Go to the doctor with a sore throat and you should come away with a prescription for antibiotics, right? Not necessarily, say experts. Research has found that doctors often prescribe antibiotics when they’re not needed, with serious consequences for patients and for public health.
Many antibiotics can have serious side effects, like irregular heartbeat, drug interactions with other medications, nerve damage and tendon ruptures, said Michael Silverman, chair of infectious diseases at Western University in London, Ont.
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Not only that, prescribing antibiotics when they’re not needed contributes to antibiotic resistance, where bacteria develop a resistance to a given drug. Over time, as bacteria become more and more drug-resistant, doctors start to run out of ways to treat the infection – such as the recent development of drug-resistant gonorrhea and other diseases. Eventually, we run out of effective drugs.
“We know by evolution, the natural pattern is, bacteria will become resistant. They always do.”
But the less bacteria get exposed to antibiotics, the longer we can put off their evolution into a more drug-resistant form, he said.
Doctors overprescribe antibiotics for many reasons, said Silverman, including a lack of education of the possible problems with antibiotic use, time crunches – writing a prescription is a quick way to end an appointment – and pressure from patients who say they want the drugs.
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Antibiotics are important but should only be prescribed in specific cases, said Silverman. And although he says patients should follow their doctor’s instructions, he does encourage them to ask the doctor questions, such as whether they really need an antibiotic for their condition.
“Instead of just always asking, ‘Are you sure I don’t need one?’ also asking, ‘Are you sure I really need this?’”
Here are some conditions where an antibiotic isn’t always the way to go.
The common cold and laryngitis
Antibiotics are never indicated for these two common conditions, said Silverman, yet patients – particularly elderly patients – often get prescribed them anyway.
Sinusitis and acute bronchitis
These two conditions “the vast majority of the time do not need antibiotics,” he said. He did a study recently of elderly patients who had colds, laryngitis, sinusitis and acute bronchitis and found that they were often prescribed antibiotics, even though it’s rarely called for.
READ MORE: Nearly 1 in 2 Ontario seniors prescribed unnecessary antibiotics
“We found that 46 per cent of the time they still got an antibiotic, even though for two of those, antibiotics are never indicated and the vast majority of the time, in the other two, they’re not indicated as well.”
Sore throats
“Most sore throat is not streptococcal, is not Group A strep and so does not need antibiotics,” said Silverman. Sometimes though, it is strep throat and needs the drugs. “The recommendation is only to treat if Group A strep is found.”
Pinkeye
A recent study published in the Journal Ophthalmology found that of 300,000 patients diagnosed with acute conjunctivitis, commonly known as pinkeye, 58 per cent filled a prescription for antibiotic eye drops.
However, a press release notes that antibiotics are rarely necessary to treat pinkeye because most cases are caused by viruses or allergies. Even bacterial infections tend to be mild and resolve themselves within a week or two, it notes. The authors say that it can be tough to distinguish between the different causes of pinkeye and many doctors might prescribe antibiotics “just in case.”
The American Academy of Ophthalmology is telling health-care providers to avoid prescribing antibiotics when they don’t know the cause of the infection.
Urinary tract problems
Silverman has found that many elderly patients receive antibiotics after a urine test shows bacteria in their urine.
“Many elderly patients have bacteria in their urine and that’s normal for them,” he said. Unless they have other symptoms, such as a burning sensation during urination, fever or increased frequency of urination, it might not be an actual infection and might not need antibiotics, he said.
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