Older adults in the South take antibiotics more often than those in other regions, a new study shows. And it's not because they get more infections. The results suggest that some of the prescriptions may not be needed, the authors said. Antibiotics are used to treat infections caused by bacteria. Excess use of antibiotics can help bacteria to develop resistance to the drugs. Then the drugs won't work when needed. This is a growing problem around the world. The new study looked at 3 years of Medicare data on prescriptions and infection rates. About 21% of Medicare patients in the South used an antibiotic in an average 3-month period. The West had the lowest average, about 17%. Regions with more prescriptions did not have higher rates of infections that needed antibiotics. For example, the Northeast had the highest rates of bacterial pneumonia. But its rate of antibiotic use was one of the lowest. In all regions, there were more prescriptions in the winter. Numbers were lowest in summer and early fall. The journal Archives of Internal Medicine published the study. HealthDay News wrote about it September 24.

By Lori Wiviott Tishler, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

It's not uncommon for me to get a call from a patient saying, "I've had this cold for a week. I need antibiotics."

Colds are viruses and antibiotics won't help. It's hard to say this to a patient who is suffering and miserable, though. It's even harder to say it to a senior who is miserable and who might have heart or lung disease. For this reason, this article captured my attention.

The article looks at the differences in antibiotic prescribing for senior citizens across the United States. This may be the first study that looked at this question for older people. Seniors may be more likely to get sick. They are also more likely to have problems as a result of medicines they take.

The authors found that seniors were more likely to take antibiotics in some areas of the country than in other areas. All seniors were more likely to have antibiotics in winter than in summer. During an average 3-month period:

• 21% of seniors in the South took antibiotics
• 17% of seniors in the West did so

We don't really know from the data if the use of antibiotics was appropriate or not. The authors did look at the rates of some common infections in each region. But regions that had more antibiotic use did not have higher rates of infections that usually require these drugs.

If doctors were only prescribing for people who truly needed antibiotics, the numbers should have been closer to the same in different regions. Since they are not, it is a reasonable conclusion that some of the patients didn't really need the medicine.

Seniors are more likely to develop side effects from antibiotics, including diarrhea and confusion. They are also more likely to have interactions with other drugs, since they take more drugs than younger adults. For these reasons, it's essential for all doctors to think about when an antibiotic will make a difference and when it won't. We should explain this to patients and provide care and comfort when a pill won't do much good.

What Changes Can I Make Now?

Be willing to listen to your doctor. If you think you might need antibiotics and your doctor doesn't think so, ask why not. The doctor may think that antibiotics won't help. If that's the case, don't put yourself at risk for side effects with no benefit!

For many kinds of infections, such as bronchitis, antibiotics don't make much of a difference. Ask your doctor what you can do to help the symptoms and feel better.

If you do need an antibiotic, take it as prescribed. Finish it even if you feel better.

Finally, as winter approaches, do what you can to prevent infections in the first place. Most older adults should have a flu shot. They are available now. Get one!

In addition, adults over 65 should have a pneumonia shot. So should people who are younger but have chronic (long-lasting) illnesses. These are both safe vaccines, and it's worth a sore arm to avoid weeks of illness.

Last February, the U.S. Centers for Disease Control and Prevention (CDC) added another recommended vaccine. The CDC says seniors should consider getting the pertussis (whooping cough) vaccine as part of their tetanus booster shot. Ask your doctor if you need this.

If you are a senior with chronic illnesses, respectfully ask your family and caregivers to get appropriate vaccines as well. That will help keep you healthy this winter.

What Can I Expect Looking to the Future?

Unfortunately, I think we will continue to see super-bugs, germs resistant to antibiotics. But I hope we will also see a population educated to understand when antibiotics should be used and when they shouldn't.