Treating Viral Infections Doesn't Just Lead to Antibiotic Resistance, It Harms Your Patients

A recent, must-read article for anyone concerned about the problem of misuse of antibiotics to treat viral bronchitis, not to mention anyone who prescribes antibiotics, was recently published in Clinical Infectious Diseases. The short version: giving patients antibiotics to treat viral pneumonia is dangerous for the patients themselves (never mind the evolutionary consequences of increasing resistance).

Since antibiotics are almost never effective against bronchitis, the prescribing rate should be nearly zero, but in the U.S., 67% of adults with acute bronchitis received antibiotic therapy, even though, according to analysis of the U.K. General Practice Research Database, one would have to treat 4,000 patients with antibiotics to prevent one complication. Keep in mind that mistreatment of acute bronchitis may account for up to 50% of all antibiotic prescriptions.

The effects of misuse on patients are not good:

1. Five to 25% of patients will develop antibiotic-associated diarrhea.
2. Increased susceptibility to Clostridium difficile infections.
3. Two percent will develop a skin reaction.
4. One out of 5,000 patients will experience anaphylactic shock--and, yes, this is comparable to the percentage of patients who will be helped by therapy.
5. Antibiotics are responsible for nearly twenty percent of ER visits for drug-related adverse reactions.
6. The risks associated with antibiotics, especially sulfonamides and clindamycin, are similar to insulin, warfarin, and digoxin. Would any medical professional administer insulin just to be safe or to keep a patient happy? (Intelligent Designer, I hope not).

There is a long, sorry history of trying various interventions to prevent misuse of antibiotics that have had little success. Traditionally, these programs have relied on altruism--not a particularly good strategy since most people suck. Instead, the author advises the following response to a request for antibiotics:

For your infection, there is an 1 in 4000 chance that an antibiotic will prevent a serious complication, a 5%-25% chance that it will cause diarrhea, and an 1 in 1000 chance that you will require a visit to the emergency department because of a bad reaction to the antibiotic.

As the author notes, "For most acute respiratory tract infections, antimicrobial resistance is irrelevant. For an individual patient, the risks are greater than the benefits, and the discussion should stop there."

Cited article: Linder, J.A. 2008. Antibiotics for Treatment of Acute Respiratory Tract Infections: Decreasing Benefit, Increasing Risk, and the Irrelevance of Antimicrobial Resistance. Clinical Infectious Diseases 47:744-746. DOI: 10.1086/591149