Millions of Americans are receiving antibiotics each year for sore throat or acute bronchitis, yet only a very small number of them will benefit from the drugs, according to a study published online last week in the journal JAMA Internal Medicine.
Indeed, the study reports that doctors are handing out antibiotic prescriptions for sore throat and acute bronchitis at rates that are five to seven times higher than needed.
This finding is “sobering news,” writes the journal’s chief editor, Dr. Rita Redberg, in an editor’s note that accompanies the study. “Despite valiant efforts by the Centers for Disease Control and Prevention [CDC] and others to reduce inappropriate prescription of antibiotics for sore throats in the last 20 years, little to no progress has been made.”
The inappropriate use of antibiotics has become a major public-health problem in the United States and around the world, for it contributes to the development of potentially deadly antibiotic-resistant bacteria.
Each year, more than 2 million Americans come down with infections from antibiotic-resistant bacteria, a factor that leads to at least 23,000 deaths, according to a CDC “threat report” released in September.
A large, representative sample
For the JAMA Internal Medicine study, Dr. Michael Barnett and Jeffrey Linder of Brigham and Women’s Hospital in Boston analyzed data from nationally representative surveys of 131 million patient visits (all adults) to 8,200 primary care clinics and hospital emergency rooms during the years 1996 to 2010. Some 92 million of those visits were for sore throats; the remainder (39 million) were for acute bronchitis.
As Barnett and Linder point out in their study, only about 10 percent of sore throats are triggered by streptococcus bacteria (“strep”), the only common cause of sore throat that responds to antibiotics. The vast majority of sore throats result from viral infections, for which antibiotics are totally ineffectual. The recommended treatment for viral infections is typically rest and fluids.
Strep throat can be diagnosed almost immediately today with a simple swab test.
Yet Barnett and Linder’s analysis found that physicians prescribed antibiotics to 60 percent of the patients who came to their clinic or hospital complaining of a sore throat. That percentage has held stubbornly steady since 2000, the researchers note, although it’s down from the 70 percent of sore-throat patients who were prescribed antibiotics in 1993.
The analysis also found that physicians have increasing turned to prescribing more expensive, broader-spectrum antibiotics for sore throats, especially azithromycin, even though penicillin remains effective against strep throat and is less expensive.
The cost of these drugs is not a minor matter. As Barnett and Linder point out in their study, Americans have spent at least $500 million on unnecessary antibiotics between 1997 and 2010.
The unnecessary prescribing of antibiotics to patients with acute bronchitis was even higher than it was for sore throat. Acute bronchitis is always caused by a virus, so antibiotics are useless against it. Yet Barnett and Linder found in their analysis that 73 percent of patients who arrived in a clinic or hospital with symptoms of acute bronchitis between 1996 and 2010 were prescribed an antibiotic.
A positive trend
The study uncovered one small positive finding: Visits to doctor’s offices for sore throats declined from 7.5 percent of all visits in 1997 to 4.3 percent in 2010. No significant change occurred, however, in the percentage of emergency-room visits that were for sore-throat symptoms (2.2 percent in 1997 and 2.3 percent in 2010).
And the number of visits to doctors and hospitals for acute bronchitis actually increased, from 1.1 million visits in 1996 to 3.4 million in 2010.
“On an individual level, use of antibiotics for patients without [strep throat] exposes them to adverse effects without any benefit,” writes Redberg. “On a societal level, the increase in the use of antibiotics, particularly the broader-spectrum ones, accelerates the development of resistant organisms. Hopefully, implementation of the principles of Choosing Wisely, where in 2011 the pediatricians admonished not to use antibiotics in the absence of a confirmed diagnosis of strep, will start to lower inappropriate use soon.”
You can read the study and the editorial on the JAMA Internal Medicine website.