By William Jantsch MD
Prior to the use of penicillin by the general public in the 1940’s, bacterial infections in humans often led to devastating consequences, including amputation and death. When antibiotics became available, such infections were often cured in just a few days.
Unfortunately, the impressive power of antibiotics to cure has resulted in an expectation that these wonder drugs can cure anything, and the drugs have been prescribed for all sorts of conditions, whether or not the disease is caused by bacterial infection.
The most devastating result of the overuse of antibiotics is that many bacteria have become resistant. In fact, there are now some bacteria that are resistant to all known antibiotics. A patient with an infection caused by such an organism would have only the same options for treatment that patients had before the development of antibiotic; that is, wound care, debridement (amputation), and general supportive care. Many people with these resistant bacterial infections die.
It is very important to limit the use of antibiotics to cases where there is a high probability that their use is necessary. Doctors have been advised to follow these guidelines:
- No antibiotics for uncomplicated upper respiratory infections
- Use shorter courses of antibiotics for established bacterial infections
- Avoid broad spectrum antibiotics when more focused treatment is reasonable
“Uncomplicated viral upper respiratory infection” includes coughs, colds, most sore throats, and stuffy, congested noses and sinuses. Almost all of these illnesses get better spontaneously, and require no specific treatment. However, the experience of having one of these infections is unpleasant, and can last for 5-7 days. It is very common for people to go to doctors, urgent care centers, and even emergency rooms with these infections. Doctors have unfortunately been in the habit of prescribing antibiotics for these infections, just because that is the only thing they can do, even though the likelihood of benefit is near zero. Patients, then, become used to getting treatment for their coughs and colds, and that has reinforced the expectation of “getting something to knock this out” when going to the doctor.
There are instances in which the use of an antibiotic is likely to help; for instance, bacterial infections of the middle ears, sinuses, pneumonia, skin and soft tissue infections, and urinary tract infections. However, even in these cases, antibiotics are not always needed for resolution of the infection (the human body has immense powers to ward off infection naturally).
The dictum now is “treat for the shortest time necessary"- usually just as long as there are symptoms. For instance, treatment for pneumonia now is typically 5 days of oral antibiotic, and sometimes just a single dose for lower urinary tract infections. We often advised patients to “finish all your antibiotics, even though you feel better”, but that has changed. Doctors should be telling patients to stop the antibiotic once there is no more pain, fever, or resolution of whatever symptoms were associated with the original infection.
Certain broad spectrum antibiotics should be avoided for treatment of infections outside the hospital. That would include the use of “fluoroquinolone” antibiotics, such as Cipro, Levaquin, Avelox, and others. These drugs are very potent, and can help to cure a wide variety of bacterial infections, but their overuse has resulted in the emergence of strains of bacteria that are no longer susceptible to these agents. In addition, it has been recognized that there are potentially serious side effects of the quinolones, including tendon rupture, heart rhythm disturbances, and nerve damage.
The old paradigm of “get a cold, go to the doctor, hope to get an antibiotic” should now become: “get a cold, treat myself at home, go to the doctor if not getting better, hope NOT to need an antibiotic.”