John A Patterson MD, MSPH, FAAFP
Cough and cold season has arrived. This means more conversations about antibiotics than at any other time of year. Increasingly, these conversations have implications far beyond the exam room and beyond the immediate illness under discussion. Consumers and health care providers are being urged to refine their conversations to achieve the goals of good medicine- making a correct diagnosis, using antibiotics if the diagnosis warrants and avoiding harm to individuals and the larger population caused by unnecessary antibiotic use.
Antibiotics can relieve suffering and save lives but their overuse can cause harm- even death. Wise use of antibiotics is necessary to preserve their lifesaving potential as overuse of antibiotics contributes to the alarming increase in antibiotic resistance, leading to the emergence of potentially fatal ‘superbugs’. The more bacteria are exposed to antibiotics, the more they develop resistance to them. Many bacteria that were previously susceptible to antibiotics have developed resistance that makes them difficult or impossible to treat. Medical and public health authorities are increasingly concerned.
The Centers for Disease Control and Prevention (CDC) designated November 12-18 as Get Smart About Antibiotics Week, emphasizing the appropriate use of antibiotics and the growing problem of antibiotic resistance. Antibiotic use is also part of the Choosing Wisely Campaign, developed by nine medical specialty societies to help providers and consumers restrict the use of inappropriate testing and treatment.
Most coughs, colds and upper respiratory illnesses are caused by viruses- not bacteria. Antibiotics kill bacteria- not viruses. Therefore, it is important to use scientifically-based guidelines and sound judgment to determine whether an ear, sinus, throat or chest condition is caused by bacteria or a virus. While it is not always possible to distinguish between viral and bacterial conditions, there are guidelines that help consumers, parents and clinicians make wise choices.
Although the common cold can make children and adults feel terrible, it is caused by a virus and does not require an antibiotic. Health care providers will usually treat specific symptoms (such as fever, aches and congestion) with rest, salt water nose drops, a humidifier and lots of warm liquids. There is little evidence that over-the-counter cough and cold medications help children, though they can cause side effects, including death.
Even many childhood ear infections resolve without antibiotics. Therefore, health care providers may not initially prescribe antibiotics unless the ear infection persists or worsens.
Four out of five sore throats are caused by viruses and do not require antibiotics. An office test can determine the likelihood of a bacterial infection (strep throat), which does require an antibiotic. The Infectious Diseases Society of America recently announced revised guidelines that advise antibiotics only when a strep throat is confirmed by a throat swab.
Many ‘sinus infections’ are not infections at all, but are caused by allergies and may respond to allergy medication. When an infection is present, it is more likely to be viral than bacterial. However, there is no easy test to distinguish viral from bacterial sinusitis. Even the presence of colored mucus from the sinuses does not reliably predict a bacterial infection. Since 80% of sinus infections resolve within 2 weeks without treatment, current guidelines advise against using antibiotics in the first week of symptoms, unless symptoms worsen after initial improvement.
Although coughing can be caused by many different conditions, the majority of coughs that accompany seasonal respiratory illnesses are not caused by bacteria and do not respond to antibiotics. The CDC recommends that health care providers use the term ‘chest cold’ in their effort to explain that ‘bronchitis’ is usually caused by a virus and typically resolves on its own.
Safety is a common goal of consumers and their health care providers, as we all try to avoid causing harm. Many consumers, including many parents, are unaware of the potential harm from antibiotics, even when they are prescribed appropriately. Antibiotics are the most common cause of allergic drug reactions. These reactions can be serious and even fatal. Antibiotic-associated colitis can cause a diarrheal illness that can be life-threatening, especially in the elderly. An article this year in the Journal of Pediatrics reported an increased risk of asthma in children born to women who received antibiotics during pregnancy. Many women develop vaginal yeast infections from antibiotics, requiring another medication to treat the vaginitis, increasing overall cost as well as the possibility of an allergic reaction to a second drug.
Health care providers and consumers need good information as they both strive for medical care that is safe, effective, scientific, economical, individualized, patient –centered and socially conscious.
More information can be found at-
Get Smart: Know When Antibiotics Work www.cdc.gov/getsmart/index.html and Choosing Wisely http://consumerhealthchoices.org/campaigns/choosing-wisely
About the Author-
Dr Patterson is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty at the University of Kentucky College of Medicine and the University of Louisville School of Medicine, Saybrook University’s School of Mind Body Medicine (San Francisco) and the Center for Mind Body Medicine (Washington, DC). He operates the Mind Body Studio in Lexington, where he offers integrative medicine consultations. He can be reached through his website at www.mindbodystudio.org.