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Antibiotics
Overprescribed for Sore Throat
Excerpt By Merritt McKinney, Reuters
Health
NEW
YORK (Reuters Health) - More than half of all adults who see a
primary care doctor for a sore throat leave the office with a
prescription for an antibiotic, a new survey indicates, even though
most sore throats are caused by viruses, which do not respond
to the drugs.
When doctors
do treat a sore throat with antibiotics, they usually do not prescribe
the ones that are recommended for sore throats caused by bacteria,
according to the survey. Instead, most patients are treated with
more expensive antibiotics that target a wider range of bacteria,
a practice that the study's authors say may increase the risk
that bacteria will become resistant to antibiotics.
Sore throat
is one of the most common symptoms of people seeking medical care,
second only to cough. Most sore throats are caused by viruses
such as the cold virus, which are not treatable with antibiotics.
Although viruses
are the main cause of sore throat, bacteria are sometimes to blame.
The major type of bacterial sore throat is strep throat, which
accounts for 15% to 36% of sore throats in children and 5% to
17% of sore throats in adults.
But a national
survey of more than 2,000 visits to the doctor found that from
1989 to 1999, 73% of patients with sore throat received a prescription
for an antibiotic.
Penicillin
and erythromycin are the recommended antibiotics for strep throat,
but 68% of patients treated with an antibiotic received other
antibiotics instead of these preferred drugs, researchers report
in the September 12th issue of The Journal of the American Medical
Association.
``The use
of appropriate antibiotics for strep throat has decreased dramatically,''
one of the study's authors, Dr. Jeffrey A. Linder of Massachusetts
General Hospital in Boston, told Reuters Health in an interview.
Besides driving
up medical costs, prescribing antibiotics other than penicillin
and erythromycin for strep throat increases the odds that bacteria
will become resistant to antibiotics, Linder explained.
``Penicillin
should be the drug of choice,'' he said. Decades after its discovery,
penicillin is still highly effective at destroying the bacteria
that cause strep throat, he noted. For patients with strep throat
who are allergic to penicillin, erythromycin, another inexpensive,
narrowly focused antibiotic, is the next best choice, he said.
Many patients
have come to expect antibiotics whenever they see a doctor for
a sore throat, but Linder said that it is important for the public
to understand that the symptoms of a sore throat usually vary
depending on whether it is caused by a viral or bacterial infection.
Tell-tale signs of strep throat include pus on the back of the
throat and swollen glands. In contrast, a sore throat that is
accompanied by a runny nose or cough is unlikely to be strep throat,
he said.
As for physicians,
they should focus on ways to make their patients comfortable while
they have a sore throat rather than on treating it with an often-useless
antibiotic, Linder said.
The study
provides some signs that prescription patterns may be changing.
In 1999, the last year of the study, there was a decrease in the
use of nearly all types of antibiotics to treat sore throat.
``The 1999
data is encouraging,'' according to Linder. It will be important
to continue to follow prescription patterns, however, to see whether
the 1999 numbers mark the beginning of a trend, he said.
``We've still
got a long way to go,'' he added.
SOURCE:
The Journal of the American Medical Association 2001;286:1181-
Reference
Source 89
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