Evidence-based antibiotic usage

Stop prescribing antibioticsIn my ongoing quest to show that “antibiotic” is a word that does more harm than good to public health outreach, I frequently encounter people on the Internet who insist that confusion over antibiotic efficacy is not due, at all, to the word itself.  I value these people’s insight, of course, because their views certainly might be true for the planet they live on. There are probably a lot of habitable planets in the Universe (40 billion just in our galaxy!), and I don’t presume to know what reality is like for those places.

On Earth, however, the belief that antibiotics treat viruses is rampant, generates over-prescription, and is clearly related to the word itself. Here are Exhibit A (from answers.com) and Exhibit B (from Google definitions):

What does antibiotic mean?What is a germ?  Definition from Google.People believe that antibiotics treat viruses because on Earth we regularly use a word’s roots to infer meaning. So for the average person who doesn’t remember any biology from middle school, parsing the meaning of antiviral, antibacterial, antifungal, etc. is easy … as long as he/she knows what anti-, viral, bacterial, and fungal mean.  But that same trick doesn’t work for antibiotic.  And because people don’t realize their inference is incorrect, the misconception becomes forever entrenched in public opinion, and on the internet.  The CDC (and others) waste millions of dollars each year trying to quash the misconception, but such efforts will always fail because the strength of the “antibiotics” misnomer is always truthier to the average Joe than a bunch of patronizing posters on a doctor’s waiting room wall.

[As an aside, misnomers are words (you can probably guess, based on the roots … if you live on Earth) that deliver an incorrect meaning.  “Pencil lead” (two words, of course) is a great example, and there are thousands of parents each year who call their doctors in a panic after Jimmy gets stabbed during math class with a pencil. Or they search the internet for “pencil lead poisoning“.  Luckily, pencil lead is graphite (always has been), a harmless crystal of carbon that is not going to cause Jimmy to be developmentally delayed.]

So how bad a misnomer is “antibiotics”?   How should physicians decide whether to use “antibiotics” or “antibacterials” when discussing treatment of illnesses?  Like any medical question, the decision should be evidence-based.  Here is how to get the evidence (Pew Research Center folks, this means you):

Antibiotic versus antibacterial poll dataResponses for questions #1 and #2 show that approximately 10% and 36% (pdf) of adults are confused about the correct answers, respectively.  That’s a HUGE fraction given the daily importance of bacteria and viruses in our lives and in the news.  Unfortunately, there are no poll data for #3 and #4.  But my guess is that the fraction of incorrect responses for #3 and #4 will be 1% and 5%, respectively.  “Antibacterials” clearly suggests the drug kills bacteria — only people unfamiliar with English might be clueless.  And I’m guessing that 5% of the public think viruses are bacteria (I’ve asked dozens of virologists … and none knew of poll data on classification ignorance).  No matter what the actual numbers, the level of confusion for “antibacterials” is going to be dramatically less than that caused by “antibiotics.”

So if you are a doctor hoping to improve patient understanding and patient care, using “antibacterials” is a no-brainer.  And if you are worried that “antibacterial” is a rare word, stop worrying: it’s from the 1890s (that’s old!) and is found 13,200,000 times on the internet (that’s less than the 23.8 million for “antibiotic”, but still totally respectable).  Don’t wait for the CDC, WHO, AMA, ACP, APA, etc. to recommend the change, because chances are they won’t — they love the word, “antibiotic” (I’ve emailed them all, trust me).  So just tell your colleagues and staff on the floor to get on board.  And then let me know how it goes.

Below are my other posts on the topic, if you need further convincing.  All posts have graphics that you are encouraged to use for your talks on the topic (this week is Antibiotic Awareness Week, after all). Please consider sharing these links with others on Twitter and Facebook if you are on board with my suggestion, and if you can forward to impressionable medical students, you get bonus points.

  1. Curbing the misuse of antibiotics
  2. Antibiotics are antiviral
  3. How doctors can reduce antibiotic demands from patients
  4. Antibiotic Awareness Week poster
  5. Antibiotics work against viruses
  6. How to improve Antibiotic Awareness Week
  7. Seasonal plea for informed antibiotic usage
  8. Antibacterial soap
  9. The Walking Dead need antivirals, not antibacterials (Shopping list for anti-infectives)
  10. Venn guide to pills that kill things

[If you’re curious why I am so interested in this issue, it’s because I witnessed, first-hand, confusion over “antibiotics” when I lectured on antibacterial resistance in my evolution courses at Swarthmore College.  My students were (largely) bright, and were often bound for medical school … yet they frequently made the same incorrect assumptions about efficacy that totally uneducated people make.  Misuse of “antibiotics” became one of my pet peeves.  Because I have a blog, I thought it would be worth a try to effect some change.]

About Colin Purrington

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