Why You Probably Don’t Need Them
Patrick O’Neil, PA
They say a good article starts with the BLUF (Bottom Line Up Front). So, here is the BLUF concerning Antibiotics: For the love of all that is good….stop asking your healthcare providers for antibiotics all the time!
I have worked in a variety of medical positions since 1988. I have done austere medicine in Third World Countries…..oooops, I guess to be politically correct we now call them Developing Nations. Some of these places I went to, I was the first medically trained person they ever came in contact with. I guess they were still in the “developing stage” of their nation. I have worked family practice, emergency medicine and urgent care. My current practice is both Family Practice and Urgent Care. I can tell you with 100% honesty and accuracy that we have an antibiotic fetish, and crisis, in this country. There is not a day that goes by that I am not asked by a patient to give them an antibiotic. Sometimes they don’t even ask, they flat out tell me the only reason they came in was because they know they need an antibiotic to get over their symptoms.
So, let’s go over some basics of medicine. Antibiotics are only effective against bacteria. They don’t work against viruses and they don’t work if your symptoms are allergy related. They only work against bacteria! I cannot tell you how many times I have had this conversation:
Me: “Well, it looks like you are experiencing all the symptoms of allergic rhinitis. The runny nose, sneezing, nasal congestion, itchy/scratchy sore throat, post nasal drip and a dry cough are all related to your allergies.”
Patient: “So, what antibiotic will I be getting?”
Me: “Well, since this is not caused by a bacteria, you won’t need an antibiotic to fix this problem. You will need antihistamines, a nasal spray, some decongestants and a cough medication.”
Patient: “I had this same thing before and I always get an antibiotic. I don’t understand why I can’t get one now.”
Me: “A bacterial infection is very easily identified. You would have fever, swollen lymph nodes, and very likely, I would be able to see some pus on your tonsils or other tissues. This is definitely not bacterial, it is an allergy.”
Patient: “So why can’t I get an antibiotic?”
Me: “First, the antibiotic would do nothing to fix this. Second, giving antibiotics when they are not needed can cause other problems, such as resistance to other bacteria. Third, it is poor medicine to prescribe antibiotics when they are not needed. Fourth, they can cause a vaginal yeast infection. Fifth, your birth control will not work for possibly two months. There are a lot of other reasons why I won’t prescribe an antibiotic for you at this time, but I am sure that this short list should be sufficient.”
Patient: “So…….you really aren’t going to give me an antibiotic?”
Welcome to my world!!! (That repeated banging sound is my head as it continues to hit my desk in frustration).
Here are a few things that everyone should know:
1. A Medical Clinic is not a Burger King. You don’t “Get it Your Way.” The patient will be evaluated by a healthcare provider that has been trained for a long period of time, and has a license to practice medicine. They are more experienced than your Aunt Martha, or some other loved one, that says you “need an antibiotic.” The healthcare provider will let you know if an antibiotic is required or not. Please listen to them! You paid good money to see the person with all the degrees on the wall, so trust them. They honestly have your best interests at heart and want to treat you appropriately.
2. Antibiotic resistance is on the rise in the USA. Because of the rampant misuse by healthcare providers handing out prescriptions for every little thing they see, we have a tremendously high resistance rate now. (Yes, I am putting the blame squarely on the shoulders of the healthcare providers. It is OUR fault this problem exists). At every medical conference I have attended in the last 10 years, there is a class on Antibiotic Usage. This class is usually begging healthcare providers to “stop the nonsense.” Stop giving antibiotics when we know it is a virus or an allergy. Stop giving in to the patient’s demands and do what we know is medically correct. There will come a day in medicine when we will see bacteria not responding to antibiotics because the resistance is so high, and then we will all be in a world of “fecal matter.” I already have elderly patients that come in with a urinary tract infection, and when the culture returns, the bacteria they have is resistant to every oral antibiotic out there. We have to start them on IV antibiotics and sometimes send them to an infectious disease specialists. Resistance is becoming a HUGE issue in medicine.
3. Antibiotic usage comes with some problems. They can cause upset stomachs, diarrhea, nausea, vaginal yeast infections, ringing of the ears, etc. If you are on a birth control pill, you need to realize that the antibiotics may cause your birth control to be ineffective for a couple of months. Antibiotics are not harmless, they have side effects. Why would you risk that if it is not necessary?
4. Most infections, even bacterial, can usually be defeated by the body’s own immune system. In a healthy person, the lymph nodes will build antibodies to fight an infection. This is how your body defeats viruses and it works pretty well for bacteria also. Antibiotics are useful because they limit the severity and length of a bacterial infection, and they help us recover much more quickly. For the very young and the very old, whose immune systems are not as strong, antibiotics can be lifesaving. For the immune compromised, they are crucial. How sad would it be if the resistance levels rose so high that antibiotics didn’t work? We would see a catastrophic increase in death rates.
