such drugs when there is a better alternative contributes to the rapidly increasing and health-threatening problem of resistance to antibiotics, whereby when the fluoroquinolones are actually needed, people may be infected with bacteria that are resistant to them (see below). The recommended duration of treatment for an acute bladder infection is three days of the antibiotic, and yet less than 10% of the prescriptions were for three days. The most common duration of treatment was 10 days, followed by seven and five days. Thus, in addition to using the wrong antibiotic most of the time, the duration of therapy was too long most of the time.