"It's a lack of knowledge and communication. Most of these illnesses are caused by viruses," which don't respond to antibiotics, says lead study author Dr. Katherine Haltiwanger, pediatric resident at the University of Virginia Health Sciences Center.
The study was prompted by frustrated student health center clinicians who were concerned about patient satisfaction and possible complaints from parents, Haltiwanger says. The clinicians report that "many students expect to get antibiotics for every annoying cold or respiratory complaint. ...: I wanted to know what was really at the root of it, and how we could improve things," she says.
"I expected that most college students would know that antibiotics don't cure viral infections," Haltiwanger says. And the study showed they did. "More than half of them walked in with respiratory illnesses expecting to get an antibiotic, even if they knew it wouldn't help," she says.
The study found that while 70 percent of 129 students with upper respiratory infections said they knew the medication wouldn't help their viral infections, 13 percent sought antibiotics anyway.
And the doctors and nurse practitioners prescribed an antibiotic for more than one-third of the students in the sample, even though only a little more than 10 percent had asked for one, Haltiwanger says.
The health-care workers "feared that if they said no, the students would be dissatisfied and seek care elsewhere. It's a Catch-22. Clinicians are expected to see more and more patients per day, leaving less time to spend educating them, so writing a prescription and sending them on their way can be tempting," Haltiwanger says.
Students most satisfied with their care reported they'd been given a clear diagnosis, a prescription for antibiotics and a rationale for the treatment, Haltiwanger says.
"What this targets, more than anything else, is the degree of misunderstanding among college students about the appropriate use of antibiotics," Haltiwanger says. "It's important to target this group for education, so when they go out and have kids they're more cognizant of the issues. We need to begin to eliminate theses misconceptions they grew up with."
Haltiwanger, citing the growing resistance to antibiotics, says, "We don't have a lot [of antibiotics] left in the arsenal, and we can't be squandering them like this."
"This study alerts us to yet another place where this is going on," says Dr. Tamar Barlam, director of the Antibiotic-Resistance Project at the Center for Science in the Public Interest.
"Many have identified upper respiratory tract infections as a major source of the inappropriate prescription of antibiotics in an outpatient setting," he says.
Barlam says steps are under way to provide more education. "Medical insurers recently joined the CDC (the U.S. Centers for Disease Control and Prevention) to address this problem with physicians in office practices. They're developing fact sheets and even have prescription pads that say you have a viral infection, and antibiotics will not help."
Barlam says doctors need to spend more time communicating with their patients. "To actually do that only adds about 30 seconds to each visit. Granted, over the course of the day, that's 10 to 15 minutes," but it will be time well spent.
Haltiwanger's study was presented this week at the Pediatrics Academic Societies' annual meeting in Baltimore.
What To Do
Take your medication correctly, Barlam says. If you are given antibiotics, finish the course of treatment and never take pills left over from an old prescription or from someone else's medication.(c) 2001 HealthScout.com
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