A CDC report finds some hospitals over-prescribe the drugs

Doctor with stethoscope and handcuffs

Some hospitals and doctors overprescribe antibiotics and put patients at risk of deadly superbugs and drug-resistant bacterial infections, according to a report from the Centers for Disease Control and Prevention released this week. The CDC studied prescribing practices at 323 hospitals in 2010 and 183 hospitals in 2011 and found that some hospitals are three times more likely to prescribe antibiotics than others. The study also found that nearly a third of prescriptions for the common antibiotic vancomycin are ordered without proper testing or are given for too long. “Antibiotics are important medications…but they also have side effects,” says Arjun Srinivasan, a medical epidemiologist for the CDC. “It’s bad for patients to be on drugs they don’t need.”

Patients who continue to take antibiotics when they aren’t needed expose themselves to uncomfortable side effects and can develop infections that are resistant to common antibiotics, doctors say. Indeed, the CDC study found that reducing the use of antibiotics in hospitals can lessen the risk of catching a severe, and potentially fatal, diarrheal infection known as Clostridium difficile. And the overuse isn’t just due to patients requesting the prescriptions when they aren’t necessary. A separate article published Tuesday in the Journal of the American Medical Association Internal Medicine points out that often doctors prescribe antibiotics even before a bacterial infection is confirmed.

While it may not be smart medical advice to outright reject a prescription, doctors say patients who are concerned about overusing antibiotics can protect themselves by pushing back and asking questions. “Patients are becoming more aware to question their physicians in the outpatient setting,” says Pranita Tamma, director of the Pediatric Antimicrobial Stewardship Program at Johns Hopkins Medical Institutions. “But until now we’ve not promoted the idea that patients should also be questioning physicians in a hospital setting.”

Here are some key questions to ask before taking antibiotics.

How do you know I need them?
When a patient comes into a hospital with an apparent bacterial infection, “most doctors will err on the side of giving antibiotics,” says Scott Flanders, professor of internal medicine at the University of Michigan Medical School and the lead author of the Journal of the American Medical Association article. “No doctor wants to consider a bacterial infection as a possibility, not give antibiotics and find out it was bacterial, says Flanders. Patients worried they may not need the drugs should ask doctors for clear explanations on why they are prescribing antibiotics, says Tamma. For instance, patients can ask their doctor if something in their X-ray suggested pneumonia or if bacteria was detected in their urine. If a final confirmation is pending on test results that won’t be ready for a few days, patients should ask about when and how they can access those results, says Flanders.

What are the side effects?
Antibiotics often cause uncomfortable side effects such as upset stomach, nausea and diarrhea. Taking the drugs can also cause a severe and sometimes deadly diarrheal infection, since antibiotics can sometimes remove some of the natural bacteria in the stomach that would normally help the body fight against the infection, says Flanders. Patients should ask their doctor if their illness can be treated with a milder medication or with something that can be purchased over the counter, he suggests. However, those options may not make sense in a hospital setting. Doctors can also offer tips for reducing and treating certain side effects.

How long do I need to be on them?
Best practices for taking antibiotics used to require patients to continue their antibiotics treatment even after they started feeling better, but that thinking is changing, says Tamma. Patients who feel better should talk to their doctor about whether it makes sense for them to stop taking the medicine if they are feeling better and if there is a good chance the drugs may have cleared their bodies of the infection, she says. “What we know now is that every extra day you’re taking antibiotics you’re at increased risk of developing resistant bacteria,” says Tamma. Flanders says doctors are being encouraged to check in with patients two or three days after starting the treatment, when they may know more about any tests ordered, to decide if they should stop taking the medicine or if they should move to a lower dose.

Written by Jonnelle Marte for Market Watch, March 6, 2014.

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