Tuesday, March 20, 2007
To prescribe or not to prescribe?
To prescribe antibiotics, or not to prescribe antibiotics? That is a question thousands of doctors ask themselves every day. It's a common scenario: A patient comes into the office complaining of what is almost certainly a viral infection. The doctor knows the infection will probably clear up on its own in a few days, but the patient asks, "What about a Z-Pak or another antibiotic?" The patient tells the doctor it always works and a previous doctor prescribed it all the time. Many doctors cave. I have sometimes caved.
The truth is the infection probably would have improved without antibiotics. Usually by the time, someone sees his or her doctor, the viral infection is already starting to go away. Right around the time the antibiotics dose of five to seven days is complete, presto: The patients feel better. Of course, they attribute that to a $70 antibiotic, instead of plain old natural history.
There are many things one can do to deal with viral sinusitis, besides antibiotics. A good decongestant, such as Sudafed, will be very helpful, as would a saline flush through the nose. It's not the most pleasant, but people who use it swear it works well. Still, researchers at the University of Nebraska Medical Center in Omaha found that antibiotics are prescribed 82 percent of the time for patients with acute sinus infections. (Full Story)
That is too often. As a result, extremely antibiotic resistant bacteria, such as the flesh-eating bacteria, are developing. So, why are doctors so willing to dole out a prescription?
I have found that patients like to walk out of the office with something in hand, so they feel like they accomplished something on their visit. If you don't give them an antibiotic, they feel like you have not treated them.
How should doctors deal with patients who demand antibiotics? What are your suggestions on how to handle this?
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