Probably not a surprise to many people…
http://news.nationalgeographic.com/2016/11/a-third-of-people-given-antibiotics-don-t-need-them/
Of course, overuse by itself is a wasteful contributor to increasing medical care costs, but it goes beyond that to breeding antibiotic resistant bacteria, so that that antibiotics are more likely to fail when they are really needed, resulting in worse medical outcomes and even more medical care costs.
No surprise.
I don’t understand the idea of “patient demand” of x, y, or z and why doctors “give in” to it.
The larger problem is the antibiotics used in our food supply–for growing produce AND raising livestock that humans consume. This is a HUGE problem in increasing antibiotic resistance as well.
There are a lot of patients who don’t feel validated unless they leave the MD or ER with an Rx. I personally don’t get it, but there are a lot of patients who insist they should get SOMETHING from the visit and are happier if they leave with some prescription.
My relative was just in the ER. She was given a huge number of tests and discharged the next day. The hospitalist who managed her care wanted to give her a beta blocker, despite the fact that she was FAINT likely because of LOW blood pressure, which was why she was hospitalized. Luckily, a relative who is an MD called her internist who was happy to be informed and agreed with the relative that NO beta blocker was indicated. It’s very scary navigating medical issues and blindly trusting that the MD or provider knows what is best, especially when they’re new to your case and don’t have a good idea of your history.
while we need a new generation of antibiotics in all classes very badly.(different antibiotics are needed for different issues) i would say that antibiotics are now under prescribed…which leads to people being sick for longer and getting sicker before they get the antibiotics they needed on their initial visit for medical care. the pressure has been put on doctors to prescribe less and it is happening. has anyone ever gotten a prescription when it was not needed?..yes. but the biggest issue IMO is people not finishing the complete course of antibiotics like they are suppose to. if you do not finish off your enemies in a war the survivors can regroup and come back stronger and now able to overcome your weapons. (analogy)
Back in the day they used to give antibiotics when they thought a kid had strep throat. Now they have those rapid strip tests so they don’t prescribe as often for kids. I don’t know that they are over prescribing as much for kids anymore.
They are still over prescribing, and it is partly cya medicine (like someone with a sprained ankle getting an MRI when it is pretty obvious it is a sprain) and partly the doctor wanting to make the patient feel like they can do something for them. With viral infections, the reason given is often that the antibiotic is to prevent bacteriological infections from happening because the body is fighting off the viral one, and I kind of find that dubious. Among other things, antibiotics can wipe out the bodies own immune responses if I remember correctly, and because they tend to wipe out the ‘good’ bacteria we rely on in our gut, it further weakens us since we rely on that gut bacteria in digesting food. When I talk to people I know who get some sort of viral respiratory infection going around, it is very common for them to get a prescription for antibiotics. And yes, sometimes if they don’t know what the person really has, they will give a broad spectrum antibiotic. I remember the days @michigangeorgia is talking about, when I was growing up strep throats tended to run in my family, and when it looked like I might have it (back then the culture took like 48 hours) they immediately started me on it, I ended up allergic to penicillin because of that (in that case, I obviously don’t blame the doctor, strep throat is nasty and 48 hours could allow it to become much worse).
The results are clear, there are whole classes of microrganisms that are resistant to almost all the antibiotics out there, and that happened because of over use. And yes, the wholesale use of antibiotics in meat production, in things like fish farming in some cases, have also led to problems, in the past couple of decades to increase the growth rate of cattle ranchers started giving animals antibiotics routinely because it allows them to grow much more rapidly (and also helps ameliorate the often crappy conditions on family farms, where due to tight quarters and less than stellar cleanliness diseases spread like wildfire). I have heard the arguments from proponents, that the antibiotics by the time it is cooked are no longer present (or never were), but what that leaves out is that bacteria in the environment where this cattle are raised don’t just hang out at that ranch, they spread via the animals being transported, get into the groundwater and so forth, and those resistant bacteria breed. The last I checked (and someone on here may know more about that) the FDA has refused to ban the broad based use of antibiotics like this, but rather has left it up to a voluntary basis.
update- I checked, and apparently while the FDA has not banned the use of antibiotics like this, they (to me) did an end run, and now the use of antibioticis in animal feed requires a prescription from a veterinarian who will be responsible for its proper use (this is as of December, 2016). Doesn’t mean a friendly vet won’t gladly write the prescription, or ranchers won’t turn to black market supplies, since from what I can tell there is no one going to be checking to see if the cattle are still being fed antibiotics, that there will be no one upstream running blood screens on the cattle, and without that ranchers may be tempted knowing it is unlikely they would be caught to continue the practice…but at least the FDA finally acted, before this the last rule was a call for volunary restraint
Ugh, I have to take an antibiotic every day, or I get another urinary tract infection. I’ve already had two kidney infections resulting from a UTI, so I never want to go through that pain again (worse than childbirth). My doctor is one of the best urologists in the area, and he said he’s never had a patient become resistant to this particular drug. I hope he’s right. 
