Antibiotics For The Flu?

Good Cop, Bad Cop

Everyone in the medical profession knows the problem with antibiotics. The excessive overuse of these drugs has prompted bacteria to quickly adapt and become much more resistant to even the most powerful antibiotics.

This is a given. It’s been a widely discussed issue for some time now. And that being the case, you simply won’t believe the results of a test that reveals just how thoroughly set in their ways doctors can be.

Prompt service

Many doctors have fallen into the habit of prescribing antibiotics for flu patients. This is a curious habit because doctors are well aware that antibiotics are effective bacteria fighters, but are of no use at all in treating viruses, including influenza viruses.

By some estimates, about 90 percent of flu patients who visit their doctor are given prescriptions for antibiotics.

In the e-Alert “No Bacteria Left Behind” (3/30/04), I told you about a Swiss study that tested a new technique that quickly determines if a patient has a bacterial infection. Previously, such tests required time-consuming lab work. But as the Swiss study illustrated, patients with ambiguous symptoms (which might indicate either viral or bacterial infection) can now be quickly diagnosed with this cutting edge technique.

One of the authors of that study noted that the test “halves antibiotic use.” He might have added: “In theory,” because he apparently forgot that prescriptions are written by doctors, and doctors are all too human.

Behavior non-modification

A new study, conducted by researchers at the University of Rochester (UR), examined how antibiotic use might change when patients are given a flu test with quick results.

Researchers examined medical records for 166 patients who were diagnosed as having potential flu symptoms. Rapid response tests revealed that 86 patients had viral influenza infections. Nearly 100 percent of the patients who tested negative for the flu were prescribed antibiotics.

Ready for the kicker? Among patients who tested positive for the flu – without any evidence of bacterial infection – 86 percent were prescribed antibiotics!

In a UR press release, study leader Ann R. Falsey, M.D., stated that sometimes doctors prescribe antibiotics when they feel a flu patient may be in danger of bacterial infection due to other health problems. Okay – fair enough – but Dr. Falsey also noted that more than 60 percent of the patients who received antibiotics were judged to be at low risk of bacterial infection.

And according to Dr. Falsey, no studies have shown that antibiotics given in anticipation of possible bacterial infection actually prevent infections.

Tough love

So why did so many doctors prescribe antibiotics in spite of solid evidence that no bacterial infection was present? Quite charitably, Dr. Falsey points out that doctors are just trying to do the right thing by their patients.

Dr. Falsey: “Oftentimes people get sick, they just want to feel better, and they assume there is a pill that will make them better quickly. Unfortunately, that’s not the case for many respiratory illnesses that are caused by viruses. Instead they should rest, drink plenty of fluids, and take over-the-counter medications to help ease their symptoms. But many patients don’t want to hear that, and it can be difficult for a doctor to deliver the news.”

Rightor it’s just so much easier to write a prescription and send patients on their way. In either case, it’s time for someone to step up and be the bad cop to Dr. Falsey’s good cop.

Doctors, it’s simple: Do the difficult thing! Get tough with your flu patients who are supposedly longing for antibiotics they don’t need. Besides the fact that antibiotic overuse is creating widespread bacterial resistance, there are two very good reasons to put away the prescription pad.

Reason One: A 2004 study revealed that excessive antibiotic use may be linked with a higher risk of aggressive breast cancer. In that study, the women who had the highest rates of cumulative days of antibiotic use over 17 years had a sharply increased risk of death due to breast cancer.

Reason Two: In a 2003 study of antibiotic use among children, nearly half of 448 children were found to have received antibiotic treatments within the first six months of life. Among those children, the risk of developing asthma was two and a half times greater than among children who received no antibiotics within their first six months. Risk of developing allergies was also significantly increased in the antibiotic group.

Sources:
“Impact of Rapid Diagnosis on Management of Adults Hospitalized with Influenza” Archives of Internal Medicine, Early Release Article, posted 1/22/07, archinte.ama-assn.org
“Rapid Flu Tests May Reduce Threat of Antibiotic Resistance” EurekAlert, University of Rochester Medical Center, 1/22/07, eurekalert.org
“Antibiotic Use in Relation to the Risk of Breast Cancer” Journal of the American Medical Association, Vol. 291, 2004, ama-assn.org
“Asthma and Antibiotics” Jon Barron, Baseline of Health, 10/13/04, jonbarron.org