An imperfect prescription

Doctors' group issues guidelines curtailing use of antibiotics

Antibiotics may not be as useful as once thought
ON THE NEWS Christy Feig: New antibiotics guidelines

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By Christy Feig
CNN Medical Unit

Summary: For years, doctors have prescribed antibiotics to treat respiratory ailments such as a sore throat, bronchitis or a sinus infection. But a new report says antibiotics -- which treat bacteria but are ineffective against viruses -- are not needed to treat most such infections. Doctors say the recent findings may not prevent antibiotics from being over-prescribed, given patients' skepticism and the difficulty telling the difference between viral and bacterial infections.

WASHINGTON (CNN) -- Those who have suffered from respiratory ailments know the routine all too well.

A person gets a sore throat -- or, just as well, bronchitis or a sinus infection -- and heads to the doctor, who proceeds to prescribe antibiotics, drugs that kill or thwart the sickness-causing bacteria without harming the body.

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But that prescription for good health may be no more, following the publication of new guidelines last month in the Annals of Internal Medicine. In its report, the American College of Physicians-American Society of Internal Medicine said antibiotics are not needed to treat many upper respiratory infections -- including sore throats, bronchitis and most sinus infections.

The internists' group said such infections are usually caused not by bacteria -- which antibiotics usually can overcome -- but by viruses, against which antibiotics are ineffective.

"Doctors have always been taught that if you have yellow or green nasal secretions, you need an antibiotic. But that's not the case," said Dr. Sandra Fryhofer, president of the society. "The yellow or green nasal secretions or secretions from a cough can be caused by viruses as well."

Public health officials have noted the general population's growing resistance to antibiotics in recent years. The more bacteria are exposed to antibiotics, the more likely they will become resistant to them -- leaving the bacteria to reproduce and cause further harm.

Moreover, the American Medical Association says people who take antibiotics are more likely to develop allergic reactions to the drugs the more they use them.

Bacteria are generally microorganisms that can be helpful or harmful in the body. Some bacteria can grow in the body and lead to various ailments, such as those caused by infected wounds.

Viruses aren't independent organisms, but are rather dependent on other cells to reproduce. In the process, they cause harm to the body. Examples of viral infections are influenza and HIV, which can lead to AIDS.

The American Medical Association supports the new antibiotic guidelines issued by the American College of Physicians-American Society of Internal Medicine.

A new report says many respiratory ailments, such as bronchitis, will not respond to antibiotics

But doctors said patients and doctors should not think that antibiotics are no longer useful or that no infections -- including some respiratory ones -- are bacterial in nature. When in doubt or when suffering to a severe extent, they recommend getting an expert medical opinion.

"If you have a very high temperature or difficulty breathing, or chest pain, you need to call your doctor immediately," Fryhofer said.

If the situation isn't severe, experts recommend treating symptoms at home for seven to 10 days with over-the-counter medicine.

"When the infection has been going on longer than seven to 10 days, that's when there is a higher likelihood of it being bacterial," said Dr. Set Oringher of the Washington Sinus Center.

The guidelines indicate when an antibiotic is appropriate, such as for treatment of strep throat, whooping cough and pneumonia. When a patient develops a fever of 101 to 101.5, Oringher added, he or she should see a doctor.

While Oringher said he agrees with the guidelines, he predicted physicians who follow them strictly will face significant hurdles, including skepticism from patients about their doctors' motives for not dispensing antibiotics.

"A lot of times a patient's reaction will be one of mistrust," Oringher said, "feeling that they're not being treated appropriately ... They will either go see another doctor or call back two days later and say I'm still not better."

But Oringher said the problem of antibiotic resistance is growing because doctors are overprescribing antibiotics.

"More recently, we are seeing that a lot of strains of strep pneumonia are becoming resistant to antibiotics that we used to use, like penicillin," he said. Strep pneumonia bacteria are the most common cause of sinus infections and some bronchitis infections.

It is difficult for doctors to distinguish between bacterial and viral infections. Sinus infections are particularly problematic, because no test exists that makes the distinction. So doctors often prescribe antibiotics anyway.

"Spending the time to explain to [the patients] why they may not need an antibiotic certainly takes more time and is difficult these days with managed care," Oringher said.

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CDC: Antimicrobial Resistance
MayoClinic.com: Antibiotics
World Health Organization: Anti-infective drug resistance
Alliance for the Prudent Use of Antibiotics
CSPI: Antibiotic-Resistance Project

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