Antibiotics for colds still common
Doctors prescribe antibiotics to nearly half of people who visit a health centre with complaints of respiratory infections, although most such infections are caused by viruses and are self-healing. Despite the risk that more and more bacterial strains become resistant the prescription rate has only slightly decreased over the years, according to a thesis at Linköping University.
More than 240,000 patient visits to primary care health centres in the county of Kalmar have been analysed in a study that is the largest ever of its kind in Sweden. The three most common diagnoses were common colds, tonsillitis and ear infections. During the six years covered by the study, patient visits have decreased significantly, especially for ear and throat infections, however the number of prescriptions for antibiotics have remained at almost the same high level.
Antibiotics were prescribed by doctors for 45 percent of all patients with respiratory complaints, usually Kåvepenin ® which is the recommended penicillin in suspected bacterial infections. For ear infections in children, the prescription rate was almost 80 percent, a level that has not been reduced despite the introduction in 2000 of guidelines recommending that treatment is deferred for three days to allow for self-healing.
A clinical study showed that the only effect of antibiotics was to reduce the length of pain with half a day, while healing was equally good in both groups.
Thomas Neumark, district medical officer in Kalmar and PhD student in General Practice Medicine at Linköping University, is concerned about the discoveries in their research and believes that the number of prescriptions for antibiotics should be halved.
“We have a poor common understanding and evaluate the clinical symptoms differently. The guidelines are not sufficiently established and the definitions are vague. The employers - the county councils - but also the individual practitioners should take more responsibility for staying up to date medically and for monitoring activities”, he says.
The study does not go into why so many doctors choose not to follow the guidelines issued. This is something Thomas Neumark would like to investigate further in his continued research. The problem is multifaceted: it could be about working under pressure in primary care, a poor staffing situation with temporary staff who often lack general practitioner skills, and perhaps other prescribing habits.
“Often, it seems that doctors believe that the patient expects to be prescribed antibiotics, while what the patient really wants is more time for consultation and an explanation for the symptoms.”
What we see todayis a global and rapidly growing development of resistance in bacteria. It is their way of protecting themselves against antibiotics in their environment. If the trend is allowed to continue, we risk seeing diseases that in the past have been easily cured suddenly becoming deadly.
“This is why there needs to be a conservative approach and treatment with antibiotics limited to a narrower set of diagnoses where there is no better alternative. It is also important to choose the right type of antibiotics, dose and length of treatment course”, says Thomas Neumark.
The thesis Treatment of Respiratory Tract Infection in Primary Care with Special Emphasis on Acute Otitis Media is presented in Kalmar on Friday, April 23. The opponent is Professor Morten Lindbaek, University of Oslo.
Thomas Neumark +46 70-2346400, thomas.neumark @ ltkalmar.se
Last updated: 2010-04-20