From Our 2014 Archives
Doctors, Patients Rely on Antibiotics
By Ashley Hayes
Reviewed by Arefa Cassoobhoy, MD, MPH
June 27, 2014 -- While both health care professionals and the public seem to be aware of the problem of antibiotic resistance, a new survey shows that when it comes to your personal health, it may be a different story.
According to a new WebMD/Medscape survey, some 95% of health care professionals say they sometimes prescribe antibiotics to patients even when they aren't sure they're needed.
More than half of health care professionals (53%) say they're "certain enough" to prescribe them, and only 12% do it most of the time. Others who prescribe them say they aren't sure whether a patient's illness is viral or bacterial, and the lab work to determine that may take too long. Eleven percent say they believe an antibiotic won't hurt and could help.
Those most likely to prescribe antibiotics were emergency doctors (24.4%), followed by family medicine doctors (23.6%), although the percentages did not vary widely among the specialities included: internal medicine, pediatrics, and women's health.
Patients, meanwhile, say they sometimes ask for antibiotics when they're not sure they're needed, most often for themselves (21%).When told that antibiotics aren't needed, 72% say they accepted that advice. But 9% say they were asked if they still wanted antibiotics even if they weren't needed, and accepted them.
Only 3% said they were denied antibiotics after being told they weren't needed and requesting them again.
While most people understand the concept of antibiotic resistance, they still think the drugs will help them feel better and get them back to work as soon as possible.
Eighty-five percent of patients say they requested antibiotics because they felt it would cure their illness, and 65% say they asked for them in order to feel better quickly. Forty-four percent say they needed to get back to work as soon as possible. And 25% say they believe antibiotics always work, no matter the illness.
Daniel McQuillen, MD, a past chairman of the clinical affairs committee of the Infectious Diseases Society of America, says the results show that both doctors and consumers need better education about how to use antibiotics. At least 2 million people get infected with antibiotic-resistant bacteria each year, resulting in at least 23,000 deaths, according to the CDC. The World Health Organization calls antibiotic resistance "an increasingly serious threat to global public health that requires action across all government sectors and society."
"It's clear that we're approaching a cliff with antibiotic resistance," says CDC director Tom Frieden, MD, MPH. "But it's not too late. Clinicians and health care systems need to improve prescribing practices. And patients need to recognize that there are both risks and benefits to antibiotics — more medicine isn't best; the right medicine at the right time is best."
The Myth of the Harmless Antibiotic
The WebMD/Medscape survey was done in June and included both consumers and health care professionals to better understand prescribing practices around antibiotics and knowledge of antibiotic resistance.
The online consumer survey included 1,174 people. The Medscape e-mail survey included 796 health care professionals. Both surveys had a +/- 2.9% margin of error.
Patients seen at an early stage of an upper respiratory infection typically turn out to have a virus, McQuillen says. While viral infections often get better in several days without medication, bacterial infections tend to linger and get worse. Many doctors write post-dated prescriptions for antibiotics just in case, telling patients to fill it in 3 or 4 days if their symptoms worsen.
In the survey, 49% of health care professionals say they occasionally write post-dated prescriptions, and another 4% say they did it most of the time. Among patients, 21% said they had occasionally received a delayed prescription. Of the patients who did get a post-dated prescription, 36.8% say they only filled it if needed. The same percentage say they generally didn't fill it, and 11.7 % say they filled it but saved it for future use. Another 9% say they filled it just in case, but discarded it later because they didn't need it.
"The rationale is sound, but whether it's effective, nobody knows," says infectious-disease expert Brad Spellberg, MD, of the University of Southern California. "It's a clinician trying to make the best of the bad situation."
Eighteen percent of patients say they save unused prescribed antibiotics at home for future use. Thirteen percent say they have taken antibiotics prescribed to another family member, and 13% say another family member has taken their antibiotics.
More than half of patients surveyed (53%) say their health care provider has talked to them about the dangers of antibiotic resistance.
Medscape Medical News writer Robert Lowes contributed to this report.
SOURCES: WebMD/Medscape online and email survey, June 9 to June 16, 2014.Tom Frieden, MD, MPH, CDC director.Daniel McQuillen, MD, past chairman, clinical affairs committee, Infectious Diseases Society of America.Brad Spellberg, MD, professor of medicine, Keck School of Medicine, University of Southern California.World Health Organization: "Antimicrobial Resistance."CDC: "Antibotic/Antimicrobial resistance."
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