There have been countless incidences when I’ve overheard acquaintances, neighbors, people at the store, ladies at the hair and nail salons, or even friends talk about their desire (and quest) for antibiotics anytime they are sick. If they have a cold, they want an antibiotic. If they have the flu, they want an antibiotic. If they have a sore throat, they want an antibiotic. There is this notion that antibiotics are a cure-all and should be ingested for all ailments. Antibiotics are indicated for the treatment and prevention of bacterial infections. They are not indicated nor effective to treat viruses. Colds and flus stem from viruses, not bacteria. So while it may seem like it would be helpful to take an antibiotic for a cold, flu, or any other viral infection, it is not indicated nor appropriate. Taking antibiotics outside indication may be doing you (and your community) a disservice.
Because of antibiotic overuse, certain bacteria have become resistant to even the most powerful antibiotics available today. Antibiotic resistance is a widespread problem, and according to The Centers for Disease Control and Prevention (CDC) "one of the world's most pressing public health problems." This year it is estimated that 23,000 people will die from the effects of superbugs. What’s scary? My husband was the victim of a recurring superbug infection which led to septic shock and nearly cost him his life less than three years ago.
A "superbug” is a strain of bacteria that are resistant to the majority of antibiotics commonly used today. According to the CDC misusing antibiotics (such as taking them when you don't need them or not finishing all of your medicine) is the "single leading factor" contributing to this problem. The more antibiotics you’ve taken, the higher your superbug risk. Similarly, the more encounters you have with the hospital setting, the higher your superbug risk.
Some examples of superbugs are: Clostridium Difficile (better known as "C Diff") which was the superbug my husband contracted during his long hospital stay. It wreaks havoc on the intestinal tract causing immense suffering and life threatening diarrhea for nearly one half million Americans a year. After several recurrent episodes, each with a week-long hospital stay, my husband became resistant to the most powerful antibiotic on the market and resorted to a fecal transplant to save his life. Another type of superbug is MRSA (methicillin-resistant Staphylococcus aureus). It is a type of bacterial staph infection usually acquired in hospitals, although there have been incidences of outbreaks among athletes (including in the NFL), schools, and military barracks. The bacteria can spread easily with skin-to-skin contact, with the risk being higher if you have a cut. MRSA is responsible for killing at least 19,000 people/year. Another superbug that has received recent media attention is CRE (Carbapenem-resistant Enterobacteriaceae), a naturally occurring bacteria similar to E. Coli. Although CRE does not usually affect healthy individuals, many people in nursing homes and hospitals are particularly susceptible. It can be contracted through medical scopes that have not been properly sterilized. There was a recent outbreak in February 2015 at UCLA medical center where 2 patients died and over 170 patients potentially exposed to this potential deadly bacteria, due to contaminated endoscopes that were used in surgical procedures. CRE has a 40-50% mortality rate.
Because of the alarming rise in the number of superbug cases and the growing concern over antibiotic resistance, there has been a paradigm shift within the medical community to address these problems. In years past prescribing antibiotics was commonplace without a whole lot of oversight. Physicians may have written prescriptions based on symptoms alone. Others may have prescribed a new script over the phone without even seeing the patient, a situation which now could potentially cost a physician their license. Now it is more appropriate and medically encouraged for prescribers to combine patients' symptoms and a physical exam with the results of blood and urine samples to verify the type of bacteria (if in fact bacteria is the culprit) that may be the source of the infection. Cultures may take 24, 48, even 72 hours to bare results. Once the organism causing the infection has been identified, physicians then have the option to prescribe the appropriate, matching antibiotic only if it will be of clear, clinical benefit. In cases where it is unclear it may be medically prudent for physicians to consult with Infectious Disease doctors to make sure the appropriate antibiotic regimen is selected, if at all.
