November 25, 2015
Today was a busy day in the office. There is a nasty bronchitis going around town and I saw lots of patients coughing, short of breath, and exhausted – all hoping that I could help. While I could, there is no quick fix and I had to warn them that this, like many contagious viral infections, might last awhile, even with supportive treatment.
In general, people come to the doctor when they don’t feel well. They simply want to feel better and we want to help. As physicians, we are also dads, moms, and people who sometimes get coughed on in airplanes and in our offices, so we get sick too and we don’t underestimate how bad it feels to have a cold, bronchitis, or a sinus infection. It’s miserable and exhausting – and life doesn’t stop for you to sleep, watch Netflix, and eat chicken soup the way it did when you were a kid. Wanting to feel better is normal – we all want to – and many of us associate feeling better with a treatment course of antibiotics.
There are three main points to remember when it comes to antibiotics:
- Antibiotics fix many things and are amazing medicines. We want to keep them that way (more on that later).
- Years back, doctors likely over used them, even when it was inappropriate, simply without knowing. Like in every field, our knowledge in medicine grows with new data and our practices need to change with that information.
- Perhaps most importantly, sometimes our association of feeling better with the antibiotic is really based on time correlation and NOT causation.
The average length of a cold is 7-10 days, with bronchitis and sinusitis lasting a bit longer. Most people wait it out and come to my office on day 3-4 of a cold. By the time they fill the prescription and start antibiotics and feel better in 48 hours – odds are good it’s day 6 or 7. Almost always, they were actually getting better on their own. Their immune system is doing the work, not the medicine. Lastly, people remember getting antibiotics as a kid because, due to anatomy and other factors, children are more prone to bacterial infections, like ear infections and strep throat. The bacterial ear infection part is decreasing now due to vaccination so listen to your pediatrician's recommendation for your own child, but remember, just because you needed antibiotics when you went to the doctor as a child, doesn’t mean you do now.
There are obviously exceptions, which is why we test for things like strep throat in the office and look for pneumonias and acute bacterial sinusitis, but any upper respiratory infection, including a sinus infection or bronchitis, is almost always viral. Treating a virus with antibiotics is a bad idea for several reasons. It is frankly a waste of money on your end and can increase your personal risk of side effects and allergies to the antibiotics. The last thing anyone needs when riding out a cold is to add an itchy rash or an upset stomach to the mix. Also, new data is linking gut bacteria to digestion, brain function, and overall health. Since we can’t give you an antibiotic that only affects your nose or lungs, the pill is going to affect the gastrointestinal tract that has to digest it as well. That is an additional negative with very personal risks and implications.
The biggest negative though is harder to see, because while it may eventually affect you personally, it is more important on a public health scale, similar to vaccines. That negative is antibiotic resistance, a growing problem worldwide.
Bacteria are smarter than they look, and when repeatedly exposed to antibiotics (especially when non-infectious amounts are exposed unnecessarily), they develop ways to "change their armor," so to speak, and adjust whatever mechanism it was that the medicine was using to kill them. Many people have heard of the spread of MRSA (methicillin resistant staph aureus) throughout hospitals and now through more of the general population. It responds to few medications, and particularly if people are allergic to any antibiotic classes, this infection can quickly spiral out of control. There is also a lot of growing antibiotic resistance in bacteria which cause urinary tract infections and even in yeast to the common oral treatment. There is a fear that soon there will be strains of malaria, tuberculosis, and gonorrhea which respond to NO antibiotics. We have immune systems that are smarter than they look too – and we need to use them, to help them by taking good care of ourselves, and to use antibiotics ONLY when appropriate.
In summary, we understand that the frustrating issue which stems from this is the question of “what can we actually do to make you feel better?” To help you fight off the virus and deal with the symptoms that making getting through your day difficult? I promise there are still ways.
Know that when we say an antibiotic isn’t the right choice, it doesn’t mean we are telling you to simply suffer through it. I am not going to list specific options, whether alternative/supplement, over the counter, or prescription, because every case and scenario is different, but if you were sick enough to be considering antibiotics, you should still talk to a provider and be examined, so that your symptoms can be worked up and specific recommendations made.
But remember until then… rest and fluids still help everyone, just like when you were a kid.