Healthcare and Treating the Common Cold with Antibiotics

I guess we all have to be hopeful that the government can do something productive now that the government has passed the healthcare bill. I came across an article that reviews the prescribing practices of 13 European countries that all have socialized medicine/universal coverage. One of the arguments is that reform will reduce cost and improve care. Unfortunately this is NOT true in many ways. This article points out that large % of doctors in these universal coverage countries continue to prescribe antibiotics to people with colds/virus, and their choice of antibiotic likely driven by reducing cost is amoxicillin which, if you were actually going to treat a bacteria infection, would probably not be the right choice–but it is cheap.

VARIATION IN ANTIBIOTIC PRESCRIBING AND ITS IMPACT ON RECOVERY IN PATIENTS WITH ACUTE COUGH IN PRIMARY CARE: PROSPECTIVE STUDY IN 13 COUNTRIES

Butler, C.C., et al, Br Med J 338(7710):b2242, June 27, 2009

METHODS: The multinational “Genomics to Combat Resistance Against Antibiotics in Community-Acquired Lower Respiratory Tract Infections in Europe” (GRACE) study, coordinated in Great Britain, examined the relationship between prescription of antibiotics and outcomes in 3,402 adults presenting to one of 387 general practitioners in 14 European primary care research networks with acute or worsened cough and a presentation consistent with a lower respiratory infection.

RESULTS: Complete case report forms were available for 3,296 patients (97%), and symptom diary information was available for 2,560 patients (75%). Antibiotics were prescribed for about half of the patients overall (53%), but there was marked variability between the participating networks in rates of antibiotic prescribing (21%-88%). After controlling for baseline symptom scores and clinical presentation, odds ratios for being prescribed an antibiotic ranged between 0.18 and 11.2. There was, similarly, substantial variation in the classes of antibiotic prescribed. Median intervals to a patient’s report of feeling well and to resolution of all symptoms were 11 days and 15 days, respectively. Although there was a statistical relationship between initial antibiotic treatment and the speed of symptom resolution, symptom trajectories in the various networks converged after about one week, and the use of antibiotics accounted for only one-tenth of a percentage point difference in symptom severity scores.

CONCLUSIONS: These results demonstrate tremendous variability in the use of antibiotics for adults presenting to primary care with cough and an apparent lower respiratory infection, as well as a clinically insignificant effect of antibiotic treatment on resolution of symptoms. 22 references (ButlerCC@cardiff.ac.uk – no reprints)

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Category: medicine
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