Posted by Brigham and Women's Hospital November 5, 2013
It has long been understood that antibiotics are an effective and appropriate treatment for strep throat, a bacterial infection, but not for most cases of sore throat. Yet, here in the US, antibiotics continue to be frequently prescribed as a treatment for viral sore throats – a dangerous public health trend.
“We know that antibiotic prescribing, particularly to patients who are not likely to benefit from it, increases the prevalence of antibiotic-resistant bacteria, a growing concern both here in the United States and around the world,” says Jeffrey A. Linder, MD, MPH, a physician and researcher in the Division of General Medicine and Primary Care at Brigham and Women’s Hospital (BWH), and senior author of a recent paper examining antibiotic prescribing rates. “Our research shows that while only 10 percent of adults with sore throat have strep, the only common cause of sore throat requiring antibiotics, the national antibiotic prescribing rate for adults with sore throat has remained at 60 percent.”
Even when we use antibiotics appropriately – to treat bacterial infections – we promote the development of drug-resistant bacteria, also known as “superbugs.” However, when we prescribe antibiotics for viral illnesses, we unnecessarily accelerate the development and spread of drug-resistant bacteria and unnecessarily increase the risk of difficult-to-treat conditions. As the name suggests, these bacteria are resistant to available antibiotics and the resulting infections can be deadly. According to the Centers for Disease Control and Prevention (CDC): “Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections. Many more people die from other conditions that were complicated by an antibiotic-resistant infection.”
On an individual basis, taking antibiotics for viral illnesses unnecessarily subjects patients to adverse drug reactions, allergies, yeast infections, and nausea.
Along with these direct impacts to personal and public health, antibiotic overprescribing also plays a significant role in increasing health care costs. “In addition to causing adverse drug reactions and contributing to the prevalence of antibiotic-resistant bacteria, unnecessary use of antibiotics also adds financial cost to the health care system and causes adverse effects for those taking the medication,” says study co-author Dr. Michael L. Barnett. “Most sore throats should be treated with rest and fluids and do not require a visit to the doctor,” he adds.
The CDC, along with health care advocacy groups, has worked hard for the past several decades to counter this disturbing trend, but, as evidenced by Linder and Barnett’s study, success has been limited.
Who or what is to blame for this? Research efforts at BWH are underway to determine the root cause(s) of antibiotic overprescribing and to help develop and implement effective interventions.– Chris P