Antibiotics and When to Use Them

30 07 2012

Summer has its share of illnesses, but for most physicians, the “illness season” begins to ramp up in the fall. Colds, sore throats and ear infections, among other illnesses, are much more common.

Patients come to the doctor’s to get better, and for many years that has meant leaving the office with a prescription for antibiotics. Many illnesses were treated unnecessarily, and as a result, antibiotic resistance has increased.

Antibiotics first came into widespread use in the 1940s and revolutionized medical care. Bacterial illnesses, such as pneumonia, strep throat, bladder infections, etc. could now be treated. Within a few years, however, bacteria resistant to penicillin were already present.

Antibiotics kill sensitive bacteria, but resistant ones can survive and multiply. Through the years, antibiotics that used to work for infections become less effective.

While antibiotics work against bacteria, they do not treat viruses. Viruses cause the majority of infections (colds, many sore throats, influenza, most coughs). In many cases, however, antibiotics are prescribed for viruses. This leads to increasing bacterial resistance.

Why are antibiotics overused? The answer is multi-fold. Parents often come to the office with an expectation that they will be given something to make their child better. Doctors want to help people.

In the early years of my practice, it was common to treat for an “early” ear infection, or sometimes, “to head off the illness.” Our knowledge of the natural history of illnesses has advanced. We used to think that if a cold produced yellow or green drainage, this was an indicator of sinus/bacterial infection. Now we know that discolored drainage is a normal part of an illness that may last 10-14 days. Some ear infections will clear up on their own. Sore throats that are not caused by strep do not need an antibiotic.

When antibiotics are needed, the most specific antibiotic is best. Some antibiotics are “broad spectrum.” They kill many bacteria, not just the ones causing the infection. Many of these are newer antibiotics, and while they might be more convenient, taste better, etc, they may be more than is needed, hastening antibiotic resistance.

The advantages of using antibiotics wisely are many. Short term, there will be fewer side effects (diarrhea, rashes, stomach ache), and long term, hopefully, when antibiotics are needed for a serious bacterial infection, they will be more effective.

So, when your doctor says, “Good news, they don’t need an antibiotic,” it really is good news.

By Dr. Katherine Vaughn

Image courtesy of AJC1





Antibiotics – Not Always Invited

17 11 2011

George Armelagos is an anthropologist (kind of like Apolo Ohno is a skater).

A few years ago, one of George’s students detected an antibiotic called tetracycline in the bone of an ancient Nubian. Both the student and George thought this was odd, since tetracycline had not come into common use until the 1950s.

George and his student, along with some of their colleagues, got busy and discovered that lots of Nubians, Egyptians, and others from the early years of the second period of the Gregorian calendar had detectable tetracycline in their bones.

Turns out, the antibiotic was consumed in the beer of the day.

George wrote up this find in Natural History Magazine. As for the beer . . .

The beer produced in ancient times, according to Barry Kemp, author of Ancient Egypt: Anatomy of a Civilization, was quite different from the modern commercial product: “It was probably an opaque liquid looking like a gruel or soup, not necessarily very alcoholic but highly nutritious. Its prominence in the Egyptian diet reflects its food value as much as the mildly pleasurable sensation that went with drinking it.”

Spores that produce tetracycline were inadvertently captured during the beer-brewing process and before they knew it, the ancients were slinging back antibiotics with their brewskies.

The old-timers might not have known how their beer came to be medicinal, but know it they did. George went on to write:

Given that the ancient Nubians and Egyptians were getting doses of tetracycline, another question is whether this afforded them any medical benefits. In Food: The Girl of Osiris, William J. Darby and coauthors provide archaeological, historical, and ethnographic accounts of beer’s use as a mouthwash to treat the gums, as an enema, as a vaginal douche, as a dressing for wounds, and as a fumigant to treat diseases of the anus (the dried remains of grains used in brewing are burned to produce a therapeutic smoke). This shows that even in the distant past, Egyptians and their neighbors appreciated beer’s medicinal qualities.

This sounds like a classic case of antibiotic overuse to me, and who knows? Maybe it was.

Overuse or misuse is certainly a concern these days. CDC is in the middle of Get Smart About Antibiotics Week, which is an international collaboration with the European Antibiotic Awareness Day and Canada′s Antibiotic Awareness Week.

Antibiotics are effective “against bacterial infections, certain fungal infections and some kinds of parasites.” They don’t do squat against viruses.

Misuse of antibiotics is a pervasive problem. For instance, if I take an antibiotic against a bacterial infection but I don’t take it long enough, the bacteria that survive become resistant to the antibiotic and can infect other people. The bacteria also reproduce and their offspring or clones are resistant.

When someone is infected with the resistant bacteria and he or she takes the same antibiotic I took (but didn’t finish), it may not work.

If this happens often enough, and it has, then we end up with a plethora of germs against which we have little or no defense.

It’s not a theory. It’s reality. It’s happening right now.

What can be done?

Healthcare professionals can stop giving antibiotics against viral infections and in other circumstances where the drug is not helpful.

We can stop asking for antibiotics. The healthcare professionals will know when we need them and when we don’t. Also, we must comply with the dosing instructions. We need to take the drug as directed and for as long as directed.

That’s about it. Pretty simple. But here’s hoping it’s not too late for scientists to come up with a new class of antibiotics that will allow us to have a do-over.

By Trish Parnell

Image courtesy of National Health Service





Antibiotic Resistance

20 01 2010

Nurse Mary Beth explains when, and when not, to use antibiotics.

Listen now!

Right-click here to download podcast (4mb, 9min)


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