According to a 2014 WebMD/Medscape survey, patients request antibiotics for the following reasons: 85% believe they will cure the illness; 65% to feel better quickly; 44% because they need to get back to work as soon as possible; 27% because they (antibiotics) can’t hurt and it’s better to be safe than sorry; and 25% believe antibiotics always work.
The same survey shows that health professionals often give into their patients’ demands, with 95% admitting to prescribing antibiotics when not always sure they are necessary. In other words, many of these prescribers admit they might be doing the wrong thing—yet they do it anyway.
Feeding this problem is the issue of “decision fatigue,” which can make doctors more likely to prescribe antibiotics to patients who don't need them later in the day compared to the morning, according to a study in JAMA’s Internal Medicine (Oct. 6, 2014), which analyzed data from more than 21,000 visits by adults with acute respiratory infections to 23 primary care doctors over 17 months.
Among the most common reasons people go to the doctor’s office is because they have an upper respiratory infection. In fact, the upper respiratory infection is the most common infectious disease in humans. The average person gets between 2 to 3 a year. Given the widespread use of antibiotics, one would assume that they are the best defense again this type of infection. But in actuality, around 80% of upper respiratory infections are viral and cannot be treated with antibiotics.
There is an educational gap that exists between patients and their healthcare providers. At the same time, healthcare has become increasingly “consumerized” and there are more pressures on doctors than ever before. Poor patient satisfaction reviews can lead to loss of employment and negative Yelp reviews can destroy businesses. It’s an awkward situation when a patient takes the time to visit the doctor’s office, has been waiting to see someone for 45 minutes to an hour, only for the provider to tell them they don’t need anything. It’s unacceptable to most.
It’s even worse when the patient comes in requesting a specific antibiotic or drug by name, saying things like, “My doctor gives this to me every time. It’s the ‘ONLY’ thing that works.” In reality, the natural course of most of these infections is that the immune system recognizes it, mounts a response, and the patient gets better on their own.
Getting to the Root of the Problem
The problem of over-prescribing antibiotics is much larger than most people think. According to the World Health Organization (WHO), the overuse of antibiotics can lead to an issue called “antimicrobial resistance” (AMR), i.e., “drug resistance,” which is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it. Compounding the issue, resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g., antibiotics), antifungals, antivirals and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.
WHO considers drug resistance, “an increasingly serious threat to global public health that requires action across all government sectors and society.” There are now two million drug resistant infections in the U.S. annually resulting in 23,000 deaths. It is estimated that deaths due to drug-resistant infections will surpass cancer by the year 2050.
The rampant prescribing of antibiotics has reached a tipping point. In fact, a 2013 retrospective study conducted by the Centers for Disease Control (CDC) found that in 2010, U.S. physicians and associated healthcare providers prescribed 258 million courses of antibiotics to approximately 309 million Americans. This translates on average to more than eight antibiotic prescriptions for every 10 people.
Most experts agree that strengthening the immune system is far more productive than breaking it down, as antibiotics often do. By their very nature, antibiotics are designed to wipe out bacteria. Unfortunately, they are not selective and can wind up taking out the good with the bad.
An Innovative Solution to the Problem
As patients continue their search for alternatives in immune support, the market continues to thrive. Some of the most popular ingredients in the immune support segment include Echinacea, zinc, amino acids, cranberry extracts, garlic, vitamins C and D, probiotics, resveratrol and multivitamins. This market, growing at a healthy 5-7% clip a year, brings in $12 billion annually, according to market research firm Frost & Sullivan.
More than 150 million Americans take dietary supplements each year, according to a survey from the Council for Responsible Nutrition (CRN). Of these, one quarter takes dietary supplements for immune health. There are certain dietary supplements that provide the body key nutrients that can support the immune system. Product options that help prime the immune system are definitely important, but so are those that can help alleviate an issue once it arises.
A new product that may be a strong contender in supporting the immune system, while also relieving patient pressure for inappropriate antibiotics is the EZC Pak. It consists of capsules containing a combination of Echinacea, zinc and vitamin C. Research shows that all three ingredients are effective in supporting the immune system. The capsules are taken in a 5-day regimen at a higher frequency initially and then slowly tapered off.
EZC Pak was originally conceived as a solution to the awkward interaction between maintaining or improving patient satisfaction, while also doing the right thing in reducing inappropriate antibiotic prescribing. The EZC Pak provides physicians and patients a tangible evidence-based regimen with concrete, physician-directed guidance to manage situations in which an antibiotic is likely not indication-based. Our work is about preserving the effectiveness of antibiotics.
Dr. Sarath Malepati is Medical Director of the PPC Group, Los Angeles, CA, and the creator of the EZC Pak. For more information: www.ezcpak.com