Reprinted with permission,
Courtesy, Asbury Park Press, a Gannett Co. newspaper.
ASBURY PARK PRESS STAFF WRITER
little girl has a sore throat. You take her to your pediatrician.
He has a look, tells you it's nothing major and should pass
in a few days. He prescribes nothing beyond water and some
over-the-counter lozenges. You go home, but, in a day or two,
you're back because your child still has the sore throat and
now a slight fever, too.
The doctor has another look, then tells you the same thing he
said the last time. But your child's in distress, and you're
worried. You say, "But Doctor, isn't there an antibiotic you
Your pediatrician, his office filled with cranky patients and
crankier parents, sighs, writes the order and goes on to the
next patient. Relieved, you and your child hurry off to the pharmacy.
The little girl takes the medicine. It has no effect. In a few
days, as predicted, the sore throat passes.
Scenarios like this — in which antibiotics are taken when
not needed — are happening on a frequent basis, and with
increased risks to children's health, according to medical professionals.
"It is easy to write a prescription," said Dr. Rajendra Kapila,
an infectious disease specialist at the University of Medicine
and Dentistry of New Jersey in Newark. "It is more difficult
and time-consuming to sit down with a patient or a parent and
explain why the child does not need an antibiotic, and how giving
him a medicine he doesn't need could harm him."
In an article in this month's issue of the Journal of the American
Medical Association, Dr. Jeffrey Linder of Harvard Medical School,
using data from national medical surveys from 1995 to 2003, reported
that more than 50 percent of children brought to pediatricians
and family doctors for sore throat were prescribed antibiotics.
But strep infection, the only type of sore throat treatable
with antibiotics, occurs in only 15 percent to 36 percent of
sore throat cases in children.
"It's undeniable that doctors — pediatricians, family
physicians, general practitioners — are overprescribing
antibiotics, and not only for sore throat, but also bronchitis
and sinusitis," said Dr. Steven W. Kairys, chairman of Jersey
Shore Children's Hospital at Jersey Shore University Medical
Center in Neptune.
"Antibiotics only work on bacterial infections," Kairys said. "Most
of these infections are not bacterial, but viral."
As the AMA journal article points out, there are tests to determine
if the sore throat is strep — but some physicians make
judgments without the test, or prescribe antibiotics despite
the test results.
"There is no easy answer to why physicians, who are trained
regarding strep and strep tests and ought to know better, still
prescribe unnecessary antibiotics," said Dr. Robert Spierer,
a family doctor and pediatrician who practices in Monroe Township
and is president of the New Jersey Association of Family Physicians.
"There is parental pressure to do something, and the pressure
of a busy schedule," Spierer said. "But there is also a natural
inclination in physicians, as in parents, when confronted by
a sick child, to try to do something to help."
As Spierer and other doctors pointed out, prescribing antibiotics
when they are not needed not only will not help, but may actually
harm the patient.
"All drugs have side effects," said Dr. Meg Fisher, chairwoman
of the Department of Pediatrics at Monmouth Medical Center in
Long Branch, as well as a professor of pediatrics at Drexel University
and a fellow with the New Jersey chapter of the American Association
"A patient could have allergic reactions to penicillin," Fisher
said. "A side effect of erythromycin is gastrointestinal distress.
Furthermore, antibiotics do not just attack the pathogenic bacteria.
They also attack the protective bacteria natural to the system.
That's not a good thing."
Fisher explained that when bacteria natural to the body's system
are destroyed, the system is susceptible to the substances that
normal bacteria had been warding off, like yeast.
"Women who take unnecessary antibiotics are exposing themselves
for no reason to contracting a vaginal yeast infection," Fisher
said. "Children can develop thrush when their normal bacteria
has been destroyed."
The broader health risk from the unnecessary use of antibiotics — according
to physicians, researchers and the national Centers for Disease
Control and Prevention — is the increased resistance bacteria
build through exposure to the drugs.
"There has been a dramatic increase in resistance in the last
several years in all strains of bacteria," Kapila said. "The
new strains are not only more resistant, but also more toxic.
This means increased risks of infections, now and for the coming
Fisher said that when the current classes of antibiotics began
hitting the markets in the 1980s, they were considered wonder
drugs, and some people were predicting the imminent eradication
of infectious diseases. That is why, she said, some people still
look on the drugs as panaceas.
"But we've learned antibiotics are a two-edged sword," she said.
Michelle Kelly, 47, of Carlton Avenue in Lakewood, is the mother
of three children, two of whom are asthmatic. Two are now grown
and one a teen, but Kelly took all three to the same pediatrician,
Dr. Raga F. Michael of Howell.
"He was the best doctor imaginable," Kelly said. "My children
had every sort of nose and throat infection. Dr. Michael never
overprescribed antibiotics. He often said that antibiotics would
not help and that the infection would run its course. And he
was right, time and again. Both my asthmatic children played
sports. I attribute that to how well Dr. Michael cared for their
Michael died on Oct. 31 from injuries sustained when an SUV
smashed through the window of his Howell office.
"He was an excellent, old-fashioned type doctor. He knew what
he was doing, and he explained things," Kelly said.
The communication between doctor and patient that existed between
Michael and the Kellys is just what is needed, say physicians
and the CDC, to stop the abuse of antibiotics.
"Communication is everything," Kapila said. "If the patient
or the parent understands that the antibiotic will not help and
may cause harm, it's likely they will stop pressing for it.
"And the word must be gotten out to the public and the medical
community. This is a serious matter," Kapila said.
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