Antibiotic giveaways stoke fear of patient pressure

Physicians are anxious that more parents will demand the medications for children or themselves now that some pharmacies are offering them for free.

By Karen Caffarini — Posted Jan. 28, 2009

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Antibiotic giveaways by a growing number of supermarket pharmacies have raised fears among some physicians that they could feel more pressure to prescribe the medications when they are not necessary.

Overuse of antibiotics is blamed for the growth of resistant organisms such as methicillin-resistant Staphylococcus aureus.

Several large grocery store chains with pharmacies have been marketing free 14-day prescriptions of generic versions of the most prescribed antibiotics as a way of helping parents in a flagging economy. Promotions typically run January through March, during the peak of cold and flu season.

The idea is not new. Walker, Mich.-based Meijer began offering free antibiotics -- including amoxicillin and penicillin -- in 2006. But the concept has picked up steam as the economy grows weaker, with more grocery chains jumping on board this winter. Among then are Lakeland, Fla.-based Publix; Giant Food, based in Landover, Md.; Rochester, N.Y.-based Wegmans; and Stop & Shop, based in Quincy, Mass.

Store executives are clear that it's an enticement to draw more customers. But they also say it's a service to families who might otherwise not fill a prescription or see a doctor because of cost concerns.

Parents are already pressuring physicians to give their children antibiotics, even though viruses cause the most common childhood infections, said Wayne Snodgrass, MD, PhD, chair of the committee on drugs for the American Academy of Pediatrics and professor of pediatrics and pharmacology at University of Texas Medical Branch at Galveston. Offers of free medication will probably even more pressure.

"Is what the stores are doing unethical? No. But it is resulting in one more thing on the physician's plate that takes time away from more important issues. They now have to see what drugs are free and if they can work in each child's case," he said.

Even if the infection is bacterial, some cheaper generic brands may not always work, he said. But parents may not understand that and object to prescriptions for antibiotics that are not on the free list.

Dr. Snodgrass said the idea of helping financially-strapped families is admirable, but added if the grocers really wanted to make an impact they should offer free vaccines instead.

Ed Septimus, MD, member of the board of directors of the Infectious Diseases Society of America, concurred. "From a physician's standpoint, they are already getting pressure from parents to prescribe antibiotics. Now the threshold is even lower."

Kristin Drynan, MD, a family physician in Geneva, Ill., said physicians need to just say no to parents. While physicians are aware that overuse has caused antibiotic resistance, she said she's not sure if all physicians are participating actively to reduce that overuse, and this promotion doesn't help.

Physicians who specialize in infectious diseases are even more critical of the giveaways. In a news release issued Jan. 16, IDSA warned against the "unhealthy promotional gimmick." It blasted grocers' ads that falsely associate antibiotics with treating colds and flu, and called on grocers to provide free influenza vaccinations instead.

Martin Blaser, MD, professor of internal medicine and chair of New York University's Langone Dept. of Medicine, noted that the costs of antibiotics go beyond money.

"Every time you use antibiotics, it promotes antibiotic resistance, and using them could lead to other illnesses, such as asthma," Dr. Blaser said. "When a doctor prescribes these medications because a patient asks for them, no one is taking these hidden costs into account."

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