What should the doctors order?
In the last of a three-part series on the misuse of antibiotics, Ella Lee examines the need to reduce the number of patients wrongly prescribed the drugs
It is a familiar scenario at clinics across the city: a patient shows up with sniffles and a sore throat and walks out with a plastic bag of different coloured pills - including an antibiotic for a sore throat that does not require such treatment.
Frequently patients are also given only about half the drugs they need to complete the course of antibiotics, for reasons including the fact that their insurance limits medication to a few days at a time.
These practices, which continue despite repeated advice from medical experts, contribute to the risk of the development of drug-resistant superbugs.
Care is needed in diagnosis, the experts say, because only 10 per cent of sore throats are caused by the streptococcus bacteria, requiring antibiotics. They say doctors also need to take more time to explain to patients why proper use of the drugs is necessary.
One of four doctors a Post reporter visited for treatment of common flu symptoms prescribed antibiotics. A doctor in Kwai Fong prescribed the first-line antibiotic Ampiclox to the reporter after she complained of headache, sore throat and fatigue.
The doctor said a seven-day course of antibiotics would be needed for the sore throat, but only prescribed it for four days and asked the reporter to come back later to get the remaining medicine.
Guidelines of the Centres for Disease Control of the United States say sore throat and common cold do not require antibiotics.
Hong Kong Medical Association chairman Choi Kin said the doctor was 'overcautious'.
'Only 10 per cent of sore throats are caused by streptococcus infections and in general, a doctor should not prescribe antibiotics for common sore throat and cold.'
Dr Choi admitted some doctors were using antibiotics inappropriately but said the situation was improving. 'Such practice had dramatically dropped over the past decade with a lot of education.
'Practising medicine is both an art and science,' Dr Choi said. 'When a doctor prescribes a drug, he or she may only think about its benefits on the patient, instead of looking at the broader picture of the drug resistance problem in the community.'
Donald Li Kwok-tung, past president of the College of Family Physicians, which is responsible for training of family doctors, said doctors were always reminded to use antibiotics with caution.
'First, they should not use antibiotics just because patients want them to; they should spend more time explaining to them that for some illnesses, antibiotics are not the answer,' he said.
'Doctors should also educate patients for drug compliance. It is very important to take a full course of antibiotics. If doctors were willing to spend 20 or 30 seconds more in each consultation to give this information, they could make a big difference.'
The CDC said physicians were often too pressured for time to engage in long explanations of why antibiotics will not work.
'And when the diagnosis is uncertain - as many symptoms for viral and bacteria infections are similar - doctors are more likely to yield to patients' demands for antibiotics,' it said.
A study by the Hong Kong Society of Hospital Pharmacists, to be released today, found that more than half of the several hundred patients it interviewed were given incomplete courses of antibiotics. Many were given three days' medication instead of five to seven, as recommended.
An incomplete course means the medication may not kill all the bacteria, perhaps allowing some to evolve into 'superbugs'.
In Hong Kong, some doctors complain that many of their patients are covered by insurance plans which limit the period of medication for each consultation to three days.
But Dr Li said it should not be the excuse for misuse of medicine.
He said doctors should not join medical plans that would compromise quality of care.
'Some doctors may find themselves struggling with their business if they don't join those plans, but it is important to build up a good reputation,' he said.
University of Hong Kong microbiologist Ho Pak-leung said patients' expectations should not always be taken as a reason for doctors to misuse antibiotics.
He quoted a local study in 1995 which showed about a quarter of 476 patients interviewed said they did not always expect medication after a consultation.
Tim Pang Hung-cheong, spokesman for the Hong Kong Patients' Rights Association, said patients should learn to ask more questions during a consultation.
'Patient should know they have the right to ask what the medicines are for and if they are necessary. But they often feel the consultation time is just too short.'