Cough and cold season has arrived. This means more conversations about antibiotics. Increasingly, these conversations have implications far beyond the exam room.
Consumers and health care providers are being urged to refine their conversations to achieve the goals of good medicine — making a correct diagnosis, using antibiotics if the diagnosis warrants, and avoiding harm to individuals and the larger population caused by unnecessary antibiotic use.
Antibiotics can relieve suffering and save lives, but their overuse can cause harm — even death.
Wise use of antibiotics is necessary to preserve their lifesaving potential, as overuse of antibiotics contributes to the alarming increase in antibiotic resistance, leading to the emergence of potentially fatal superbugs.
The more bacteria are exposed to antibiotics, the more they develop resistance to them. Many bacteria that were susceptible to antibiotics have developed resistance that makes them difficult or impossible to treat. Medical and public health authorities are increasingly concerned.
The Centers for Disease Control and Prevention designated Nov. 12 to 18 as Get Smart About Antibiotics Week, emphasizing the appropriate use of antibiotics and the growing problem of antibiotic resistance. Antibiotic use is also part of the Choosing Wisely Campaign, developed by nine medical specialty societies to help providers and consumers restrict the use of inappropriate testing and treatment.
Most coughs, colds and upper respiratory illnesses are caused by viruses — not bacteria. Antibiotics kill bacteria, not viruses.
Therefore, it is important to use scientifically based guidelines and sound judgment to determine whether an ear, sinus, throat or chest condition is caused by bacteria or a virus. While it is not always possible to distinguish between viral and bacterial conditions, there are guidelines that help consumers, parents and clinicians make wise choices.
Although the common cold can make children and adults feel terrible, it is caused by a virus and does not require an antibiotic.
Health care providers will usually treat specific symptoms (such as fever, aches and congestion) with rest, salt water nose drops, a humidifier and lots of warm liquids. There is little evidence that over-the-counter cough and cold medications help children, though they can cause side effects, including death.
Even many childhood ear infections resolve without antibiotics. Therefore, health care providers may not initially prescribe antibiotics unless the ear infection persists or worsens.
Four out of five sore throats are caused by viruses and do not require antibiotics. An office test can determine the likelihood of a bacterial infection (strep throat), which does require an antibiotic. The Infectious Diseases Society of America recently announced revised guidelines that advise antibiotics only when a strep throat is confirmed by a throat swab.
Many "sinus infections" are not infections at all, but are caused by allergies and might respond to allergy medication. When an infection is present, it is more likely to be viral than bacterial. However, there is no easy test to distinguish viral from bacterial sinusitis. Even the presence of colored mucus from the sinuses does not reliably predict a bacterial infection.
Since 80 percent of sinus infections resolve within two weeks without treatment, current guidelines advise against using antibiotics in the first week of symptoms, unless symptoms worsen after initial improvement.
Although coughing can be caused by many different conditions, the majority of coughs that accompany seasonal respiratory illnesses are not caused by bacteria and do not respond to antibiotics. The CDC recommends that health care providers use the term "chest cold" in their effort to explain that bronchitis is usually caused by a virus and typically resolves on its own.
Safety is a common goal of consumers and their health care providers. Antibiotics are the most common cause of allergic drug reactions. These reactions can be serious and even fatal. Many women develop vaginal yeast infections from antibiotics, requiring another medication to treat the vaginitis, increasing overall cost as well as the possibility of an allergic reaction to a second drug.
Health care providers and consumers need good information as they both strive for medical care that is safe, effective, scientific, economical, individualized, patient—centered and socially conscious.
More information: Get Smart: Know When Antibiotics Work, Cdc.gov/getsmart/index.html. and Choosing Wisely, Consumerhealthchoices.org/campaigns/choosing-wisely.
Dr. John A. Patterson is a family-practice physician on the faculty of the University of Kentucky College of Medicine and the University of Louisville School of Medicine. He operates the Mind Body Studio in Lexington.