April 22, 2011 Antibiotics Use Vs. Misuse
One of the greatest breakthroughs in medicine was the discovery of antibiotics. Antibiotics have saved more lives than any treatment or other type of medication to date. When used properly antibiotics can heal individuals, who previous to their discovery, would never have recovered. However, often antibiotics are used inappropriately and indiscriminately. This leads to a number of problems.
The first of these is antibiotic resistance. The bacteria we are trying to eliminate get “smart”. A mutation occurs in the bacteria and they “develop” defenses against the antibiotics. Picture it like a battle front in your body. You get infected with a bacteria and then you send an “army” of antibiotics against the bacteria. If used properly you eliminate all of the bacteria. However, sometimes not all of the bacteria are eliminated and now that they have been exposed to that type of antibiotic they develop a defense mechanism against it. This “smart” bacteria can be passed on to another individual or remain in your system. The bacteria can grow and next time you try to treat the bacteria the antibiotic is no longer effective. This leaves doctors with fewer antibiotics to treat the same infection. Eventually “Super Bugs” are created which can’t be treated with the usual antibiotics and the individual can develop an untreatable infection that may be life threatening.
The second problem with overuse of antibiotics are adverse drug reactions. One in five emergency room visits for adverse drug events are due to antibiotics. Antibiotics can also cause side effects such as diarrhea and rash. As well, patients can sometimes develop C. Difficile diarrhea. This is an extremely perfuse diarrhea which can result in hospitalization. Some antibiotics can interfere with patient’s medication like warfarin and cause the patient’s INR to fluctuate. They can affect patient’s blood sugar if they have diabetes, and can cause problems for elderly patients if they aren’t dosed properly for ageing kidneys.
Sometimes it’s difficult to know when an antibiotic should be used, however, statistics show they are not needed for most upper respiratory infections. The common cold and influenza do not respond to antibiotics. Less than 10% of acute bronchitis cases are caused by bacteria. Most middle ear infections also resolve without antibiotics. Sore throats are usually caused by a virus. Only 15% to 30% of sore throats in children are cause by bacteria and only 10% of cases are strep throat in adults. Also, almost all cases of acute bacterial sinusitis resolve without antibiotics.
If your family or emergency physician are reluctant to prescribe an antibiotic it is because they suspect a viral infection that is usually self limiting. Also it is best not to save antibiotics from dental visits or previous infections. Firstly, they expire and become less effective over time. Secondly, what is good for one type of infection is not necessarily what is needed for a different type of infection. Different bacteria are susceptible to different types of antibiotics. A chest infection requires a different agent from a urinary tract infection. If you are using the wrong type of antibiotic you are delaying appropriate treatment and putting yourself at risk for resistance and side effects. Sometimes it is best for the physician to order blood work or urine cultures to determine the type of antibiotic needed. This allows them to choose the agent that will best treat your infection.
All this being said there are definite times when antibiotics are needed and patients shouldn’t hesitate to be seen by a physician. Often we see patients with skin infections caused by bug bites where they have delayed being treated because they didn’t realize they needed an antibiotic.
If you are unsure whether an antibiotic is necessary contact a physician, or your pharmacist. Follow the directions on your medication and finish all of it as directed. There is definitely a need for antibiotics but overuse is going to lead to fewer and fewer treatment options. This will be less of a problem if patients and health care practitioners work together to make good decisions about their medication.
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