Antibiotic use for sore throats criticized

Drug-resistant bacteria may be result, study says

By Raja Mishra, Globe Staff, 9/12/2001

octors mistakenly prescribe antibiotics in the vast majority of sore throat cases, helping create a new class of drug-resistant bacteria, according to a study in today's issue of the Journal of the American Medical Association.

Only about 10 percent of sore throat cases actually require antibiotics but doctors give them 73 percent of the time, the study found. Insistent patients and rushed doctors are mostly to blame, said the study's authors.

''Over the years, patients have come to expect an antibiotic,'' said author Dr. Jeffrey A. Linder, a research and clinical fellow at Massachusetts General Hospital. ''For doctors, it's quicker to prescribe an antibiotic than to take 10 minutes to explain that this is an illness that's going to go away in a few days and doesn't need an antibiotic.''

Not only did doctors often unnecessarily give antibiotics, but, in 68 percent of cases they prescribed more expensive types, the study found. The inexpensive warhorses penicillin and erythromycin cure most bacterial infections of the throat.

In the vast majority of sore throat cases, patients have viral infections, which are impervious to antibiotics. But when they take antibiotics, the numerous types of bacteria they do carry are exposed to the drugs, allowing them to evolve and develop resistance. If these bacteria become harmful, they might be difficult to destroy, creating prolonged illnesses.

In addition, all antibiotics carry slight risks of allergic reactions, an unnecessary risk for most sore throat patients. ''They are being exposed to all the risks of the medicine with no chance of any benefit,'' said Linder.

Antibiotics are similarly overprescribed in common cold and acute bronchitis cases, Linder said.

To avoid overprescription, Linder said, doctors should more regularly perform bacterial tests on those complaining of sore throats. Also, patients should not expect antibiotics for every minor ailment.

Antibiotic mania was born in the 1940s and '50s, said Linder, when the now-rare disease rheumatic fever was widespread, with a sore throat as a symptom. Doctors became liberal in prescribing antibiotics as a precaution against the deadly ailment. Now even the most minor sneezes and sniffles come with requests for antibiotics, said Linder.

And rushing doctors are often happy to oblige.''I think there's a genuine desire on the part of doctors to want to do something for their patients,'' Linder said. ''An important message for patients is that if you do have a sore throat, nine times out of 10, you really shouldn't be getting an antibiotic.''

Drug-resistant bacteria from overprescribing have yet to cause a major public health problem. But doctors are concerned that the bacteria that cause pneumonia might soon develop resistance to most common antibiotics. Already, more cases of drug-resistant pneumonia are turning up in emergency rooms. ''That is a big concern,'' Linder said.

This story ran on page A26 of the Boston Globe on 9/12/2001.
© Copyright 2001 Globe Newspaper Company.