Antibiotic Resistance

Soon after penicillin became commercially available (1940s), "bugs" became resistant. It was war: Researchers kept developing new antibiotics. "Bugs" kept developing adaptations to resist the antibiotics and flourish. Today's microbes are gaining the upper hand from one of the hallmarks of our modern age:

the Internet.

For decades, the key to slowing the development of drug-resistent infectious agents has been to reduce inappropriate prescribing by physicians.

When I was in practice, patients would occasionally come in with symptoms that were clearly viral. Yet they'd want antibiotics. It took me more time to explain to them the reasons why antibiotics were not indicated and could cause harm than it would have taken to pull out my script pad. 

My insistent patients then would seek out other physicians who might prescribe (inappropriate) antibiotics. Now patients have an easier resource: the Internet.

As explained in an article, "Availability of Antibiotics for Purchase Without a Prescription on the Internet" by Arch G. Mainous, III, PhD, et al, patients can obtain antibiotics without a prescription by ordering online.

But not only did many Internet vendors not require a medical interview or a physician's prescription, they also sold more doses than usually required in a course of treatment. Even ignoring the usual shipping delay, you have inferior care. 

As a Healthy Survivor, remember to discuss ALL self-prescribed treatments with your physicians before proceeding. Sir William Osler's warning to fellow physicians now applies to you: "A physician who treats himself has a fool for a patient."  

Comments

[Kairol Rosenthal]

I agree that this is troubling.

I found the journal article to lack information about these parts of the equation: How many people in the U.S. are actually using this service, how many of them are using it because they have no prescription drug coverage and/or this service is cheaper, how many people have persistent infections treated with antibiotics and can't pay for an office visit so get these drugs as a sort of un-prescribed refill, and what barriers could be put in place to prevent this activity?

While from a scientific perspective I see the dangers here. I also see from a political perspective, if we are going to allow the free market system to corrode our access to care and drugs, maybe we can't be so critical of people who gotta get their drugs from somewhere when they don't have a doc to Rx. Seems like the free market is both creating a problem and making a buck off the solution too.

Kairol

[Wendy S. Harpham, M.D.]

Dear Kairol,

I appreciate your concerns. But keep in mind that studies are only useful if they are well-designed to answer one clear question. This study successfully looked at the opportunity for patients to bypass physician involvement in obtaining antibiotics.

I'll address your concerns in future posts.
With hope, Wendy