Aug. 7, 2007 -- 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.
"It's a bad idea," he said. "These drugs cost pennies to manufacture. The problem is that some people will want a prescription 'just in case.' since it's free anyway. If it's free, I believe they will be less likely to finish a course of prescribed therapy because being free, it loses its value and importance."
Antibiotics account for nearly 50 percent of the generic pediatric prescriptions filled at its stores. Publix, which has more than 900 stores in Alabama, Florida, Georgia, South Carolina and Tennessee, runs 684 pharmacies.
"Part of this is an economic issue," said Donn. "It's a whole lot easier in the day of managed health care to take a call from a patient and write a prescription than to bring the patient in and assess whether it's a true bacterial infection."
Resistance to bacterial infections has risen in the United States since penicillin was first widely used by the Allied forces during World War II. Some historians say the drug helped win the war effort, reducing the number of deaths and amputations caused by infected wounds among Allied forces.
At the advent of antibiotics in the 1940s and 1950s, women commonly died of puerperal sepsis during childbirth, and doctors zealously used penicillin to treat them.
"Women were treated willy-nilly and it disappeared," said Donn. "Everybody said we cured it, but group A strep was replaced with staph. We developed a resistant penicillin, and low and behold, we got rid of staph and came up with E. coli and now group B strep."
Meijer started giving away the same antibiotic drugs as Publix plans to -- primarily drugs for strep and bronchitis -- last October. A month before, Wal-Mart started offering certain drugs for $4 per prescription in Florida. The world's largest retailer then expanded the plan across the country.
"Retail outlets often feature so-called loss leaders to lure customers into their store," said Uwe Reinhardt, a professor of political economy at Princeton University. "This happens to be the ultimate loss leader; but it fits the general pattern of loss leaders.
"There is a spillover effect … to other items in the store. That is, the surmise that if the loss leader is cheap or free, other items in the store must be cheap as well," said Reinhardt.
Picking antibiotics is a "smart move," he said, because most people don't buy them regularly. "The economic calculation by the store is that the added profits triggered by additional sales of other merchandise will more than cover the incremental cost of supplying these drugs."
Reuters contributed to this story.