Doctor’s Tip: Antibiotics can be too much of a good thing
Many organisms cause harm and even death in humans and animals, including bacteria, viruses, fungi and parasites. Anti-infective agents have been developed against some but not all organisms in these various classes, but this column is about antibiotics, which are active against bacteria.
Prior to the antibiotic era, people in the U.S. died by the thousands every year from infectious diseases, such as pneumonia, meningitis, tuberculosis, whooping cough, tetanus, diphtheria, soft-tissue infections that spread to the bloodstream and rheumatic fever (a complication of the strep bacteria). In 1928, Alexander Fleming found that mold in a petri dish prevented growth of bacteria, and thereby discovered penicillin, which was first produced as a drug in the early 1940s.
I often hear patients say they don’t want to take pharmaceuticals, but antibiotics can clearly be lifesaving, and we should feel fortunate to live in an age when many pre-antibiotic-era causes of death and disability can be treated and prevented.
However, it is true that antibiotics have a downside. First of all, there can be side effects, including death such as severe allergic reactions. Second, in part due to indiscriminate use of antibiotics, bacteria are becoming resistant to antibiotics, which is a huge problem. Eighty percent of antibiotics in this country go to farm animals. Conscientious farmers use antibiotics only for sick animals. But factory farms often use them routinely to “prevent illness,” which leads to antibiotic resistance.
Regarding human use, doctors are criticized for overprescribing antibiotics and patients for demanding them. Half of antibiotics prescribed in the U.S. are for viral infections, such as colds and flu, even though viruses do not respond to antibiotics.
It’s not always easy to differentiate between a viral and a bacterial infection. For example, bacterial pneumonia is usually associated with a high white blood count and a classic white patch on a chest X-ray, but there can be exceptions. The rule of thumb is that if a patient has a high fever, shaking chills and other signs of severe infection that could be caused by bacteria, they should be covered with antibiotics until blood culture results are back, which can take a day or two.
So don’t go see your doctor for cold symptoms (sore throat, runny nose, aching, mild cough), and demand an antibiotic. It’s best to let him or her know that you prefer not to have an antibiotic unless one is truly indicated. The easiest thing for a doctor to do is to give you a prescription for an antibiotic and get you out the door, but a conscientious provider will take the time to explain why an antibiotic isn’t indicated, if indeed it isn’t.
A final point is that immunizations are now available against some bacteria. Many immunizations prevent viral diseases, such as polio, measles, German measles and hepatitis B. But others prevent bacterial infections such as pertussis (whooping cough), tetanus, diphtheria, and pneumococcal infections (the most common cause of pneumonia, among other things). Some patients worry about side effects from immunizations, but they are extremely rare, and the benefit far outweighs any possible risk. Check with your provider, the Garfield County public health nurse, or the CDC website for currently recommended immunizations, and make sure you and your children are up to date.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.
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