Health Column: Ebola rages, but the real threat is antibiotic resistence
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
The world is experiencing the largest Ebola outbreak in history and it is worsening. Ebola is getting lots of press and deservedly so, with its fatality rate of 55-60 percent. The public health community is all over the Ebola epidemic, however. In spite of many barriers in third-world countries, the outbreak will be terminated. The Centers for Disease Control and Prevention reports that Ebola poses no significant threat to the U.S. general population.
A less dramatic, but much bigger health threat to Americans and all people is the progressively increasing incidence of antibiotic resistance. Each year, over 2 million Americans experience an infection with bacteria that are resistant to antibiotics and 23,000 die as a direct result. Antibiotics have been around since the 1940s and, along with clean water, have led to increased life spans around the globe. Yet every time a person takes an antibiotic, sensitive bacteria are killed and resistant germs are allowed to grow and multiply. Repeated and inappropriate prescribing of antibiotics are the important causes of drug resistant bacteria.
Why has this happened? In the ambulatory setting, the misuse of antibiotics stems from several, mostly non-medical factors:
1) Physicians wish to please patients. In multiple studies, doctors wrote prescriptions for patients requested drugs, even when the docs knew it was not appropriate.
2) Patients demand antibiotics. “Gorillacillin worked last time!”
3) It takes less time to write an antibiotic prescription than it does to explain to a patient why an antibiotic is not appropriate.
4) Physicians have frequently become the pawns of the pharmaceutical industry by dispensing samples of the latest and greatest (and most expensive) new antibiotic where lowly, cheap amoxicillin or no drug at all was more appropriate.
Hospitals and other health care facilities are at war with drug resistant organisms, a great reason to avoid or minimize a hospital stay. People with drug resistant organisms are more likely to have longer and more expensive hospital stays, and may be more likely to die as a result of the infection. When the drug of choice doesn’t work, treatment with second or third line drugs often is not as effective and may be more toxic.
Worldwide, there are worrisome patterns of increasing drug resistance of tuberculosis, malaria and HIV disease. Amantadine (Symmetrel) used in the past for prevention of Influenza A is no longer effective.
In the community at large, we have seen increased resistance of women’s urinary tract infections (E. coli) to inexpensive sulfa drugs (generic Bactrim/Septra), the resurgence of drug resistant gonorrhea and increased reports of skin infections caused by Staph aureus bacteria that do not respond to antibiotics that worked in the recent past.
The good news is that physicians are increasingly tuned in to antibiotic resistance and its potentially disastrous sequellae. Fewer physicians are seeing drug reps and taking brand name antibiotic samples. More docs are using the “wait and see” approach to treating sinus and ear infections, handing the patient or mom a prescription and encouraging them to hang on to the prescription and see what happens with the illness over the next few days. Studies show that up to 65 percent of these prescriptions are never filled.
What can you do to slow antibiotic resistance?
Don’t ask for antibiotics and, if offered an antibiotic prescription, ask if it is really necessary. Ask what will happen if we “wait and see.” If an antibiotic is appropriate, take it all and don’t share it with your spouse or save the rest of the bottle for next year.
Remember antibiotics kill bacteria, not viruses. All influenza and colds, most sore throats, many ear and “sinus” infections and a high proportion of bronchitis illnesses (think of bronchitis as a “chest cold”) are caused by viruses. Antibiotics won’t work, can’t work and there is a one in eight chance you’ll develop diarrhea.
GJ Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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