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Sniffles don't need drugs, so don't ask

The CDC is teaching parents that antibiotics don't fight viruses, which cause most colds.

By Associated Press
Published September 18, 2003

CHICAGO - The government has a new strategy for reducing the unnecessary use of antibiotics: Persuade parents to stop pestering pediatricians to write prescriptions for runny noses.

Health officials have hammered on doctors to quit dispensing antibiotics in situations where they are practically guaranteed not to work, such as common colds. A straight-to-mom-and-dad campaign is next.

The effort, announced Wednesday, is built around public service ads featuring pictures of cranky-looking kids and the headline: "Snort. Sniffle. Sneeze. No antibiotics please."

"Doctors, like everybody else, like to please their patients," said Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention in Atlanta. "If a patient comes in with strong expectations, it is tempting, and takes less time, to write the prescription for antibiotics."

And that, most everyone agrees, is not a good thing. Overuse of antibiotics has led to the evolution of germs that are resistant to standard medicines, such as penicillin. Anyone who has recently taken antibiotics has an increased risk of coming down with a resistant infection.

Some resistant bugs are particular problems in the Tampa Bay area, said Dr. Juan Dumois, chairman of the infectious disease division at All Children's Hospital in St. Petersburg. The area has long had a problem with strep pneumonia that is resistant to drugs. In the past year, Dumois said, more cases of another bacteria, staphylococcus aureus, are showing up as resistant to a common antibiotic.

Earlier campaigns, aimed at health professionals, seem to have paid off. Various studies suggest that use of antibiotic pills has fallen about 25 percent in the past decade and the decline has been greater in pediatric medicine.

Still, officials say, there is room for improvement. Dr. Richard Besser of the CDC said a study in 1995 found more than 40 percent of outpatient antibiotic prescriptions were for viral infections.

That violates a basic rule of medicine: Antibiotics kill bacteria. They are powerless against viruses, which cause the common cold, among other things. Most of these common viruses cannot be cured with any drug - only time.

Nevertheless, many people expect, or demand, an antibiotic if they feel under the weather, even if their illness is clearly viral. Doctors often oblige because it is easier than arguing.

"A lot of people think, "My kid has a green runny nose, he needs antibiotics,' and that's not the case," said St. Petersburg pediatrician Steve Karges.

Karges practices what he preaches. His 16-month-old daughter, Elli, has had six colds and has never taken antibiotics.

A recent CDC survey found that half of adults believe that if they are sick enough to see the doctor for a cold, they deserve an antibiotic. Even more are unaware there is any risk to taking antibiotics.

The $1.6-million campaign will involve print, TV and radio ads. Besser said a focus will be to convince parents that they don't need antibiotics for their children's colds. Instead, they should settle for doctors' advice on treatments that will relieve symptoms while the infections run their course.

Otitis media, middle-ear infections, are another area where antibiotics are misused. About half of these infections are caused by viruses and will not be helped by antibiotics.

Dr. Margaret Rennels of the University of Maryland, chairwoman of the American Academy of Pediatrics' infectious-disease committee, said doctors are becoming more willing to suggest "watchful waiting" for these infections.

Telling the difference between bacterial and viral infections isn't always easy. Doctors can test for some bacteria, such as strep throat, or look at an eardrum that is red and bulging and say it's probably a bacterial infection. But often the biggest indicator is time: When symptoms drag on for several days, it's more likely to need an antibiotic.

- Times staff writer Lisa Greene contributed to this report.

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