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Antibiotic acrimony persists

Coughing and sneezing? That doesn't mean you need an antibiotic

Date published: 3/23/2008

"IKNEW you'd say that" was the slightly resentful retort of one of our office receptionists when I told her I didn't think antibiotics would help her respiratory infection.

Another believer having her hopes dashed, subjected to the cruel and inhuman withholding of treatment by some persnickety, purist doctor. Or at least that's how I think the patient sees this oft-played-out scenario, in which a patient wants antibiotics and the doctor insists it is not the right treatment.

Almost all these respiratory infections are caused by viruses--which do not respond to antibiotics. But try telling patients that.

We are getting out of the cold/flu/upper-respiratory-infection season, though allergies are taking over and can sometimes cause indistinguishable symptoms, just to muddy the waters. But the recent flu epidemic has provided many of the acrimonious interactions I am talking about. And although this has been written about a lot, it intrigues me that it is so hard to dislodge this idea that any respiratory-tract infection, even in the first day or two, will benefit from antibiotics.

In an editorial for the American College of Physicians journal, Dr. James D. Sargent of Dartmouth-Hitchcock Medical Center relates the results of a Centers for Disease Control and Prevention initiative in which doctors educated their patients about the real cause of these infections (viruses). They also educated them as to why antibiotics are ineffective or even harmful; offered them symptomatic relief; and encouraged patients to be "glad" they have only a mild condition.

Did the patients change their ways?

"The shocker is that after careful physician and patient education intervention based on these principles, the antibiotic prescription rate for presumed viral illness remained over 60 percent," Sargent noted.

Some of this can be explained by doctors prescribing antibiotics out of expedience. It's a whole lot quicker to bang out a prescription for amoxicillin than to get into a long wrangle/educational session with the patient.

And some of this is due to the influence of marketing, claims Sargent. The New York Times, in an article titled "What's Black and White and Sells Medicines," noted that the Pfizer drug company's cutesy invention, Max the zebra, helped make Zithromax (azithromycin) a billion-dollar drug despite federal officials' stating that other antibiotics were both cheaper and more successful in treating children's ear infections.

THE WAY IT WAS

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Date published: 3/23/2008