Posted on 09/22/2010 5:26:39 PM PDT by decimon
Doctors frequently misuse antibiotics when treating patients hospitalized with respiratory tract infections (RTIs), according to a study to be published in the November issue of Infection Control and Hospital Epidemiology.
The study, which tracked patients in two Pennsylvania hospitals, found that doctors often use antibiotics to treat patients whose infections are known to be caused by viruses. The findings are alarming because antibiotics are not effective against viruses, and antibiotic overuse has been linked to the development of resistant bacterial strains.
"[T]hese data demonstrate at least one area where antibiotics are commonly used in hospitalized patients without clear reason," write the study's authors, Kevin T. Shiley, Ebbing Lautenbach and Ingi Lee, all from the University of Pennsylvania School of Medicine. "Recognition of this may be helpful in developing interventions to limit inappropriate antibiotic use in the future."
In recent years, new diagnostic tests have been developed to distinguish infections caused by viruses from those caused by bacteria. In theory, more definitive diagnoses should reduce the inappropriate use of antibiotics in patients with viral infections. But that does not appear to be happening, according to Shiley and his colleagues.
The researchers looked at data on RTI patients admitted to two hospitals over a two-year period. Of 196 patients who were diagnosed with viral infections, 125 remained on antibiotics after their diagnoses. It would be understandable to keep a patient on antibiotics if an abnormal chest x-ray suggests a concurrent bacterial infection, the researchers said. However, only 37% of these patients had abnormal chest x-rays. "It is less clear why the remaining 63% of patients with normal chest imaging were prescribed antibiotics," Shiley and his colleagues write.
NO CLINICAL BENEFIT
Patients in the study who remained on antibiotics did not benefit from the treatment, the researchers found. In fact, antibiotics may have led to harm in some cases. For example, a significant number of antibiotic patients developed Clostridium difficile diarrhea, a condition linked with antibiotic use.
On average, the antibiotic group had longer hospital stays and higher mortality rates than the non-antibiotic group. While those poorer outcomes cannot be attributed directly to antibiotic treatment, they do suggest that there was no clinical benefit, the researchers say.
"This study highlights the crucial role of antimicrobial stewardship in improving patient care," said Neil O. Fishman, M.D. at the University of Pennsylvania and president of the Society for Healthcare Epidemiology of America. "Appropriate use of antibiotics is not only essential to limiting emergence of resistance, but also may help improve clinical outcomes."
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Kevin T. Shiley, Ebbing Lautenbach, and Ingi Lee, "The Use of Antimicrobial Agents after the Diagnosis of Viral Respiratory Tract Infections in Hospitalized Adults: Antibiotics or Anxiolytics?" Infection Control and Hospital Epidemiology 31:11 (November 2010). The study will publish online next week.
Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. It is published by a partnership between The Society of Healthcare Epidemiology of America and The University of Chicago Press.
Heal thyself ping.
Doubtful. Doctors are not pressured by average people for drugs, when they very well know the drugs won’t do anything.
Sometimes doctors are worried secondary infections (by bacteria) will set in due to the primary viral infection.
Sometimes it is because all doctors today are only trained to treat illnesses with prescription drugs. Person has x, exhibiting symptoms a,b,c, treat with drug y. Hardly have any naturopathic doctors out there.
Sometimes because it’s the quickest way to get a person in and out the door because the doctor is overworked and has a large case load of patients to deal with, and its SOP to throw antibiotics at certain illnesses.
Or they can not treat the patients, and the bacterial infections grow stronger and get spread to the community requiring more and more antibiotics to be used.
I say resistance is caused by underuse of antibiotics. Use antibiotics and kill the infections. Culture and make sure the antibiotics are effective for the bug you are treating. (Remember when that was routine?) Quarantine serious infections and use good hygiene and good ventilation systems and you won’t have to worry about resistance.
Don’t worry guys,, Obamacare is on the way. Soon there will no longer be a problem of too much medicine being prescribed.
I know over prescribing antibiotics is a problem but the opposite is also true some times.
My Mother was in the hospital and dying from something like pneumonia. They changed doctors because the current one went on vacation. The old Dr. who was just about to retire, gave Mother an antibiotic and she almost immediately starting getting better.
I recall from prior threads some M.D. FReepers saying otherwise.
As a concidence, I have one of these bugs as we speak. It lives in me. Never going to completely get rid of it. My problem is I work too hard, get weak, and when it starts to cool off outside I come down with it. I come down with it every year, for the last 5, about this time of the year. It will last for 4-6 weeks. I feel terrible. Still work too hard. Not enough sleep. Not eating well, or at all.
So if my posts get crazier, or dumber, it’s just the delirium.
Last year, my daughter kept on getting respiratory viruses. We would wait about 10 days, and it it started getting worse put her on the anti-biotics. It would immediately clear up.
We’re trying prevention this year to see if she gets sick less. She started allergy shots, she’s on lots of vitamin D, she is taking a nasal spray, and a inhaled steroid. It’s too early to see if it’s working.
“Doctors are not pressured by average people for drugs, when they very well know the drugs wont do anything.”
Untrue. I say this from experience. Most people don’t actually understand the difference between a viral and a bacterial infection. I have to explain the distinction to my patients constantly. Also, many doctors (bad ones) hand out Zithromax like it’s candy just to get people asking for an antibiotic out the door, which only reinforces the idea to those patients that they need an antibiotic for everything.
Know the subject about which you are speaking before you open your mouth.
Were I less lazy I’d keep track of who are the medical doctors here.
I recall at least one other saying some of his patients would simply go to another doctor for what he wouldn’t prescribe. Doctor shopping. I guess.
Hard to believe. 30 years ago, believing that would be a benefit, I asked for same and was quickly corrected by the doctor. My asthma is properly corrected these days.
If you read my full response you’d see I did say sometimes what you say happens. But nobody can force a doctor to write a prescription. That is bullsh1t and you know it.
I know doctors have to explain viruses are not affected by medicines that attack bateria. That is why you have to sit there and explain it to them. That’s part of the job. It’s also part of keeping a good reputation as a doctor, because other doctors if and when they review your treatments will see you are incorrectly prescribing meds that are not appropriate for what a patient has.
Post 10
Went to two docs last year for this bug. One ended up (after trying a ceplaosporin cause the first tried a amoxicillin) giving me a z-pack. No help.
You got any home remedies, or over the counter advice? I eat a lot of aspirin. Helps with the low grade fever. Should I dose on vitamins?
cephalosporin. Must be the delirium.
Too many people just don’t know the difference between a virus and bacteria, and insist upon antibiotics because they know the word. Mothers are especially guilty of this. The problem is receding as awareness increases regarding antibiotic resistance, but this is one of the prime reasons for that resistance. The other reason is failing to complete the course of the drug, leaving bacteria alive that have survived the antibiotic, which then go on to reproduce like crazy, and do not respond to the particular antibiotic to which they were exposed but not killed.
I seriously try to avoid antibiotics myself, for all but the serious infections such as strep or staph. There are perfectly fine, natural antimicrobials that should serve as the front line, starting with garlic. Topical would be tea tree oil. Your kitchen is filled with natural antimicrobials. Salt, sugar, honey, vinegar, two thirds of the average spice rack. Just take the time to learn, and leave the antibiotics for the serious stuff, to help avoid further resistance. We’re down to, what, Cipro and one other now? There’s going to be something ugly of near-plague proportions if we don’t reign it in now, and conserve the remaining effective medications we have.
Thanks for reminding me, I just dumped some cinnamon powder into my coffee.
You're probably right though it looks like vitamin D should probably be the first line of defense.
Corrected or controlled?
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