Despite government officials’ best efforts to encourage health care providers to lay off the prescription pad, doctors continue to overprescribe antibiotics to patients pressuring them for fast results, with potentially long-term consequences. The overuse of such drugs in the U.S. has diminished their effect and led to certain bacteria not responding to existing treatments. Every year, tens of thousands of Americans die from these so-called antibiotic-resistant superbugs, germs that have survived the best modern medicine could throw at them and have risen stronger and more stubborn than ever. 

By some accounts, the problem has become one of liability. Many doctors don’t want to be pinned for being negligent if a patient’s illness worsens after his or her first visit. “I think the perception among physicians is, ‘boy, what if I don’t prescribe an antibiotic and they end up getting pneumonia and then suing me?’” said Dr. Mark Ebell, a family physician and professor of epidemiology at University of Georgia College of Public Health in Athens. “Patients have been trained to believe that ‘acute’ means serious or that an infection is something they need an antibiotic for,” even if the infection is viral and therefore won’t respond to antibiotics.

This week, health officials in Los Angeles were met with an outbreak of a deadly bacteria known as carbapenem-resistant Enterobacteriaceae, or CRE, which has infected a least seven patients, two of whom have died, at Ronald Reagan UCLA Medical Center. The infections were linked to dirty medical equipment, specifically two endoscopes – long tubes affixed with small cameras on the end that are inserted down a patient’s throat – that were not fully sanitized. A similar outbreak two years ago in Seattle was also linked to tainted medical scopes and led to 32 infections. Such outbreaks have become increasingly common in the U.S. Since 2000, localized outbreaks of CRE have jumped from one state to 38 states, according to the Centers for Disease Control and Prevention (CDC.) 

Health experts estimate that there are over 11.4 million needless prescriptions for antibiotics every year. Last year, more than half of all respiratory infections in the U.S. were treated with such drugs, however only one out of four of those infections were actually caused by bacteria, a study by the American Academy of Pediatrics found. Doctors prescribe antibiotics for everything from sexually transmitted diseases and animal bites to ear infections and sore throats. 

Bacteria reproduce rapidly, meaning the ones that do survive an antibiotic attack give birth to more super-powered bacteria. Resistance rates in hospitals have more than quadrupled from 10 to 15 percent in the 1990s to up to 60 percent today, according to Healthline. At least 2 million Americans become ill with superbugs that are resistant to one or more types of antibiotics each year. About 23,000 of them die.

Federal health officials have warned physicians about the dangers of overprescribing and antibiotic resistance.  Bacterial resistance is rising dramatically, in some cases tenfold, according to the Food and Drug Administration. The CDC has advised medical care providers and patients to “get smart about when antibiotics are needed.” Antibiotics won’t work on viral infections like the cold or flu, but the overuse of drugs for such ailments has allowed superbugs to develop resistance. 

The most nefarious drug-resistant superbugs circulating today are gonorrhea, C. difficile and CRE. C. difficile, an infectious form of diarrhea, kills an estimated 14,000 people in the U.S. ever year – a more than 400 percent increase from 15 years ago – and sickens hundreds of thousands more.

A drug-resistant strain of gonorrhea, among the most spreadable superbugs, has caused nearly 250,000 annual infections across the country. If left untreated, the infection can lead to serious and sometimes permanent health problems including infertility in men and women as well as pelvic inflammatory disease.

When used properly, antibiotics are one of the world’s best defenses against infections and have saved millions of lives worldwide over the last century since the first antibiotics came off the conveyer belt in the early 1900s. Before penicillin, the first generation of which came about during World War II, treatable infections like pneumonia and tuberculosis were among the world’s leading causes of death. Health providers saw antibiotics as a kind of miracle treatment and, with the best intentions, began prescribing them with little restraint. The caveat was that very infections antibiotics were killing were also evolving.

Often doctors feel pressured to give in to a patient’s request for antibiotics. “There’s a belief that it’s sometimes more expedient to prescribe an antibiotic then to have that conversation,” said Ebell. “It’s very quick to prescribe an antibiotic. It’s as easy as writing Z-Pak and signing your name,” an inexpensive, widely available and popular antibiotic that first came to market in the 1990s.  

Most infections physicians see in their clinics today are viral and do not require antibiotics. Health experts have said that patients’ perception that antibiotics can fix anything shouldn’t dictate what a doctor prescribes. “Just because a patient demands an antibiotic, doesn’t mean they should be given an antibiotic,” said Dr. Mobeen Rathore, a pediatric and infectious disease specialist in Jacksonville, Florida. Instead, physicians should be willing to engage in dialogue with their patients, and to not be afraid to say no. Doctors should tell their patients to “watch for this, this and this, and bring the child back or the patient back, and at that time we’ll see if we need an antibiotic.”

Overuse of antibiotics began in the 1970s at the same time that research and development of new antibiotic drugs began to lag. Pharmaceutical companies spend billions to manufacture a single medication. Drugs like antidepressants and anti-inflammatories are far more lucrative for drug companies in part because they don’t lose their effectiveness over time. Several major drug companies have stopped making antibiotics altogether, an investigation last year by Healthline found.

The problem of overprescribing often comes down to the words health providers use with their patients. Research has shown that patients were more likely to be satisfied with not being prescribing an antibiotic when doctors used the term “chest cold” instead of “bronchitis,” according to a 2005 study published with the National Center for Biotechnology Information.

Until the patient-doctor dynamic can be balanced, superbugs will continue to spread and get worse. “People should ask, If you’re prescribing this antibiotic, can you tell me what this is for? Is there an alternative?” said Rathore.