The appropriate use of antibiotics

This past week we have seen an explosion of infections in our community-it seems like everyone has a stuffy nose, sore throat and cough. The media is full of reports of an early and severe flu season, and emergency departments and physician offices are full. From a physician’s perspective, one of the most contentious issues in diagnosing a viral illness and in counseling an anxious patient is explaining that antibiotics are not necessary.

Antibiotics are powerful and important drugs that fight bacterial infections (as opposed to antiviral medications, which are used to fight certain viral infections). In specific situations (i.e. urinary tract infections) their use may prevent serious complications; in others (i.e. pneumonias) they may save lives. However, like all drugs, antibiotics have side effects.  Most of these side effects are mild and self limited, but some are severe and even life-threatening.  That is why it is important to only take them when really needed. There is also the issue of antibiotic resistance—the ability of bacteria exposed to antibiotics to adapt and become immune to their killing action.  Resistance to bacteria is a community wide phenomenon and develops as a result of excessive community wide use of these medications. Although this may sound esoteric and not of importance to you, over years dozens of bacterial strains have become resistant to multiple antibiotics, and this has become a public health challenge everywhere, particularly in hospitals and to the very young and very old.

Antibiotics do not fight viral infections. They are useless against the common cold, the flu and most coughs, sore throats and sinus infections.  The challenge is to determine whether you have a viral or bacterial infection. For example, whereas most sore throats are viral in origin, a significant minority are caused by Streptococcus-the classic strep throat.  By either history or physical examination, or by bacterial testing, your primary care physician can advise you on the likely cause of your illness, and whether antibiotics are appropriate.  Unfortunately, many patients equate a visit to a physician’s office with the need for a prescription, and some pressure their physician’s to “give me an antibiotic”.  This pressure is often successful, and studies have indicated that throughout the United States, antibiotics are given inappropriately, particularly for upper respiratory tract infections.

It is important to emphasize that in the case of influenza there is anti-viral medication available. This medication is not for everyone, and is most effective if given within 48 hours of symptoms. If you are over 65, have underlying medical conditions, or are pregnant and have a fever with a cough or sore throat, you should ask your primary care physician if anti-viral therapy makes sense.

As a reminder, it is not too late to get the flu vaccine. Once vaccinated, it takes two weeks for immunity to develop so there is time to be protected before February, which is traditionally the peak of the flu season.