Doctors are being urged not to prescribe antibiotics to treat common colds, in a bid to curb overuse.
As cold season ensues, patients typically visit their doctors seeking antibiotics because of mucus turned green, or a cough that has nagged for weeks.
Despite years of warnings, doctors still overprescribe antibiotics for acute respiratory infections even though most are caused by viruses that those drugs cannot help.
But, now health experts are offering new tips to help physicians avoid unnecessary antibiotics for these common complaints – and how to withstand demanding patients.
Yes, bronchitis does sound scary. But doctors are being encouraged to instead describe the illness as a chest cold.
Dr Wayne Riley, president of the American College of Physicians and an internal medicine professor at Vanderbilt University, said: ‘Antibiotics are terrific.
‘Thank God we have them for really bad things. But we need to be judicious in the way we use them.’
Doctors are being urged by experts at the CDC and American College of Physicians not to prescribe antibiotics to treat common colds, in a bid to curb overuse
Dr Tanveer Mir, co-author of the new guidelines, added: ‘Physicians should not prescribe antibiotics for the common cold.’
He said symptom-based therapies provide quick relief to patients yet if the recovery period extends beyond two weeks, then additional medical attention may be needed.
Inappropriate antibiotic use for colds and other acute respiratory tract infections contribute to antibiotic resistance, an urgent public health threat, Dr Mir and his co-authors warned.
The American College of Physicians has teamed up with the Centers for Disease Control and Prevention (CDC) to issue the recommendations for prescribing antibiotics for adults suffering an acute respiratory tract infection, including the common cold, sore throat, bronchitis, and sinus infection.
They include advice about what to do while a patient’s body fights off a virus, including the benefits of over-the-counter remedies to ease a cough or pain.
Antibiotics are losing their effectiveness, and inappropriate prescribing is one factor.
Repeated exposure can lead germs to become resistant to the drugs.
The CDC estimates that drug-resistant bacteria cause 2 million illnesses and 23,000 deaths each year in the US.
Another reason not to use them unnecessarily: side effects.
Antibiotics are implicated in one of five emergency-room visits for bad drug reactions, the CDC says.
Particularly troubling is an increase in severe diarrhea caused by C-diff, the Clostridium difficile bug that can take hold in the gut after antibiotics kill off other bacteria.
CDC experts have seen improvement from pediatricians in antibiotic prescribing but overuse remains a big problem for adults, especially with respiratory illnesses, said Dr Lauri Hicks, who heads CDC’s Get Smart antibiotic education campaign.
Despite years of warnings, doctors still overprescribe antibiotics for acute respiratory infections even though most are caused by viruses that those drugs cannot help. But, now health experts are offering new tips to help physicians avoid unnecessary antibiotics for these common complaints
The new guidelines move beyond simple statements that antibiotics don’t work for viruses like the common cold or the flu.
They lay out how doctors begin deciding if antibiotics are warranted for some other common respiratory complaints, explain that decision to patients and offer guidance on symptom relief.
Unless pneumonia is suspected, doctors should not prescribe antibiotics or even perform testing for patients with uncomplicated bronchitis.
Physicians should not prescribe antibiotics for the common cold
Instead, the new guidelines suggest patients be offered symptomatic relief in the form of cough suppressants, expectorants, antihistamines, decongestants, and beta agonists.
‘For sore throat, physicians should recommend analgesic therapy like aspirin, acetaminophen, non-steroidals, anti-inflammatory agents or throat lozenges to minimize pain,’ said Dr Mir.
The usual course of a sore throat is less than a week and an antibiotic will do little to improve symptoms.
The same is true of uncomplicated sinus infections, which lasts less than 10 days or does not cause high fever, facial pain, and nasal discharge for three days or more.
In such cases, a physician might write a script for an appropriate antibiotic.
‘In addition, if a viral illness that was improving initially continues for five days or more, antibiotics may be indicated as well,’ added Dr Mir.
This is known as ‘double-sickening.’
According to Dr Mir, there are other times, however when antibiotics may be necessary.
He said a patient suffering with streptococcal pharyngitis would benefit from antibacterial drugs, though this infection must first be confirmed by a test.
The new guidelines are published in Annals of Internal Medicine:
HOW PATIENTS CONTRIBUTE TO ANTIBIOTIC RESISTANCE
In the United States, at least two million antibiotic-resistant illnesses and 23,000 deaths occur each year, the CDC estimates.
It’s easy to play the blame game when it comes to the urgent public threat of antibiotic resistance:
Overzealous doctors wielding prescription pads may be the easiest targets, but high-pressure patients play an important role in antibiotic overprescribing as well.
The CDC calculates roughly half of all antibiotic prescriptions written by doctors in their offices may be unnecessary or inappropriate.
Unfortunately, concerns about patient satisfaction scores appear to be the driving force underlying this trend.
‘Patient satisfaction depends more on the patient-centered quality of the encounter, such as the provider spending enough time with the patient to explain the patient’s illness, than on the receipt of an antibiotic prescription,’ wrote the authors in their published report.
To increase patient satisfaction, they suggest doctors label acute bronchitis as a ‘chest cold’ or ‘viral upper respiratory infection’ and then provide information sheets about alternatives to antibiotics for managing symptoms.
When healthcare providers gave advice on symptomatic therapy and explained why antibiotics were not needed for acute respiratory tract infections, an 85 per cent decrease in inappropriate prescribing plus increased patient satisfaction ratings occurred, the authors added.
Another approach shown to decrease drug use while increasing positive ratings is the ‘wait-and-see’ method.
A delayed or postdated antibiotic prescription offers the possibility of future antibiotic treatment if the condition does not improve.