Doctor and Patient Wage Tug of War on Antibiotics. I like this story. Physicians act responsibly.

As flu season approaches, doctors and patients are gearing up for the annual antibiotic battle, when miserable patients, coughing and sniffling, demand antibiotics.

But many doctors, being pressured to prescribe fewer antibiotics over concerns of drug-resistant bacteria, are refusing to write the prescriptions. Behind the battles is the diagnostic uncertainty that surrounds most upper respiratory tract illnesses. Symptoms of viral and bacterial infections can look remarkably similar.

Patients insist that antibiotics they have taken in the past have cured them. Some doctors, echoing infectious disease experts, contend that because a vast majority of upper respiratory infections are viral, not bacterial, the likelihood that the antibiotics had any effect was minuscule. They say it is either coincidence that the viruses began to clear up after antibiotics or it was the placebo effect.

These experts add that doctors should not turn away patients who need antibiotics.

“I think that as we promote appropriate antibiotic prescribing, we need to be sure that these campaigns don’t leave patients who truly have bacterial infections without appropriate therapy,” said Dr. Richard E. Besser, director of the Centers for Disease Control and Prevention’s Campaign for Appropriate Antibiotic Use. For example, pneumonia should always be ruled out when a patient comes in with bronchitis.

The elderly and those with underlying illnesses are two groups that should be treated with caution. “Our efforts on appropriate antibiotic use are not designed for application for elderly,” Dr. Besser said.

Physicians wrote 24 percent fewer antibiotic prescriptions for children and adults making ambulatory visits in 1999 than they did in 1992.