Originally created 03/01/05

Doctors try to curb use of antibiotics



LaTassha Scott, of Wrens, Ga., knows not to demand antibiotics for a cold or for her 5-year-old daughter Niya's sniffles. But she knows some parents insist even when the doctor tells them the drugs won't help with a viral illness.

Patients don't know "what it's curing really," Ms. Scott said.

Not only is it not curing, it might also be creating more resistant bacteria that could one day render those drugs useless, said James Wilde, medical director of the pediatric emergency department at Medical College of Georgia Children's Medical Center.

"There are some experts that believe we may be headed for the post-antibiotic era," when those drugs are no longer effective, he said.

The drug-resistant bugs are also part of a larger infection problem for health care institutions. The Centers for Disease Control and Prevention released voluntary guidelines Monday for Georgia and other states that are considering mandatory public reporting on health care-acquired infections. Some of those guidelines focus on the proper use of preventive antibiotics before and after surgery to curb surgical site infections, which occur only about half the time, according to a recent study. Another guideline looked at monitoring flu vaccination rates among health care workers, which Dr. Wilde said range from 40 percent to 60 percent.

"It's long been my opinion that it should be mandatory," he said.

The new standards were suggested because the emphasis should be on prevention, said Dr. Patrick J. Brennan, the chairman of the CDC's Health Care Infection Control Practices Advisory Committee. Hospitals already track these things to monitor quality improvement, said Vivian Ashline, infection control coordinator for University Hospital. Any mandatory standards should take into account hospitals' size, patient population and complexity of procedures, she said.

With antibiotic resistance, the focus has been on education, and Dr. Wilde and MCG are part of a nationwide project that seeks to improve that with innovative patient-education tools, such as an interactive kiosk in the waiting room that can advise patients whether their symptoms will likely warrant antibiotics. For instance, the vast majority of bronchitis cases, particularly in children, are viral, and prescribing antibiotics would do no good, Dr. Wilde said.

The antibiotics actually kill off the natural bacteria, leaving less competition for those resistant to the drug, he said.

"You're killing off the sensitive bacteria," he said.

Yet patients are often insistent, particularly those who were used to getting them, said Dr. Karen Foushee of Pediatric Partners of Augusta.

"While antibiotics are very good and they have their place, there are times when they actually are harmful," she said. "It's good to be aware of the fact that antibiotics are not for everything."

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.

ANTIBIOTIC STUDY

The Medical College of Georgia and the Augusta Department of Veterans Affairs Medical Centers are taking part in a nationwide 16-hospital study that seeks to educate physicians and patients on the proper use of antibiotics. Patients often request the drugs for things such as colds, which are more often caused by viruses and unlikely to be affected by the drugs.