The easy fix may not be the best answer
By Dr. Adam Aronson
Cough and congestion. Fever and muscle aches. Who has time to be sick? There is that important meeting at work or my daughter’s basketball game…..I need to feel better quickly. Or my son needs to get back to school for his big exam or just so that I can be at work. In our fast food, instant message society – we all want immediate results. Unfortunately, when it comes to treating infections – your doctor may not have the quick fix you are hoping for.
Most of the infections that adults and children will experience during the coming months will be caused by viruses. The majority of coughs and runny noses are viral infections, with a much smaller number being caused by bacterial pneumonia or sinus infections. The same statistics apply to sore throats – less than half are actually caused by the bacterial infection known as strep throat – most are viral.
If your doctor diagnoses you or your child with a viral illness, the appropriate treatment will be “supportive care.” This means rest, lots of fluids, acetaminophen or ibuprofen for fever, maybe even some old fashioned chicken soup. It is critical to realize that antibiotics are NOT on that list. Antibiotics kill bacteria – but have no effect on viruses. Treating a viral infection with an antibiotic will not help the person get better faster – but they actually expose the patient to a number of potential adverse drug effects.
Up to 25% of patients taking antibiotics will have diarrhea, some will have rashes, and a small number will experience more severe reactions. These result in repeat visits to doctor’s offices and even more trips to Emergency rooms where patients are exposed to patients with other infections.
Perhaps the most pressing issue that has developed during the past several years is the growing problem of antibiotic resistance. It is not just the rare “super bug” that makes the news – but the CDC (Centers for Disease Control and Prevention) reports that many bacterial infections are becoming resistant to the most commonly prescribed antibiotics. Community acquired skin infections are frequently resistant to many antibiotics, and some of the most common infections seen in Pediatrician’s offices, such as ear infections, are requiring much higher dosages to adequately treat. When a patient takes antibiotics, sensitive bacteria are killed – but resistant strains may remain to grow and multiply. Infectious Disease experts have clearly established that repeated and improper use of antibiotics are the primary causes of the rising number of resistant bacteria.
If the doctor does diagnose a patient with a bacterial infection the next important decision will be choosing the correct antibiotic. The pressure for that quick fix has led to a tremendous rise in popularity of Azithromycin. Everyone loves the famous Z-Pak. Once a day for just five days – what could be easier? Another popular choice is Cefdinir, which is also effective with just one dose per day, and the liquid preparation for children tastes great. The problem that faces doctors who feel pressured to prescribe these popular medications – is that they are often less effective than traditional penicillin or Amoxicillin. The trendy and popular medications, which taste better and has an easier dosing regimen are often an inferior choice from a medical perspective.
The dangers and risks of inappropriate use of antibiotics are clear. Every day doctors see patients who tell stories about a co-worker or relative who had the same symptoms and went to the quick care clinic at the pharmacy and got a Z-Pak…it “helped” that person so of course it should work for me to. Unfortunately this pressure to get an antibiotic makes a difference. Studies have shown that in Pediatrician’s offices, doctors prescribe antibiotics over 60% of the time if they believe that parents expect them, but only about 10% of the time if they feel the parents do not expect them.
It is critical for the medical community to educate patients regarding the nature of different types of infections and the appropriate treatments. And if your Doctor diagnoses you with a viral infection and explains that you do not need and antibiotic – or that the bacterial infection your child has will be best treated by an antibiotic other than the popular or easy choice – remember that the quick fix may is not the safest or most effective. “There is STILL no cure for the common cold.” To learn more visit the CDC site.