"IKNEW you'd say that" was the slightly resentful retort of one of our office receptionists when I told her I didn't think antibiotics would help her respiratory infection.
Another believer having her hopes dashed, subjected to the cruel and inhuman withholding of treatment by some persnickety, purist doctor. Or at least that's how I think the patient sees this oft-played-out scenario, in which a patient wants antibiotics and the doctor insists it is not the right treatment.
Almost all these respiratory infections are caused by viruses--which do not respond to antibiotics. But try telling patients that.
We are getting out of the cold/flu/upper-respiratory-infection season, though allergies are taking over and can sometimes cause indistinguishable symptoms, just to muddy the waters. But the recent flu epidemic has provided many of the acrimonious interactions I am talking about. And although this has been written about a lot, it intrigues me that it is so hard to dislodge this idea that any respiratory-tract infection, even in the first day or two, will benefit from antibiotics.
In an editorial for the American College of Physicians journal, Dr. James D. Sargent of Dartmouth-Hitchcock Medical Center relates the results of a Centers for Disease Control and Prevention initiative in which doctors educated their patients about the real cause of these infections (viruses). They also educated them as to why antibiotics are ineffective or even harmful; offered them symptomatic relief; and encouraged patients to be "glad" they have only a mild condition.
Did the patients change their ways?
"The shocker is that after careful physician and patient education intervention based on these principles, the antibiotic prescription rate for presumed viral illness remained over 60 percent," Sargent noted.
Some of this can be explained by doctors prescribing antibiotics out of expedience. It's a whole lot quicker to bang out a prescription for amoxicillin than to get into a long wrangle/educational session with the patient.
And some of this is due to the influence of marketing, claims Sargent. The New York Times, in an article titled "What's Black and White and Sells Medicines," noted that the Pfizer drug company's cutesy invention, Max the zebra, helped make Zithromax (azithromycin) a billion-dollar drug despite federal officials' stating that other antibiotics were both cheaper and more successful in treating children's ear infections.
THE WAY IT WAS
I think a large part of what makes patients demand
In the bad old days before their invention, people died like flies from even the most trivial wounds if they got infected. Many of the deaths in the American Civil War and the First World War, for example, were from infection rather than enemy action.
Then along came sulfonamides, and shortly after that penicillin, and bacteria were on the retreat--to the point where in 1960, Surgeon General William Stewart declared, "The time has come to close the book on infectious disease. We have basically wiped out infection in the United States."
I think people are all stuck in this euphoric era, and are only slowly becoming aware that bacteria are masterful in their ability to survive and adapt into resistant forms--helped along by the overuse of antibiotics.
So we are now in an era with bacteria that cause pneumonia, ear and sinus infections resistant even to relatively new drugs like azithromycin. Intestinal infections that are resistant to previously infallible ciprofloxacin (Cipro). And the terror of our schools and perhaps the most infamous, methicillin-resistant Staphylococcus aureus (MRSA)--which is now becoming resistant not just to methicillin, as its name implies, but to the only drug that previously would subdue it, vancomycin.
One other point to bring up is that, however energetic and diligent we doctors might be in withholding antibiotics from our patients, "some 70 percent of the antibiotics used in the developed world are given to farm animals simply to promote growth or as a precaution against infection," wrote Bill Bryson, in his wonderful --if immodestly named--"A Short History of Nearly Everything."
So that is my case to our sick receptionist--who incidentally survived without antibiotics and is back keeping the office running again.