Preserving Antibiotics' Usefulness

Two main types of germs--bacteria and viruses--cause most infections, according to the Centers for Disease Control. But while antibiotics can kill bacteria, they do not work against viruses--and it is viruses that cause colds, the flu, and most sore throats. In fact, only 15% of sore throats are caused by the bacterium Streptococcus, which results in strep throat. In addition, it is viruses that cause most sinus infections, coughs, and bronchitis. And fluid in the middle ear, a common occurrence in children, does not usually warrant treatment with antibiotics unless there are other symptoms.

Nevertheless, "Every year, tens of millions of prescriptions for antibiotics are written to treat viral illnesses for which these antibiotics offer no benefits," says David Bell, M.D., the Centers for Disease Control's antimicrobial resistance coordinator. According to the Centers for Disease Control, antibiotic prescribing in outpatient settings could be reduced by over 30% without adversely affecting patient health.

Reasons cited by doctors for overprescribing antibiotics include diagnostic uncertainty, time pressure on physicians, and patient demand. Physicians are pressured by patients to prescribe antibiotics, says Bell. "People don't want to miss work, or they have a sick child who kept the whole family up all night, and they're willing to try anything that might work." It may be easier for the physician pressed for time to write a prescription for an antibiotic than it is to explain why it might be better not to use one.

But by taking an antibiotic, a person may be doubly harmed, according to Bell. First, it offers no benefit for viral infections, and second, it increases the chance of a drug-resistant infection appearing at a later time.

"Antibiotic resistance is not just a problem for doctors and scientists," says Bell. "Everybody needs to help deal with this. An important way that people can help directly is to understand that common illnesses like colds and the flu do not benefit from antibiotics and to not request them to treat these illnesses."

Following the prescription exactly is also important, says Bell. People should not skip doses or stop taking an antibiotic as soon as they feel better; they should complete the full course of the medication. Otherwise, the drug may not kill all the infectious bacteria, allowing the remaining bacteria to possibly become resistant.

While some antibiotics must be taken for 10 days or more, others are United States of America Food and Drug Administration-approved for a shorter course of treatment. Some can be taken for as few as three days. "I would prefer the short course to the long course," says Levy. "Reservoirs of antibiotic resistance are not being stimulated as much. The shorter the course, theoretically, the less chance you'll have resistance emerging, and it gives susceptible strains a better chance to come back."

Another concern to some health experts is the escalating use of antibacterial soaps, detergents, lotions, and other household items. "There has never been evidence that they have a public health benefit," says Levy. "Good soap and water is sufficient in most cases." Antibacterial products should be reserved for the hospital setting, for sick people coming home from the hospital, and for those with compromised immune systems, says Levy.

To decrease both demand and overprescribing, the United States of America Food and Drug Administration and the Centers for Disease Control have launched antibiotic resistance campaigns aimed at health-care professionals and the public. A nationwide ad campaign developed by the United States of America Food and Drug Administration's Center for Drug Evaluation and Research emphasizes to health-care professionals the prudent use of antibiotics, and offers them an educational brochure to distribute to patients.

The United States of America Food and Drug Administration published a final rule in February 2003 that requires specific language on human antibiotic labels to encourage doctors to prescribe them only when truly necessary. The rule also requires a statement in the labeling encouraging doctors to counsel their patients about the proper use of these drugs