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When a physician decides what to prescribe a patient, the expectation that antibiotic treatment will provide some benefit to the patient often outweighs the concern that this use will contribute to the shared problem of antibiotic resistance. Even when antibiotics are not needed — and the expected benefit to the patient is small — physicians regularly prescribe antibiotics anyway, with the intention of preventing potential complications of illness or simply appeasing patient demand for a cure. Recent evidence indicates, however, that antibiotic therapy may cause many patients more direct harm than good.

A large number of antibiotics are prescribed for viral infections, against which antibiotics are not useful. Most antibiotic prescriptions in the US are for acute respiratory infections (ARIs), such as the common cold, and over half of these prescriptions for ARIs provide no direct benefit to patients, because ARIs are predominately viral rather than bacterial infections. Jeffrey Linder (Harvard Medical School) argues that there are serious, immediate risks to these patients from antibiotic use that are greater than any potential benefits:

 

Physicians should be comfortable with making the following statement to most of their patients with acute respiratory tract infections: “For your infection, there is an ~1 in 4000 chance that an antibiotic will prevent a serious complication, a 5%–25% chance that it will cause diarrhea, and an ~1 in 1000 chance that you will require a visit to the emergency department because of a bad reaction to the antibiotic.”
... For an individual patient, the risks are greater than the benefits, and the discussion should stop there. (Clinical Infectious Diseases, September 2008)




The common conception that antibiotics are safe to provide to patients as precautionary measures has been debunked. Antibiotics are more likely to cause serious complications than they are likely to prevent complications for common respiratory tract infections; antibiotic therapy puts patients at significant risk of severe allergic reaction and infection by opportunistic pathogens such as Clostridium difficile. For physicians who will not change their excessive prescribing practices on antibiotic resistance grounds alone, the clear, recent evidence that they may be jeopardizing their patients' safety may make them rethink their choices.