Doctors see light on antibiotics

PUBLISHED : Sunday, 17 March, 2002, 12:00am
UPDATED : Sunday, 17 March, 2002, 12:00am

Hong Kong's doctors seem to be getting the message that dishing out antibiotics with little thought for the long-term consequences is doing their patients more harm than good, a Sunday Morning Post survey has found.

In a survey of six private clinics picked at random, a healthy Post reporter complained to the doctors that she had a sore throat and felt a cold coming on.

Only one of the six prescribed antibiotics, with all the others recommending either rest and plenty of fluids or other remedies.

A similar survey carried out by the Post in 2000 saw three of four doctors who were consulted prescribing antibiotics.

Last week, the problem of over-prescribing antibiotics was highlighted during the International Congress on Infectious Diseases in Singapore.

At the conference, respiratory expert Ron Grossman revealed that Hong Kong had the highest percentage in the world - 70 per cent - of infections resistant to antibiotics.

In the United States, the figure is 30 per cent and in Canada 15 per cent.

Dr Lo Wing-lok, an expert on infectious diseases and a legislator representing the medical sector, said: 'Both doctors and patients are more educated nowadays and the situation is improving.

'In the past, patients would ask why no antibiotics were given. But now, they ask whether it is necessary to take them.'

Anselm Lee Chi-wai, senior medical officer of the Tuen Mun Hospital's Paediatrics Department, said more data was needed before they could decide whether the situation had improved or not.

'If we judge it from general observations, things seem to be improving a little,' Dr Lee said.

He said doctors often prescribed antibiotics in order to play it safe.

'The chance of having serious complications associated with bacterial infections, such as acute rheumatic fever or tonsillar abscess, was much higher in the past than at present . . . less than one per cent will trigger these kinds of complications nowadays,' he said.

Medical experts have repeatedly warned that the abuse of antibiotics will lead to the development of antibiotics-resistant bacteria, which will make it harder for patients to fight off infections and spur the rise of resistant bugs. Doctors also often stress that antibiotics are useless when it comes to viral infections such as a cold or sore throat.

Of the six doctors our reporter consulted to cure a sore throat and a cold, only one prescribed an antibiotic, Zinnat.

The whole consultation process took just three minutes, including a brief examination of the heartbeat and throat.

The instructions on the antibiotics were to take two tablets twice a day, with an interval of 12 hours.

When a nurse was asked about their use, she said: 'They're used to cure your sore throat. Remember to take them all in order to complete the whole course of treatment.'

However, the other five doctors consulted did not prescribe antibiotics and some of them said that they were not appropriate for curing the symptoms complained of.

Dr Lee agreed. 'Most of the cases related to upper respiratory tract infections such as a cold and sore throat do not need antibiotics because they are viral infections rather than bacterial infections,' he said, adding that Zinnat had to be used for seven days consecutively.

'If they are not, bacterial-resistant antibiotics develop as [the bacteria] are not killed in such a short time.'

In the 2000 Post survey, three out of the four doctors consulted gave the reporter antibiotics, including APT-Amoxycillin, Ampetox and Cefadroxil.

Dr Lee said although the situation was improving, doctors still prescribed them as a precautionary measure or because of patients' demands.

'Some patients demand antibiotics, as they believe they can cure all kinds of infections,' he said.

A spokesman for the Hong Kong College of Physicians, Dr Yuen Hon, said doctors actually needed more time to judge whether their patients needed antibiotics or not by carrying out tests on their blood or urine.

But Dr Yuen conceded it was hard to do that in practice. 'It's difficult to ask patients to come back for another observation, that's also one of the reasons doctors give antibiotics to them during the first consultation, as a precautionary measure,' he said.

While saying the assessment could not fairly reflect Hong Kong's situation, Dr Lo said intensive re-education was under way, including the distribution of practical advice to doctors about the treatment of upper respiratory tract infections.

There was also a plan to track the use of antibiotics for the next three years, with a $1 million funding application awaiting approval, he said.

Graphic: DOC17GET