Global Health Asia-Pacific July 2020 July 2020 | Page 17

Q
: In which cases are antibiotics overprescribed?
A
: Overprescription of antibiotics is common. It
usually occurs when a patient is treated for an
infection from a virus that won’t benefit from antibiotics or
when a patient is treated when there’s really no infection.
For outpatients, the most common unnecessary antibiotics
are for upper respiratory infections, which are almost always
viruses.
For hospital inpatients, treatment of false-positive
urinary tract infection, which is usually caused by
bacteria, is most common.
Q
: Is overprescription related to antibiotic
resistance?
A
: Overprescription is a major cause of antibiotic
resistance. However, appropriate use of antibiotics can
also cause resistance. The major problem is that certain
antibiotics don’t work anymore because the bacteria become
resistant.
Q
: What should be done to tackle antibiotics
overprescription, such as the overuse of antibiotics
for false-positive urinary tract infections and for upper
respiratory infections?
A
: Doctors need to know that there’s harm in using
antibiotics and to avoid them if it’s unlikely there’s
an infection. Patients need to know they’re often better
off without an antibiotic. Antibiotics must always be given
through prescription only and never over the counter.
Overprescription
is a major cause
of antibiotic
resistance
Q
: In which common cases can antibiotics be
effectively replaced by other drugs?
A
: Mostly the issue isn’t around replacement for antibiotics
but just not using them. Patients who have viral
colds often feel better from ibuprofen and antihistamines,
sometimes nasal saline irrigation. Antibiotics just make them
more likely to have diarrhoea.
Q
: If antibiotics are necessary, how should
they be taken?
A
: Antibiotics are amazing, lifesaving
medications if used appropriately. They should
be taken as directed, which varies for each disease.
More and more studies are showing that short
courses of antibiotics are often equivalent or better than long
courses, but this varies by disease.
Also, the guidance to always complete a course is wrong. It’s
the equivalent of a wives tale that’s been passed along. A few
years ago, research published in the British Medical Journal
reviewed the lack of evidence for this. So, it’s always good to
speak with your doctor about antibiotics but not unreasonable
to stop them early if you’re feeling well.
Dr Daniel J Morgan
Dr Daniel J Morgan is Professor of Epidemiology and Public
Health and Medicine at the University of Maryland School of
Medicine.
GlobalHealthAndTravel.com
JULY 2020
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