T Rex Family

T Rex Family

Wednesday, October 14, 2009

Antibiotic Use

We've been learning about infectious diseases in my pharmacotherapeutics class this week. It's actually pretty interesting. The hot health topic as of late has been flu and H1N1 vaccines. However, I guess I did not realize how over-prescribed antibiotics are. Really interesting to me - far more than flu vaccines (which, by the way, I am still advocating).

Why would over-prescribing of antibiotics be a problem. Well, we're basically breeding more resistant bugs. And over-prescribing does not neccesarily mean prescribing antibiotics when they really aren't needed. It also means prescribing ones that are more powerful than neccessary.

Ever had sinusitits or a sinus infection? Most common cause - viruses. Thus, antibiotics won't work. Viruses can take 7 to 10 days to clear. You can definitely feel miserable during that time, but studies are finding there is little to no difference in symptom resolution if antibiotics are given for an acute case of sinusitis and that most patients improve without antibiotics. Only patients with moderate to severe symptoms should be given antibiotics therapy, and then narrow spectrum antibiotics should be used. If it lasts longer than 10 days and the nasal discharge is no longer clear, then antibiotics might be appropriate. I know, when you go to the health center feeling bad, you want to walk out with something. But sometimes, Tylenol or Ibuprofen, sleeping with a vaporizer, and some intranasal saline might be what you need. Along with rest, of course.

Bronchitis: More than 90% caused by viruses with only 5-10% of cases being bacterial. That's what we all ended up with in our household following our recent virus. It's been two weeks and I still have a pretty horrible sounding cough. The cough can linger 3 to 4 weeks. Wow! That was news to me! If it is caused by influenza, then the influenza should be treated within 48 hours of symptoms but otherwise, you have to let it run its course. Fun stuff? You can use adjunct therapy in the form of Tylenol/Ibuprofen, bronchodilators (i.e. albuterol - we all took a few puffs from T Rex's nebulizer and that helped), cough meds, and vaporizers. Again, if viral, no help with antibiotics.

Otitis Media (middle ear infection) - if you have kids, you're probably familiar. Viruses actually only account for about 30 to 40% of cases and it is really difficult to distinguish between viral and bacterial. However, there is now more movement toward a "wait and see" policy before prescribing antibiotics for middle ear infections. Some things that would disqualify from waiting: symptoms for more than 48 hours, bilateral ear involvement, antibiotic therapy within the past 7 days for whatever reason, less than 6 months of age, possible impending rupture of ear drum, ear tubes, hearing impairment, chronic condition, recent ear infection within past 3 months, or another bacterial infection. The key is treating with the appropriate antibiotics and not going for the "big guns". Amoxicillin (as long as no allergy) is an absolutely appropriate choice to start with or maybe even Augmentin (again, as long as no penicillin allergy).

Urinary Tract Infections or UTIs (refers to infection anywhere along the urinary tract): 90% are caused by E. coli. This actually makes a lot of sense if you think about it. Your gut is heavily colonized with E. coli. And it's portal to the body is relatively close to the urinary opening (especially in females). Thus, it is very common for the bacteria to migrate up the urinary tract and cause cystitis (bladder infection) or pyelonephritis (kidney infection). The key to diagnosis is a "clean catch" urine specimen. If proper technique has not been used, then it is possible to get contamination and get a false positive. Risk factors: use of diaphragm and/or spermicide, pregnancy, estrogen deficiency, prostatic hypertrophy (men), incomplete voiding. Although, most common in females, it can also be seen in males (especially older). You can even get a UTI from infrequent trips to the restroom because you're just too busy. So, when nature calls - go. Or, a child that has a high fever and is dehydrated and not urinating as frequently, this, too can happen. Hydration, hydration, hydration!!! The key to treatment, the correct antibiotics. Going straight to something like Cipro or Levaquin might be over kill. Bactrim or Septra is by far the drug of choice.

I guess the take away here is often antibiotics are not necessary and if they are, make sure you're getting the right ones. Tell your practitioner you want one that is appropriate for the bug you have. And ask if it might be appropriate to "wait and see" since often there is no difference in symptom resolution with or without the antibiotics. Not all antibiotics work the same. And not all bacteria are the same. It takes the correct drug to kill those bugs. And if we keep using "big guns" the day will come when there is nothing else we can escalate to and then we really will have to let the illness run its course.

Please let me know your thoughts on the matter. When you make the effort to see someone about the illness you have, do you expect to walk out of the office with a prescription for something?

How do you feel about the new "wait and see" policy?

Did you find this posting interesting or helpful in any way?

Is there an infectious disease process you'd like more information on?


Jenners said...

I wanted to come over to tell you how much I enjoyed your comment this morning ... and I'm happy to find another person who shares my name! I feel like we have a closer bond now!!! I live your husband's variation!

And I have heard about the overuse of antibiotics. I'm glad my son's doctors tend not to prescribe them easily. I know one mom whose kids is always on some type of antibiotic or another and they don't seem to be working now ... probably because of overuse.

I love that you are sharing what you learned on your blog. It is helpful and interesting.

Kim said...

This was an excellent post. Last winter when I came back to work, Deaglan was sick all the time. And almost every time it was an ear infection or a throat infection. I definitely felt that he was overprescribed but felt powerless because of my ignorance. At first they always prescribed amoxycillan. Finally we realized that the throat infections or ear infections weren't clearing up after the prescribed time. They then started prescribing cephalexin which he hated the taste of. Anyway, I've heard in the news that Canada too is going to start taking the wait and see approach and I'm thankful.

Nina said...

Our Pediatrician office is very much a wait and see on just about everything except ear infections. Both my boys had them regularly up until the age of two and antibiotics were always given.

Our insurance will be changing next year and we will have a much bigger deductible to meet before we ever get any coverage and I have mixed feelings about wait and see if it is going to cost me two offices visits instead of one. I typically don't take the boys to the doctor unless they have a fever of at least 101.1 and then I believe it justifies a trip.

I have had lots of bladder infections over the years. I ended up with them after the births of both my boys. I hate to think it is e-coli but it does make sense.

Caitlin said...

Very interesting and informative! This is one of the reasons that my Dr. had us go ahead and get ear tubes for Joseph at a young age- he hasn't had to be on any antibiotic since! (Which is especially important since he just has such a limited few that work for him.)
I enjoy hearing what you are learning about!

septembermom said...

Thanks so much for this interesting and informative post! I tend to have a wait and see approach with my kids. I have heard about the over use of antibiotics. It takes a lot for me to get my kids to the doctor. So often, they are afflicted by something viral, and not bacterial. The doctors sometimes are way to quick to prescribe an antibiotic. I like to see how well our bodies fight things naturally for a while.

shell said...

It is quite amazing how demanding patients can be sometimes about getting antibiotics. I feel bad for the docs and practitioners that have to say no and have patients really mad at them for actually doing the right thing. It can be quite a challenge.

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