Almost 25 percent of the antibiotics prescribed in the United States to people covered by private insurance are inappropriate, according to a study published in the BMJ.

The study examined the insurance records for the year 2016 of more than 19 million privately insured U.S. children and adults (aged 18 to 64). About 7.6 million of those patients, or 40 percent, filled at least one antibiotic prescription that year.

The study then looked to see what those antibiotics were prescribed for. They found that in 23 percent of the cases, the drugs were not medically justified.

Most of the inappropriate antibiotics were given to patients for viral and other conditions that don’t respond to antibiotics, such as colds, chest infections and cough.

Another 36 percent of the antibiotics prescribed in the study were for conditions that only sometimes need such drugs, such as sinusitis. That suggests, say the study’s authors, that the proportion of unnecessary prescriptions was probably much higher than 23 percent.

“Despite decades of quality improvement and educational initiatives, providers are still writing antibiotic prescriptions for illnesses that would get better on their own,” said Dr. Kso-Ping Chua, the study’s lead author and a researcher at the University of Michigan, in a released statement.

An urgent health threat

These troubling findings underscore the magnitude — and seeming intractability — of what has become one of the world’s most urgent health threats: the development of antibiotic-resistant bacteria.

In the United States alone, more than 2 million people come down annually with an antibiotic-resistant infection, such as clostridium difficile, and at least 23,000 of them die, according to the Centers for Disease Control and Prevention (CDC).

The misuse of antibiotics — the prescribing of the drugs in medical situations where they are either ineffective or unnecessary — has been identified as a major factor behind the rise of those infections.

Who’s to blame for the continuing overprescribing of antibiotics? A study published last year pointed to patients as well as doctors. Many people tend to have a “why not take the risk?” attitude toward the drugs, even in situations where it’s known that the drugs aren’t indicated for the patient’s illness.

That attitude, however, overlooks the fact that these drugs are not benign — and not only because of their contribution to antibiotic resistance. Antibiotics have a long list of potential side effects, including diarrhea, stomach cramps, yeast infections and allergic reactions.

Sometimes those side effects can be quite serious. Last August, CDC researchers reported that adverse reactions to antibiotic drugs send about 70,000 children to U.S. hospital emergency departments each year.

What you can do

All of us need to be become better stewards of antibiotics and their use. We need to shed that “why not take a risk?” attitude.

To help us do that, the Choosing Wisely campaign has formulated five questions you should ask your doctor before you take antibiotics. These are questions you should ask yourself as well.

• Do I really need antibiotics? Antibiotics fight bacterial infections, like strep throat, whooping cough and symptomatic bladder infections. But they don’t fight viruses —like common colds, flu, or most sore throats and sinus infections. Ask if you have a bacterial infection.
• What are the risks? Antibiotics can cause diarrhea, vomiting, and more. They can also lead to “antibiotic resistance”— if you use antibiotics when you don’t need them, they may not work when you do need them.
• Are there simpler, safer options? Sometimes all you need is rest and plenty of liquid. You can also ask about antibiotic ointments and drops for conditions like pink eye or swimmer’s ear.
•  How much do they cost? Antibiotics are usually not expensive. But if you take them when you don’t need them, they may not work for you in the future — and that may cost you a lot of time and money.
• How do I safely take antibiotics? If your doctor prescribes antibiotics, take them exactly as directed, even if you feel better.

FMI: You can read the BMJ study in full on the journal’s website.