August 31st, 2011

It’s Time for Antibiotic Placebos

As I’m sure you all agree, it’s high time we had a good antibiotic placebo.

Just think — we’d be able to prescribe a 100% effective treatment for viral respiratory tract infections, with the assurance of no risk of antibiotic resistance, C diff, allergic reactions, tendon ruptures, photosensitivity, drug-drug interactions, or any of the myriad other side effects that real antibiotics have.

Plus, based on studies like this one, we could even tell our patients that they’re receiving an antibiotic placebo, and they’d still get better. There, ethical quandaries of placebo prescribing solved.

What inspired this thought on antibiotic placebos was this email exchange:

Hi Paul,
Our primary care group would love to have you come give an update on antibiotics during our Friday conference. Am cc’ing Chuck our practice director to make sure he agrees with the topic. There’s a lot of variability in antibiotic prescribing within our group, hoping you can enlighten us.

So Chuck chimed in:

Sounds great.  But Nora, what do you mean “variability in antibiotic prescribing” if everyone gets azithro?

Now it hardly bears mentioning that Chuck is one of the funniest doctors I know, and that he was being facetious.

But just think how much macrolide resistance we could avoid if, instead of a “Z-pack”, we had an “S-pack” (“S” for sucrose). That’s 6 pills (two on the first day, then one a day for 4 additional days), with the promise that it will be just as effective as azithromycin.

And if you don’t believe me, read this paper in The Lancet for proof (figure from paper in above image). And this news article in The Onion for more information.

Sucramycin (brand name Sucracil®), anyone?

2 Responses to “It’s Time for Antibiotic Placebos”

  1. P.Murphy says:

    You do realise that the Onion is satire, don’t you?

  2. Paul Sax says:

    Dear P. Murphy,

    Whenever I’m in need of a good laugh, I head right for here:


HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

Learn more about HIV and ID Observations.