And yes, I’ve tried all of the “tricks” to avoid getting UTIs and they haven’t worked. The doctor said they think that a very small percentage of women have a condition where bacteria sticks to the urinary tract like velcro, so the bacteria doesn’t wash out as it does with most women.
“and when it looked like I might have it (back then the culture took like 48 hours) they immediately started me on it, I ended up allergic to penicillin”
you are not allergic to penicillin because of that. that is not why you have an allergy to penicillin.
" With viral infections, the reason given is often that the antibiotic is to prevent bacteriological infections from happening because the body is fighting off the viral one, and I kind of find that dubious. "
you want bronchitis followed by or at the same time as a bout with pneumonia follow your belief system.
" Among other things, antibiotics can wipe out the bodies own immune responses if I remember correctly" I am not sure where that came from. I googled it just now and the only sources to say that are “alternative” organic type websites.
p.s.
I am anti-pesticides , fertilizer (non organic) household chemicals etc…but when it comes to medicine I fall out of line with those beliefs. so take that for what it is worth. (and my opinion is not worth much)
@zobroward:
I am not anti antibiotics, I am just against the way they have been used for things where a)they definitely don’t help and b) they cause both people to become less sensitive to the antibiotic in question and cause bacteria to develop immunity. I do know antibiotics wipe out gut bacteria and there is more and more evidence out there just how important they are to our overall health, and it wouldn’t surprise me if they have a factor with the immune system.
As far as developing an allergy to penicilin, I developed that allergy as a young adult, I took penicilin as a kid between ear infections and strep, a lot, and I was told, including by a friend’s wife who is an MD (infectious disease specialist working in pharm research for about 20 years now), that you can develop not just immunity to an antibiotic, but also an allergic reaction, from having used it a lot.
No one is saying don’t use antibiotics, if they are called for they should be used, but I still see people getting them for something the doctor admits is a virus and every article I read citing medical journals talks about how overused antibiotics are. If someone has something like a respiratory virus and they have a high likelyhood of developing pneumonia (an older person, a young kid) or someone with a compromised immune system, it may make sense to give an antibiotic as a precaution, but those would be relatively rare, and just from talking to people i know who get sick, they get viral infections and they routinely are given prescriptions…and the proof is in the pudding, if antibiotics were not being abused, we would not be in the position we are today, where there are whole classes of bacteria that can be defeated with maybe one drug, and there are some where there is no effective treatment, and there are quite a few antibiotics out there because of people’s own resistance and bacteria mutating, work on almost nothing any more, and it isn’t getting any better. They should never have been a general purpose placebo to make patients happy, kind of like the old “take two aspirins and call me in the morning” kind of thing.
There is definitely a pendulum swing in the underprescription direction - at least in some places like in my neck of the woods. Here is a personal anecdote. I literally had to beg my doc to get me on something when I knew I had something going on with my kidney - pain accompanied by fever. The doc decided to send me to the CT facility that told me to come back in a week. I staged another protest there… After the $800 imaging, I got my $20 antibiotic because the imaging revealed… wait… a kidney abscess. The infection got that bad. Had I waited a week for that image, I could have been permanently injured. All in the name of not “overprescribing” that antibiotic.
I read something recently that said that antibiotics ought not be prescribed automatically for confirmed strep throat. IIRC, the antibiotics primarily serve to reduce the risk of rheumatic fever, but that risk is so low currently that the antibiotics pose more danger than rheumatic fever does.
I tend to pick up a lot of respiratory “stuff,” and my personal rule of thumb is “miserably sick for at least 9 days with no improvement, or miserably sick for at least 7 days with improvement followed by worsening.” At that point, I figure it’s not getting better on its own and antibiotics would do more good than harm. But I’ve been berated by doctors both for waiting too long and for not waiting long enough.
Well if an adult doesn’t want antibiotics for strep throat that’s fine but for kids, I think its different. Especially if they have other health issues.
Not news at all inside the medical profession. And yet…
This isn’t anything new, but I think some posters are oversimplifying. A lot of the time when I go to the doctor, they tell me they can’t determine with any degree of confidence whether the infection is bacterial or viral.
For folks with chronic lung conditions, we are often given antibiotics when we have viruses because we often get a secondary bacterial infection. Additionally, when we get infections we can permanently lose lung function and many of us have already lost too much.
Similarly, I get antibiotics whenever I show signs of infections. Since I’m immune suppressed, by the time they figure out whether my infection is viral or bacterial, it can spread quite a bit. They just don’t risk it.
Yes, if we wait, we end up VERY ill and may need to spend time in the hospital and take IV antibiotics and more stringent measures. If we start antibiotics at first sign of ANY infection (viral or bacterial), we can generally head off the infection and only take the medication for a week or so instead of a month or longer. Of course, we always try to avoid infections in the first place but so many people go all over the place with their infections that they’re unconsciously spreading everywhere they roam.