May 27, 2020 by John Fernandez
Antibiotics: Curbing Their Misuse and Overuse
Arguably one of the top medical breakthroughs of the 20th century was the discovery, in the late 1920s, of penicillin’s ability to prevent bacteria from growing. That revelation led to a class of medications commonly known as antibiotics.
Now, in the 21st century, our focus has turned from celebrating these medications for their ability to cure infections to looking for ways to reduce their usage. Why the change? Public officials warn that overuse of antibiotics is leading to the evolution of bacteria that survive existing treatments. Known as antibiotic resistance, this phenomenon could lead to untreatable “superbugs.”
Overuse of Antibiotics
So doctors, who have been prescribing antibiotics for nearly 75 years, must now be careful to offer these medications only when their use has proven beneficial. Further, healthcare providers must re-educate their patients that antibiotics only work for some infections, meaning a patient’s prescription for recovery may involve no medication at all.
“Good communication is key,” said Rozan Razzouk, M.D., a Baptist Health Medical Group physician with Baptist Health Primary Care. “When patients come in with symptoms of the common cold, which is a virus, they may get medications to minimize their symptoms, but they’re not going home with a prescription for an antibiotic.”
Dr. Razzouk says that’s because antibiotics only treat bacterial infections. Viruses, like the common cold, she reminds her patients, must run their course. And while some viruses respond to drug treatment, the medications used are not antibiotics.
Misuse of Antibiotics
Yet recently published research by the U.S. Centers for Disease Control and Prevention and The Pew Charitable Trusts reveals that as much as 30 percent of antibiotics prescribed to patients in outpatient settings are for illnesses, such as viral infections, that don’t respond to antibiotic treatment.
Additionally, of those patients with bacterial infections that affect the sinuses, middle ear and throat, only 52 percent received the most effective antibiotic for that infection with the most appropriate dosage. The study found that children are more likely than adults to fall into this appropriate treatment category. The remaining patients were treated with broad-spectrum antibiotics that target a variety of bacteria, rather than one or two specific strains.
“When we prescribe a broad-spectrum antibiotic instead of the first-line antibiotic we know kills a particular strain of bacteria, we set the stage for adverse reactions and complications,” Dr. Razzouk said. “We also contribute to the antibiotic resistance we’re seeing.”
Complications and Resistance
While antibiotic resistance is a growing public health concern that shouldn’t be discounted by doctors or patients, Dr. Razzouk says the most immediate threat to patients is the resulting complications from antibiotic overuse.
She explains that complications from prescribing broad-spectrum antibiotics range from diarrhea, skin rashes and yeast infections to life-threatening anaphylactic reactions and Clostridium difficile, or C. Diff, which can lead to emergency colon surgery or death.
“We should reserve these broad-spectrum antibiotics for when patients have numerous infections or have failed to respond to first- or second-line treatments, which replace first-line treatments when a patient can’t tolerate them,” she said. Additionally, elderly people, who often seek medical attention for atypical symptoms and whose health can deteriorate quickly, may also receive broad-spectrum antibiotics.
Common Illnesses Treated With Antibiotics
But for the largest portion of the population – between the adolescent years and age 60 – first-line antibiotics, if available to treat their illness, should be prescribed, once a bacterial infection is diagnosed. Dr. Razzouk says common bacterial infections treated effectively by first-line antibiotics include ear infections, strep throat, pneumonia, bronchitis, and sinusitis, when symptoms don’t resolve on their own within a week.
She recommends that patients ask their doctors for a first-line antibiotic treatment for their specific infection. She also advises patients not to push for antibiotics if their illness doesn’t warrant antibiotic treatment. On the other hand, if their symptoms don’t improve within a few days, either with or without treatment, they should notify their doctor.
“If a patient doesn’t improve within a few days of starting the antibiotic treatment, I always advise them to call me and let me know, so another treatment can be considered,” she said. “Viruses, too, will improve with time, so if patients experience symptoms for more than a week or they seem to be getting worse, they should be reevaluated by a doctor.”
Dr. Razzouk adds that it’s important for patients to advocate for their own health and to discuss their symptoms openly with their doctors. “It’s also important that patients understand why sometimes the best treatment may be no treatment at all,” she said.