Why Are Doctors Still Prescribing Antibiotics for Coughs and Colds?

The threat of increasing antibiotic resistance is a situation everyone should be aware of by now, especially those in the medical profession, but that doesn't seem to have stopped a growing trend in prescribing the precious antibiotics we currently have in cases where they're really not needed.

A new study out in the Journal of Antimicrobial Chemotherapyfound that for some conditions rates of prescription are flying in the face of national best practices, with more antibiotics prescribed for coughs and colds now than before there were any recommendations to reduce antibiotic resistance. In the study, researchers led by Jeremy Hawker of Public Health England looked at data from 537 UK general practice surgeries from 1995 to 2011.

They found that in 1995, 47 percent of cough and cold episodes were prescribed antibiotics. This went down to 36 percent by 1999 but then raced up to 51 percent in 2011. That's half of all patients with coughs and colds receiving antibiotics, even though the recommendations tell GPs one of the things they can do is "no prescribing of antibiotics for simple coughs and colds."

Hawker told me the reason for this was due to the interaction between doctors and patients and the pressure that puts on doctors to prescribe. Patients obviously feel ill enough to seek treatment and are likely under their own pressure to get well quick. They often think that antibiotics are the solution, which is probably largely down to a misunderstanding of how they work; most coughs, colds, and sore throats are viral and antibiotics only work on bacteria. You should know this by now.

"Most doctors don't like not giving patients what they want," said Hawker, adding that they may also be wary of missing the ten percent of sore throat cases that actually do benefit from antibiotics. "Also, they're under a lot of pressure; the last thing they need is somebody trying to make a second appointment to come back," he said. "That kind of pressure from both sides I think leads to some GPs giving antibiotics when they shouldn't."

Why does it matter? As superbugs become more common, with bacteria building up resistance to the treatments we currently have, we'll see more and more untreatable cases. That's pretty common knowledge by now, but the UK and US don't seem to be doing all too much about it.

One way to help avert a crisis is to discover new treatments that can come into play when our old ones fail. But not only is that difficult, there's also little incentive at the moment for pharmaceutical companies to invest in the research.

But another way to hold superbugs at bay and stave off antibiotic-resistant doom is to keep our current antibiotics working as much as possible, and that means using them sparingly. If you've got a cough or cold, you might think it can't hurt to just throw antibiotics at it in case they help.

The thing is, bacteria in your body can then get used to that antibiotic and develop resistance. And if those bacteria then cause an infection, it might not respond to antibiotics. Basically, taking antibiotics when you don't need them can make them useless when you do.

The study findings show a somewhat positive trend hidden in the cough and cold statistics, however: there was an unexpectedly marked discrepancy between prescription rates at different practices, with the lowest prescribers giving out antibiotics at half the rate of the highest. This, Hawker said, proved that lowering prescription rates could be done.

"They're showing it can be done; what we need to do is make sure that the strategies being used by those GPs can be adopted by the GPs who are prescribing much more," he said. Giving out recommendations clearly hasn't had much effect, and Hawker said a good strategy would work on making the interaction between doctors and patients smoother.

He said patients responded well to being given something by their doctor, even if it wasn't antibiotics. For example, the Royal College of General Practitioners makes patient information leafletsthat doctors can give to patients to inform them as to why they're not being given antibiotics and what they can do themselves to alleviate symptoms. Hawker said this strategy had had some success.

Another option is delayed prescribing: Patients get a prescription for antibiotics but are only allowed to collect them after a set number of days if their condition hasn't improved. According to Hawker, studies have shown this results in many fewer patients actually using antibiotics, but still meets with a positive response. "They feel they'e got something if they need it and they haven't actually been ignored."

Meanwhile, the government-backed Longitude Prize is trying to find a foolproof way of figuring out if patients actually need antibiotics or not. Antibiotic resistance was voted by the UK public as the most pressing issue to address, and entrants are challenged to "create a cost-effective, accurate, rapid and easy-to-use test for bacterial infections that will allow health professionals worldwide to administer the right antibiotics at the right time."

At least a yes/no device like that might take some of the pressure of doctors trying to please their patients.