Thanks to the works and discoveries of Sir Alexander Fleming who first discovered penicillin in 1928 and was first used in 1942, we have been fortunate to have access to some of the most life-changing antibiotics to treat potentially lethal infections, such as pneumonia or endocarditis, that in their own right could lead to death. Antibiotics, without a doubt have changed the lives of many. The use of antibiotics in the hospital have improved surgical outcomes and have contributed indirectly to lower lengths-of-stay.
Yet now we are at a crossroads. The development of new antibiotics is not keeping pace with newer forms of bacteria that have increasingly become resistant to the collection of antibiotics currently on the market. This has become an epidemic, but with a multi-faceted approach between healthcare providers and patients, we can help curb the destruction of this problem before it’s too late. The medical community is doing what they can to educate physicians and medical personnel with prescribing privileges, regarding the dangers of over-prescribing antibiotics. They are changing guidelines and protocols to warrant the use of antibiotics only after a thorough diagnostic evaluation has been taken and for which there is clinical benefit. In the pediatric arena a “watchful waiting” approach over an antibiotic prescription is encouraged for minor infections such as otitis media (ear infection) when, if given ample time, the infection will likely clear up on its own. Furthermore, physicians are encouraged to be conservative on their choice of medications and to reserve the more potent antibiotics for the appropriate patient.
We as patients can be an asset to the situation by following some simple rules. For starters, don’t expect that with every ailment you suffer will antibiotics be warranted. In fact in most cases they won’t be. A 2013 study published in JAMA (Journal of The American Medical Association) reported that in the period between 1997 and 2010 doctors prescribed antibiotics in 60 percent of all sore throat cases, while only 10 percent of adults with sore throats have strep, the bacterial infection requiring antibiotics. This is a good example of misuse, overuse, and abuse of antibiotics. Even worse, in the early 1990s and prior the percentage of antibiotic prescriptions for sore throat complaints in adults was as high as 70-80%. What was most interesting was the reason for the excessive use of antibiotics: patient demand.
Physicians should make sound and informed decisions based on evidence-based medicine. But the sad fact is there are still those out there that are still letting the tail wag the dog. Of course the writing of prescriptions lie in the hands of physicians and those licensed to prescribe. Although committees have been set up within hospital and doctor communities to improve medical outcomes and educate and encourage physicians to move away from prescribing antibiotics unless entirely appropriate, there may still be a willingness among some to follow the path of least resistance, especially when an ill-informed, demanding and outspoken patient comes into an office expecting to walk out the door with script in hand. Even with the new changes, I’ve seen it happen. It’s dangerous not just for the person being prescribed the antibiotics, but for the community at large.
If and when you are given a prescription for an antibiotic have a discussion with your doctor about the results of your blood/urine test, the choice of medication, and to ensure that you aren’t receiving something stronger than is necessary. Some doctors opt to prescribe a broad-spectrum antibiotic to cover all possibilities of bacteria (such as a Cipro or Augmentin). While that approach may sound good, those types of antibiotics are very strong and should only be reserved when some of the narrow-spectrum antibiotics aren’t effective. It’s better to start small than vice versa. Once you’ve resisted to the strongest, most potent antibiotics, there is no other place to go and you are out of options. Secondly, make sure you take ALL the pills that are prescribed. Even if you start to feel better it is imperative that you take all the remaining pills in order that you have knocked out the bacteria to the best of that medication’s potential. Bacteria left behind can lead to drug resistance. Third, be patient and allow the process to bare full results. Sometimes it’s important to wait a day or two before we know what the problem is and if we in fact have an infection where an antibiotic is relevant. Although we want things now (especially if we are in pain) we must be patient in order to achieve maximum results. Lastly, and most importantly, stop asking physicians for an antibiotic anytime you feel under the weather. Let the medical process, which has been fine-tuned to our benefit, take it’s course. Doctors are under enough pressure, don’t make their job harder and tempt them into making a an unwarranted decision just for your satisfaction. If you suspect your ailment is bacteria-driven, be sure to see your doctor and make sure all avenues are explored before an antibiotic script lands in your hands. Together we can make a difference and ensure that if the time ever presents itself, we will have all options available to us.