5. Viral infections are FAR MORE PREVALENT than bacterial infections. We know for a fact that most infections are viral. Yet, providers will see a red ear drum and give an antibiotic to a little child. Even if they didn’t see any pus behind the ear drum (pus = bacteria), they will give an antibiotic. A child can get a red eardrum from crying! How many infants cry when being held down for an ear exam? ALL OF THEM! What should happen is we tell mom that little Susie appears to have a minor ear ache and it should resolve in a few days on its own. Give her Tylenol and Children’s Motrin to control her symptoms. If it looks like she is having increased pain, bring her back in for re-evaluation. The problem for the doc is: Mom doesn’t want to come back again and pay another co-pay; plus she wants instant gratification knowing that something is being done for little Susie. So, she gets the antibiotics from the doc and they do nothing. Mom feels better because she is giving Susie something. Susie’s symptoms get better in a few days (just like we knew it would) and mom thinks the antibiotics are what fixed her.
6. It’s OK to get sick! Even with most bacteria, it’s OK to let your body fight it off for a few days. The more infections your immune system is introduced to, the better protected you will be later in life. Your immune system is remarkable! It keeps a memory of every infection you have had and is prepared to build antibodies for those infections. As long as you are healthy and the symptoms aren’t completely debilitating, LET YOUR BODY FIGHT IT OFF! It will be better for you in the long run.
What if my healthcare provider is wrong?
OK, so sometimes we do get it wrong. That’s why they call medicine an ART, and not a SCIENCE. There are no guarantees our diagnosis will be absolutely correct every time. We take a lot of pride in getting it right, but once in a while we get it wrong. This can happen when the symptoms don’t point clearly at a particular diagnosis. I have had patients come in with a fever and fatigue. That was all that was bothering them. Nothing else was out of the ordinary either. I did urine and blood tests and ordered cultures. I gave them a good physical exam. I came up with Zip…..Zero…..Nada…..a big fat goose egg! We call that a fever of unknown origin. At that point, I usually have a very candid conversation with the patient and let them know I have absolutely no idea why they are having the fever and that the infection has not “fully declared” itself. Maybe in a few days, if symptoms start to appear, I can make a better diagnosis. I explain that we just need to see if the body will defeat it, or if the symptoms worsen, what area we need to concentrate on. The last thing I want to do is prescribe an antibiotic that would cover head and chest bacterial infections, only to find out they have the beginnings of a kidney infection that won’t be cured by that particular antibiotic. That wouldn’t be good.
Most patients appreciate honesty. They can tell when a provider is tap dancing and feeding them a line of bull. It’s OK to not have an answer at that particular moment. All the patient really wants is the truth and a plan on how we are going to approach this; even if the plan is to push fluids, Tylenol for fever and body aches, rest x 48 hours, and return if symptoms worsen....It’s a plan!
What’s the Solution?
► Make sure your provider isn’t someone that prescribes antibiotics like they are Skittles. Have a conversation with them and let them know you are not one of those patients that demands antibiotics for you and the kids for simple, routine infections. Let them know you are concerned about bacterial resistance rates and are not in favor of providers prescribing antibiotics so much. Tell them you are OK with a diagnosis of Allergies or Viral Infection and you don’t necessarily come in seeking antibiotics. They will probably look at you like you are a freak of nature, because we just don’t see that very often. However, I am sure they will really appreciate that point of view.
► When you go in for a visit, start off the conversation with something like, “I’m having some symptoms and I’m not sure what this is. I’m not crazy about antibiotics, but if you think I actually have a bacterial infection, AND I NEED THEM, then I will be open to the idea.” “I just want to make sure I don’t have something serious.” Some bacterial infections are very short-lived and self-limiting. A Staph infection of the intestinal tract usually only lasts 24-48 hours. Antibiotics for this sort of infection aren’t needed, even though it is a bacterial infection.
► If you know your provider well, and have a good relationship with that person, TRUST THEIR JUDGMENT! Most providers I know went into medicine because we enjoy helping people. We want to make them feel better and we want them to know we have their best interests at heart. If they tell you that you really don’t need an antibiotic, listen to them.
I hope this article provided some good information for you. Check out some of the other information we have regarding common illnesses and a logical approach to them.
Please remember one last thing about healthcare providers:
My job is to give you what you need…not what you want. What you want may not be in your best interests.