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Caution about overuse antibiotics { September 18 2003 }

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Caution About Overuse of Antibiotics

By Roni Rabin

September 18, 2003

It has been called one of the world's most pressing health problems, and yesterday U.S. health officials launched a $1.6-million campaign to educate patients about the overuse, and inappropriate use, of antibiotics.

Antibiotics are powerful agents against bacterial infections, but they have no effect on viral infections such as colds, flu, many cases of bronchitis and 85 percent to 90 percent of sore throats, doctors say. Antibiotic overuse can breed deadly strains of bacteria that don't respond to available drugs.

Yet many patients laid up by a bad viral infection demand antibiotics, public health officials say. They may take the pills for a few days and then stop. Then, if they get sick again, they dip into the pills again, or dole them out to a family member.

"The overuse of antibiotics is backfiring," said Dr. Margaret Rennels, chairwoman of the American Academy of Pediatrics' committee on infectious diseases. "The best way to breed resistant bacteria is to start and stop antibiotics, start and stop, start and stop. If you take them just for a few days, you kill the less resistant bacteria and you're breeding the hardy ones," which require more powerful drugs.

The U.S. Centers for Disease Control and Prevention started its campaign to promote appropriate antibiotic use in 1995, said Dr. Richard Besser, a pediatrician who is medical director of the public education campaign called, "Get Smart: Know When Antibiotics Work."

At the time, federal public health officials estimated that more than 40 percent of about 50 million prescriptions for antibiotics each year in physicians' offices were inappropriate, Besser said.

The campaign initially focused on educating physicians and promoting testing for illnesses like sore throats and ear infections, which may be either viral or bacterial, before writing a prescription.

But the number of inappropriate antibiotic prescriptions is still in the tens of millions, and consumer attitudes play a significant role, Besser said. He pointed to a recent survey that found that 48 percent of all Americans believe if they are sick enough to go to a doctor, they should leave with a prescription.

"Programs that have just targeted physicians have not worked," Besser said. Direct-to-consumer advertising of drugs is to blame in some cases, he said.

The problem of inappropriate antibiotic use is particularly prevalent among children, doctors say, because parents can be very persistent in demanding a prescription when they are worried about a child. Doctors often worry that an ear infection, which in some cases may be bacterial, may cause hearing impairment if not treated appropriately, said Dr. Lucy Pontrelli, an assistant professor of clinical pediatrics at Stony Brook University Hospital.

Dr. Tom McDonagh, a pediatrician with the Huntington Medical Group in Huntington Station, said he spends a lot of time with parents explaining when antibiotics are not required.

"Statistically, over 90 percent of childhood infections are not bacterial infections," McDonagh said. "But some children with a virus can be sick for a week, and by the fourth or fifth day, parents are pleading for antibiotics."

Many hospital-acquired infections, which are responsible for 90,000 deaths a year, are caused by bacteria that are resistant to common antibiotics, including strains of staphylococcus that are showing increasing resistance to one of the most lethal agents used to combat it, vancomycin.

The Get Smart campaign is running a radio jingle that goes, "Snort, sniffle, sneeze/ No antibiotics please." "Those are symptoms of a viral infection," Besser said, "and antibiotics is not the way to go."

Curbing Antibiotic Resistance

Don't insist on a prescription for an antibiotic once your doctor has decided one isn't appropriate.

Never take an antibiotic for a viral infection. Antibiotics are usually not needed for: cold; flu; fluid in the middle ear; sore throats, except strep; chest colds and bronchitis in otherwise healthy children and adults.

Take medicine as prescribed. If it's an antibiotic, take it until it's gone, even if you're feeling better.

Don't take leftover antibiotics or antibiotics prescribed for someone else. Taking the wrong medicine may delay appropriate treatment and enable bacteria to multiply.

If you have a viral infection, ask your health care provider for help with symptom relief. Rest, drink plenty of fluids and use a humidifier.

Contact your doctor again if your symptoms get worse, last a long time or if you develop signs of a more serious problem, such as vomiting, severe nausea, high fever, shaking chills and/or chest pain.

SOURCES: Centers for Disease Control and Prevention, U.S. Food and Drug Administration
Copyright 2003, Newsday, Inc.

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