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Antibiotic Use: When to Say 'No'

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ANTIBIOTIC USE
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Feeling sick? Your doctor may weigh the evidence and say you don't need an antibiotic. If you insist, chances are, she'll sigh, pull out her script pad, and give you one just to get your annoying self out of her office. Physicians are busy people who don't necessarily feel like giving you a lesson in Antibiotics 101 during your three-minute visit.

"Patients will, in many cases, insist that they be given an antibiotic," says Frank Myers, the director of clinical epidemiology at Scripps Mercy Hospital, in San Diego. Some even threaten to see another doctor if they don't get the drugs.

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However, there are a lot of really good reasons why you should meekly leave the doctor's office empty handed, save for the standard advice to get enough fluids and bed rest.

For one, antibiotics also kill off good bacteria in your body, which help to digest your food or maintain a healthy balance in your throat or genital tract. "You're not just killing bad bugs; you're killing good bugs," says Tom Campbell, M.D., a family physician in Rochester, N.Y. When good bacteria die, it can cause diarrhea as well as yeast infections of the throat and vagina.

In recent years, there have been outbreaks of a potentially life-threatening intestinal bacterium called C. difficile, which can gain a foothold in people who are treated with antibiotics.

In addition, antibiotic overuse creates superbugs that are resistant to treatment. Take methicillin-resistant Staphylococcus aureus (MRSA), which was recently responsible for some highly publicized deaths in teens and children. The staph strain is resistant to antibiotics such as methicillin, oxacillin, penicillin, and amoxicillin. The U.S. Centers for Disease Control and Prevention says that between 1999 and 2005, the number of MRSA-related hospitalizations increased 62 percent, from 294,570 to 477,927.

Another dangerous bacteria is penicillin-resistant Streptococcus pneumoniae, or strep pneumo, a common problem with childhood ear infections. "This is much more difficult to treat because of antibiotic resistance, and it causes a lot of illness," Myers says. "It's a big problem with kids' ear infections and can also result in meningitis in both children and adults."

The overuse of antibiotics has become so problematic that state health agencies around the world have created public-education campaigns -- including advertisements on television, buses, and billboards -- to warn both doctors and patients (and especially parents) about the dangers of antibiotic resistance.

Should you say no to an antibiotic prescription?
Antibiotic overuse isn't a problem just because patients ask for the drugs when they don't need them. It's also due to misuse -- not matching the antibiotic correctly to the organism, or not taking the drug long enough. And doctors sometimes err on the side of caution; they may order antibiotics even if they're not 100 percent certain you need one or if they're using the right drug for the right bug.

"There are approximately 13 or 14 million visits every year to doctors and emergency rooms for sore throat and more than 50 percent get antibiotics when it's pretty clear that strep throat is quite uncommon," says Mary Caserta, M.D., an associate professor of pediatrics at the University of Rochester Medical Center, in New York.

Besides not pressuring your doctor to give you a prescription for antibiotics (or worse, buying one without a script or taking someone else's), there are a few other things you can do:

Be patient. Tell your doctor you're willing to wait for a lab test that determines exactly what bacteria you have, and the drug that will best treat it.

Be open-minded. Studies have shown that doctors often give patients a prescription because they perceive that patients want it. Make it clear that you're just as happy to skip the script if it's unnecessary.

Take your medication as directed. If your doctor still thinks you need an antibiotic, take the entire dose as directed. Stopping medication too early is a big contributor to drug resistance.

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