Chapter 63 Question 055

Why Do Doctors Tend to Prescribe Overdose of Antibiotics? (Fred Heberer) If a patient complains of an ear or respiratory infection, many doctors will prescribe antibiotics.If the infection is bacterial (rather than viral), antibiotic treatment should speed recovery.But every time a patient swallows an antibiotic, the risk of bacterial resistance increases.As a result, public health officials are asking doctors to prescribe antibiotics only for patients with severe infections.But why do so many doctors continue to prescribe antibiotics for patients with mild infections? Most doctors understand that if antibiotics are overused, bacteria can quickly develop resistance.For example, in 1947, just four years after penicillin was widely used, a variant of staphylococcus (S. aureus) resistant to penicillin was discovered.Most doctors also know that resistant strains of bacteria can lead to more serious problems.When S. aureus emerged, doctors had to treat it with another antibiotic, methicillin.But this is only an emergency measure.In 1961, the methicillin-resistant bacterium MRSA superbug was discovered in Britain, and it can now be found in hospitals around the world.In 1991, 4% of patients who died of sepsis in the UK were caused by MRSA infection; by 1999, this proportion had risen to 37%.

Like overfishing in the ocean, the overuse of antibiotics is a tragedy of public goods.Just as the amount of fish an individual fisherman catches is not enough by itself to have a significant impact on fish populations, nor is the antibiotic prescribed by an individual doctor enough to contribute to the emergence of deadly drug-resistant bacteria.However, whenever doctors prescribe antibiotics, there is a good chance that some of the bacteria that caused the patient's infection will survive.The individual bacteria in this population were completely different from what they had been before, and unfortunately, the ones that had the best chance of surviving antibiotic treatment were not a random sample of the original population.Instead, their genetic makeup is most resistant to drugs.If the dose is increased, this part of the surviving bacteria may still be killed.But over time, mutations accumulated, and eventually, resistance grew among the surviving bacteria.

The dilemma doctors face is that patients believe that taking antibiotics will speed up their recovery.Some doctors refuse to treat less serious infections in this way, but others bow to pressure from patients, knowing that if they can't get the medicine, the patient may find someone else.The U.S. Centers for Disease Control estimates that one out of every year.One-third of the 500 million antibiotic prescriptions are unnecessary. Physicians agree to patients' requests, probably because they know that a single prescription will not lead to the emergence of drug-resistant bacteria.Unfortunately, the cumulative effect of such decisions will eventually lead to more toxic and resistant mutant bacteria.