Doctors say that a Florida supermarket chain's plan to give away antibiotics is a double-edged sword when it comes to health, and a downright danger for a society in which antibiotics are already overprescribed.
Publix Super Markets Inc., which is privately held, said Monday it would give away seven generic antibiotics, most often taken for such ailments as strep throat and bronchitis.
"We hope that Public will realize that antibiotics must be used carefully, or we will lose them," said Dr. Andrew Pavia, chairman of the Infectious Diseases Society of the American National and Global Health Committee. "Antibiotics should only be prescribed and taken when it is clear the patient needs them to fight a bacterial infection where the benefit is clear."
Publix's plan mimics one already put in place by Meijer, a privately held retailer with stores throughout the Midwest. It also comes nearly a year after Wal-Mart Stores Inc. and others started selling such drugs for $4 per prescription.
"Giving away antibiotics for free may be good for families if they cannot afford them and they need to fill prescriptions," said Dr. Edward E. Lawson, vice chairman of the department of pediatrics at Johns Hopkins Children's Center.
"But the other side of the coin is that it encourages use of antibiotics without checks and balances, and we get into problems with resistance to bugs."
Untreated infections like strep throat can lead to the old killer rheumatic fever, but overuse of antibiotics can build resistance to bacteria-born infections in the population at large, said Lawson.
"This will be particularly concerning in Florida, a state that already has certain antibiotic resistance problems at levels far greater than other parts of the country," said Gary V. Doern, professor of pathology at the University of Iowa College of Medicine.
Americans have already begun to see the effects of antibiotic overuse in the animal population, resulting in cases of stubborn E. coli, he said. In the last few years, several people have died from food tainted with the E. coli bacteria.
Publix, which is based in Lakeland, Fla., said it would give out amoxicillin, ampicillin, cephalexin, ciprofloxacin (excluding ciprofloxacin XR), erythromycin (excluding Ery-Tab), sulfamethoxazole/trimethoprim (or SMZ-TMP) and penicillin VK. Customers must bring in a prescription to get up to a 14-day supply for free.
At least two of those drugs on the list are "high-grade" antibiotics that doctors usually reserve for "invasive" infections, according to Dr. Steven M. Donn, professor of pediatrics at Mott Children's Hospital in Ann Arbor, Mich.
Those superdrugs are ciprofloxacin and sulfamethoxazole/trimethoprim.
"It's a real concern," said Donn. "Bacteria are smart and learn to be more resistant. If we have infections that are susceptible, and they develop resistance, we have no other drugs to fall back on."
Even if a patient receives a prescription for a "bona fide" bacterial infection, there are problems associated with free drugs, said Donn.
"If these drugs are cheap, there is a natural tendency to take them only until you feel better," he said. "The rate of relapse can go up and complications are more severe."
Giving away free antibiotics is cheaper for stores than putting a coupon in the newspaper, according to Dr. John J. Messmer, associate professor at University Physician Group in Palmyra, Pa.