Friday, November 30, 2012

The Experts Weigh In: To Drug or Not To Drug

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One of the most remarkable breakthroughs in medicine has been the discovery of antibiotics. Their use has decreased mortality and sequelae of serious infections in significant numbers.

Unfortunately though, their use has increased in recent years due to inappropriate prescribing practices and demand from patients. Bluntly, it is far easier to write a prescription for a cold than to explain to the patient that 90% of upper respiratory infections are viral. This practice is then reinforced when the patient experiences improvement while taking the antibiotic. The patient 'learns' that the antibiotic heals them, so the next time they come in with a cold, they request an antibiotic. Ironically, the cold got better in spite of the antibiotic. Some antibiotics, such as azithromycin (Zithromax) have a very potent anti-inflammatory component, thereby improving the symptoms of a cold by reducing the inflammatory responses.

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Medical literature has continually supported the reduction of antibiotic usage. Primary care offices are constantly inundated with common upper respiratory tract, ear, sinus and bladder infections. With the patients being programmed to expect antibiotics, a refusal to prescribe by their primary care doctor may cause discord between the doctor and patient. Many precribers have complained that while they acted responsibly by treating symptoms of a virus without antibiotics, patients have gone to other clinics in search of their desired antibiotic.

Antibiotics are of immense value for treatment of bacterial infections. However, they do NOT treat viral infections! But more importantly, even when antibiotics are used correctly for the treatment of bacterial infections, they still have inherent risks that need to be considered and anticipated.

Antibiotics are effective in either killing or impairing the growth of bacteria. Unfortunately, treatment can also reduce the number of beneficial bacteria in the intestines. These bacteria are a normal part of our digestive system and aid in the digestion of food. Bacteria live in concert with various yeasts, mainly the candida species. Bacteria feed on yeast, controlling their numbers. If bacteria levels are diminished, yeasts are able to overgrow, possibly causing secondary illness.

As with any medication, antibiotics can put you at risk of allergic reactions and adverse reactions. Allergy severity can range from a simple skin rash to a full anaphylactic reaction with closure of the airway structures and collapse of the cardiovascular system.

Antibiotics can also potentiate an overgrowth of clostridium difficile in the gut. Clostridium difficile is a bacteria that is found in a small number of people normally. It can also be picked up by accidentally ingesting spores in a hospital or nursing home. These bacteria, when allowed to proliferate, can cause severe inflammation in the colon, even invading the colon wall.

Lastly, some antibiotics can actually weaken tendons, putting you at risk for future rupture of these structures.

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It is important to be cautious in your decision to use antibiotics. Typically, a cold or upper respiratory infection (because it is a viral illness) will dissipate within a week. Treating your symptoms with over the counter medications, rest and good hydration is the appropriate course of action. Also, stay home from work when you are sick! Your fellow co-workers will thank you. If your symptoms persist after one week, seek out care from your doctor. However, if you develop a high fever or develop more severe symptoms than the typical cold, seek out care immediately. It may still be viral, but let your doctor decide.

When a lucid decision is made to utilize antibiotics, it is important to supplement your diet with probiotics while taking the medication. It is recommended to take the probiotics during treatment and for 10-14 days after finishing the medication. Some foods, such as yogurt and some cheeses, provide these benefits. There are numerous over the counter probiotic supplements available for use as well.

While antibiotics have certainly improved our quality of life, indiscriminate use has caused increased strains of resistant bacteria. These developments have already decreased the benefits of antibiotics, causing more serious illnesses and deaths. Please be judicious in your use of these agents. Talk with your doctor before deciding on or accepting an antibiotic prescription.

Dave Ericson is a Physician Assistant based in Western Massachusetts. He also doubles as my uncle and personal healthcare consultant. When he's not treating patients, you can find Dave fly fishing on one of the many rivers near his home or jamming out on the guitar (an instrument he taught himself to play, and play well, I might add). He once played in a cover band in New Jersey and jokes that his band mates were young enough to be his kids. A bit of advice from a patient-healing, guitar-jamming, life-saving uncle?, "Quit worrying, particularly if there's nothing you can do. Enjoy your kids more... time flies by". Well said, Uncle Dave... well said.

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