It doesn’t happen often, but every once in a while, Neil Ernst, a pediatrician at St. Charles Family Care in Redmond, encounters parents who demand antibiotics for their children, even after he tells them those drugs won’t help.

So, he takes them through his familiar lecture. He lets them know antibiotics don’t work on viruses, like the cold and flu, and describes the harm that can come from using them inappropriately.

“And then, once I’ve done that, I say, ‘Are you still interested in antibiotics?’” he said, “And they say, ‘Yes.’”

Ernst doesn’t always win the battle. Sometimes he writes the prescription — knowing they’d get it elsewhere if he didn’t — and hesitantly hands it over, making sure to tell them not to use it.

“I could do the hard-line, hardball thing, but part of this also is that you’re trying to make your patients like you and understand you and trust you,” he said, “and so you don’t want to lose a whole bunch of patients because of this.”

Such is the scenario many Oregon doctors find themselves in, even as health leaders across the state and country caution repeatedly about the dangers of using antibiotics when they’re not necessary.

Oregon is ahead of most states in this arena: It had the second-lowest rate of antibiotic use in the U.S., behind Alaska, in 2010, according to Centers for Disease Control and Prevention data. Experts attribute the state’s low prescribing rates to providers who are diligent about spreading the message as well as an informed citizenry.

“I don’t think there’s as much kickback,” said Thomas Ward, an associate professor of medicine at Oregon Health & Science University. “People are aware of the downsides of overuse of antibiotics and some of the horror stories that have been promoted from multi-drug-resistant germs that are being sustained increasingly in acute care hospitals.”

The horror stories are personal, too.

An estimated 1 in 1,000 people who use antibiotics end up in emergency rooms with allergic reactions, said Ann Thomas, medical director for the Oregon Health Authority’s Alliance Working for Antibiotic Resistance Education, or AWARE, program, which for years has been educating about the harms from misusing antibiotics.

“It’s not a benign thing,” she said.

The most common allergic reaction is a pervasive, reddish rash that covers the body, but people also experience gastrointestinal disorders like vomiting or diarrhea because some antibiotics tamper with the healthy bacteria in their digestive tracts as well, Ernst said.

And then there’s the antibiotic-resistant germs that spread rapidly throughout day cares and nursing homes and even across continents. There have been examples in the past decade of such bacteria that appeared in India and were found throughout Western Europe, South America and North America within seven years, said Ward, also the Infectious Diseases section chief at the Portland VA Medical Center.

Data from Oregon’s medical and pharmacy claims database shows that broad-spectrum antibiotics, which are used to treat a variety of bacterial infections, were used in 55 percent of upper respiratory infections in 2011.

Patients sometimes request broad-spectrum antibiotics specifically because they feel safer knowing the antibiotic will cover more ground, but they can actually be more harmful because they wipe out normal bacteria in the gastrointestinal tract, Ernst said.

Another statistic that troubles Ward is that antibiotics still are prescribed for 70 percent of sore throats, a condition that requires an antibiotic only 5 to 10 percent of the time, when the soreness is due to strep throat. The other 90 to 95 percent of the time, the sore throat is due to a virus, and antibiotics won’t help, Ward said.

“There’s a huge disconnect there for a very common problem,” he said.

The American Academy of Pediatrics last month issued new practice guidelines to help doctors distinguish between viral and bacterial infections in an effort to reduce unnecessary antibiotic prescriptions.

The AAP report focused on the three most common pediatric upper respiratory infections: ear infections, sinus infections and strep throat. It outlined the symptoms of a bacterial infection in each case, including things like a bulging membrane in the ear for an ear infection and a gray or white coating on the tonsils for strep throat.

Parents who give their kids unnecessary antibiotics do so because of a simple yet influential emotion: fear, Ernst said.

“They just fear that the worse thing has happened or is going to happen to their child unless something is done,” he said.

— Reporter: 541-383-0304,

tbannow@bendbulletin.com