Make sure your doctor prescribes the appropriate antibiotic

There are safer and better options than fluoroquinolones and other frequently prescribed broad spectrum drugs

Amoxil from $0.39

One in three people with ear pain, sinusitis or sore throat gets a wrong antibiotic, according to a study published in late October 2016 in JAMA Internal Medicine.

The findings reveal that US health care providers often ignore the well-established antibiotic prescribing guidelines of the American Society of Infectious Diseases, the American Academy of Pediatrics, and other major medical organizations.

That means millions of Americans are not getting the safest and most effective treatment for their illness. And the abuse of antibiotics poses other risks, too, including the spread of superbugs, which are bacteria resistant to medication.

“We’re talking about inadequate treatment for some of the most common reasons people go to the doctor,” says lead author of the study, Adam Hersh, Ph.D., associate professor in the Division of Pediatric Infectious Diseases at the University Of Utah in Salt Lake City.

Collectively, ear infections, sinus infections and sore throats represent more than 40 million antibiotic prescriptions annually.

Hersh and colleagues examined two years of information from the National Ambulatory Medical Care Survey, an annual government survey of patients treated at doctors’ offices, outpatient clinics and emergency rooms.

They found that instead of prescribing targeted antibiotics to the type of bacteria most likely causing infection, many doctors were too quick to achieve “broad spectrum” drugs that kill a wider range of insects.

That’s a problem for several reasons, says Hersh. The wrong antibiotic “may not work as well as the recommended treatment, or in some cases carries a much greater risk of serious side effects,” he says.

For example, fluoroquinolone antibiotics such as ciprofloxacin (Cipro and generic) and levofloxacin (Levaquin and generic) – often inappropriately prescribed for sinus infections in adults – can cause permanent and debilitating damage to muscles, tendons and nerves.

He also points out that broad-spectrum antibiotics kill more than the protective bacteria in the body, leaving people vulnerable to opportunistic infections of insects such as Clostridium difficile or C. diff, which causes a potentially lethal form of diarrhea.

And they are more likely than drugs closely targeted to lead to antibiotic resistance.

Why do doctors prescribe the wrong antibiotic?

In some cases, health care providers have a good reason to choose a different drug. A patient may be allergic to penicillin, for example, or the first drug he tried may not be helping.

But often, the main reason seems to be simply convenience, says Hersh.

For example, the new JAMA study showed that patients are frequently prescribed azithromycin (Z-Pak and generic) or other macrolide antibiotics instead of the recommended first line treatments, amoxicillin or penicillin.

“Patients tend to favor azithromycin because it is typically taken once a day for three to five days,” says Hersh. “Amoxicillin has to be taken two or three times a day for a week.”

But the popularity of azithromycin has also been its undoing. “In some areas, up to 25 percent of the bacteria that cause ear infections, sinus infections and strep throat are now drug resistant,” Hersh says.

Get the right treatment

If you or a family member has ear pain, sore throat or a prolonged cold, the first question you should ask is not “is this the wrong antibiotic?” But “do I need an antibiotic at all?” Medical Director, Orly Avitzur, MD

“Most of the time, these infections are caused by a virus, not by bacteria,” says Avitzur. “And antibiotics do not work against viruses”.

An antibiotic may be appropriate in the following situations:

Earache
Severe pain or symptoms lasting more than two or three days may be caused by a bacterial infection. Consider antibiotics right away in infants six months and younger or children from six months to two years of age who have moderate to severe pain.

Pain and congestion of the breasts
Consider antibiotics if you do not get better in 10 days, get better and worse again, or have a high fever and thick, colored mucus for more than three days in a row.

Sore throat
Treat with antibiotics only if a throat swab confirms that the symptoms are caused by streptococcal bacteria.

For ear and sinus infections that are probably caused by bacteria, the recommended antibiotic in most cases is Amoxicillin (Amoxil and Generic) or Amoxicillin with Clavulanate (Augmentin and Generic). For streptococcal pharyngitis, the recommended treatment is amoxicillin or penicillin.