Study Says Meds Over-Prescribed

Although members of the medical community have struggled in recent years to reduce unnecessary antibiotic prescription, a study released yesterday by members of the Harvard Medical School (HMS) and Boston’s Brigham and Women’s Hospital concluded that physicians are still prescribing antibiotics unnecessarily to patients with sore throats.

The study centered on the frequency of administering strep throat antibiotic to children and the frequency of testing for strep.

According to one of the authors, Grace M. Lee ’93, an instructor of ambulatory care and prevention at HMS, the study is responding to the “notion that as a general community, we are hoping to reduce unnecessary antibiotic prescribing, especially for respiratory infections.”

However, the study, which was published in the Journal of the American Medical Association yesterday, shows that pediatricians are still prescribing antibiotics to patients who do not need them.

“Approximately half of children who come to the doctor for sore throat get an antibiotic, and that is higher than we would expect need an antibiotic,” said Jonathan A. Finkelstein, associate professor of ambulatory care and prevention at HMS, who is the study’s senior author. He collaborated on the project with Jeffrey A. Linder, instructor in medicine, and David W. Bates, professor of medicine, both at Brigham and Women’s Hospital.

According to Soheyla D. Gharib, chief of medicine at University Health Services (UHS), UHS has been trying to mitigate the drug-resistant bacteria that can develop from over-prescription of antibiotics. This year, she said, UHS will begin measuring the rate at which it prescribes antibiotics.

The study published yesterday states that physicians prescribed antibiotics in 53 percent of annual visits for sore throat. This exceeds the expected 15 to 36 percent prevalence of the only common strand of strep throat treatable with antibiotics.

The study’s other major conclusion concerns the frequency in which strep throat tests are administered.

“Only about half of those who get treated with antibiotics get tested...to confirm the diagnosis,” said Finkelstein.

Lee said there is little excuse for neglecting to test for bacterial strep throat. Rapid diagnostic tests, although not perfect, can be done in the physician’s office and provide immediate results about the type of infection, Finkelstein said.

He said that the increased availability of the rapid diagnostic test, in combination with a general awareness of antibiotic use, can account for a decrease in antibiotic prescription over the past 10 years.

Finkelstein attributes public awareness of antibiotic overuse to national programs, like one offered by the Centers for Disease Control and Prevention, aimed toward educating physicians and their patients.

According to the study, the rate of antibiotic treatment for sore throat dropped from 66 percent of visits in 1995 to 54 percent in 2003.