The issue boils down to this: we use too many antibiotics. According to the CDC, up to half of all antibiotics are prescribed unnecessarily or are not “optimally effective” as prescribed.*
Our bodies are full of bacteria, most of them beneficial. They live in our gut, our throat and on our skin. Some of the bacteria inside us are naturally resistant to antibiotics. When we ingest an antibiotic, it can kill some of the “good” bacteria, allowing the resistant bacteria strains to grow and spread without competition. These bacteria can give their resistance genes to other dangerous bacteria, the ones that can make use sick.
But there’s a surprisingly simple fix. Doctors (and patients) need to be a little more patient.
Many common infections resolve within a few days without any antibiotic treatment. Rather than prescribe a drug regime right away, doctors should monitor symptoms and adopt a practice of watchful waiting, otherwise known as the wait-and-see approach to prescribing. If your symptoms get better in a day or two, you don’t need antibiotics, and you shouldn’t take them. If you’re still sick, or your symptoms get worse, then your doctor can call in an antibiotic prescription for you.
This could dramatically reduce the amount of antibiotics consumed. That, in turn, would prevent the selection of antibiotic-resistant bacteria in your body and prevent you from spreading antibiotic-resistant strains to others.
Take otitis media, or ear infections. It’s the No. 1 reason that antibiotics are prescribed to children in the United States. Doctors write more than 10 million prescriptions for ear infections each year.
However, studies show that ear infections resolve on their own, without antibiotic treatment, about 80 percent of the time. And an experiment published in the New England Journal of Medicine in 2011 showed that when doctors use strict diagnostic criteria, antibiotics are only slightly better then a placebo in reducing the duration of symptoms.
In this case, the wait-and-see approach makes sense. Rather than immediately giving children medicine they might not need, parents are given a prescription for antibiotics. But instead of filling the prescription right away, parents are asked to closely watch their children and to fill the prescription only if they don’t improve within two days.
A randomized controlled trial here in New Haven showed that the wait-and-see prescription approach reduced the use antibiotics by 56 percent. (It’s even endorsed by the American Academy of Pediatrics.)
This has an added benefit, too — antibiotics are not without their side effects. Antibiotics can cause gastrointestinal problems, allergic reactions, dizziness, headaches and accidental overdoses. More than 20 percent of children will get diarrhea after taking antibiotics for ear infections, and antibiotic prescriptions are responsible for more than 142,000 emergency department visits per year in the United States. Half of the events were due to β-lactams such as amoxicillin, drugs that are often used to treat ear infections. The risk of adverse events should be weighed against the benefits of treatment.
Now, clinicians prescribe medication for many reasons, even when it’s not strictly necessary. Doctors want to make sure they don’t miss anything, and they may aim to prevent complications and reduce symptoms. Wary of litigious parents or losing business, doctors may also feel pressured to prescribe antibiotics. Parents don’t want to see their children suffering, or can’t afford to miss work to take care of a sick child.
The wait-and-see approach will also work for other common acute respiratory tract infections such as sinusitis and for mild cases of urinary tract infections. There are guidelines on how to safely use this approach, and it requires communication between parents/patients and their doctors. Doctors will take several considerations into account, including patient age (the wait-and-see approach is not appropriate for young infants or the elderly), immune status and the severity of symptoms.
In April, the World Health Organization released a report stating that antibiotic resistance is “a problem so serious that it threatens the achievements of modern medicine. A post-antibiotic era — in which common infections and minor injuries can kill — far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century.”
Could the wait-and-see approach change that? There are compelling reasons to believe that it will. Clinicians should use stricter diagnostic criteria when diagnosing ear infections; antibiotics should be recommended only for children with signs of acute illness and severe disease. Clinicians also have an obligation to convey the risks and benefits of antibiotics to parents. Parents should ask their clinicians if their child actually needs antibiotics. And parents should know that, in the case of ear infections, antibiotics may help a little, but they may hurt your child, and the public, a lot. So let’s wait and see.
* Editors note: We’ve updated this sentence to include the source of the claim that “up to half of all antibiotics are prescribed unnecessarily.”