Antibiotics are not appropriate for most acute respiratory infections, according to a report by Linda F. McCaig of the Centers for Disease Control and Prevention (CDC). However, patients continue to expect antibiotics and physicians continue to prescribe them for viral infections. This practice contributes to antibiotic resistant bacteria in both the individual and the community.
The CDC began a campaign for appropriate antimicrobial use in 1995. To see how well this program has worked, McCaig compared antibiotic-prescribing statistics for the 1993 - 1994 winter flu season and the 2007 – 2008 season. She focused on the five most common acute respiratory infections for persons aged 14 years or younger.
The results showed:
1. For sore throat (pharyngitis), antibiotic-prescribing rates decreased 26 percent.
2. For common colds (nonspecific upper respiratory infection), antibiotic-prescribing rates decreased 19 percent.
3. Antibiotic-prescribing rates did not change significantly for ear infections (otitis media), bronchial infections (bronchitis), and sinus infections (sinusitis).
All of these are viral infections in the majority of cases. McCaig attributed part of the decrease of overall prescribing rates to the pneumococcal conjugate vaccine, which has reduced the number of respiratory infections.
The CDC web site explained that children have the highest rates of antibiotic use. One survey showed that doctors prescribe antibiotics to children 62 percent of the time when they perceive that parents expect them, but only 7 percent of the time when they do not feel parent expect them. For acute respiratory tract infections, 80 percent of antibiotic prescriptions are unnecessary based on CDC guidelines.
Antibiotics are not harmless. The Merck Manual web site lists common side effects as upset stomach, diarrhea, and vaginal yeast infections. Less common but more serious side effects can impair the function of the liver, kidneys, bone marrow, and other organs.
Some individuals have allergic reactions to specific antibiotics. These include itchy rash, wheezing, swelling of the throat, breathing difficulty, and low blood pressure. Severe anaphylactic reactions can be life-threatening.
McCraig concluded, “Antibiotic prescribing for persons aged < 14 years in the United States remains inappropriately high. Further intervention is needed to decrease inappropriate antibiotic prescribing for this population.”
References:
1. Centers for Disease Control and Prevention, “Office-related antibiotic prescribing for persons aged < 14 years – United States, 1993 - 1994 and 2007 - 2008”, MMWR Morbidity and Mortality Weekly Report 2011 September 2; 60(34): 1153-6.
http://www.ncbi.nlm.nih.gov/pubmed/21881545
2. Centers for Disease Control and Prevention. Get Smart: Know When Antibiotics Work. Web. Jan. 6, 2011.
http://www.cdc.gov/getsmart/antibiotic-use/fast-facts.html
3. Merck Manual Home Health Handbook. Antibiotics. Web. Jan. 6, 2011.
http://www.merckmanuals.com/home/infections/antibiotics/antibiotics.html
Reviewed January 9, 2012
by Michele Blacksberg RN
Edited by Jody Smith