Flu season is in full swing, and staying healthy is top of mind for patients and providers alike. While coughs, colds and sniffles find their way into nearly every family, medications are not one-size-fits-all. In fact, using antibiotics to treat viral infections like the common cold can do more harm than good. During Antibiotic Awareness Week (November, 12-18), physicians are working to educate the community about risks and benefits of the commonly prescribed drugs.
The role of antibiotics
There’s no question that antibiotics save lives and are important tools for treating a number of common and more serious bacterial infections, like those that can lead to sepsis. In the past, however, it wasn’t uncommon to take antibiotics for viral upper respiratory infections, often prescribed on a “just in case” basis. Today, doctors recognize the potentially harmful effects of antibiotics, particularly in the absence of a bacterial infection. According to the Centers for Disease Control and Prevention, at least 30 percent of antibiotics in U.S. outpatient settings are prescribed unnecessarily. Any time antibiotics are used, they can cause side effects and lead to antibiotic resistance, one of the most urgent threats to the public’s health. Antibiotic resistance happens when bacteria develop the ability to defeat the drugs designed to kill them. Each year in the United States, at least two million people become infected with bacteria that are resistant to antibiotics and at least 23,000 die as a direct result. Many more die from complications from antibiotic-resistant infections.
In general, families seem more educated on the role – and risks – of antibiotics. “The prescribing of antibiotics has seen a big shift in recent years, especially in pediatrics,” said S. Shaefer Spires, M.D., infectious disease specialist with Vanderbilt Infectious Diseases at Williamson Medical Tower. “Parents today typically understand that they won’t get a prescription for an antibiotic unless their child really needs it, and most seem to be ok with that.”
However, Spires said antibiotics are still responsible for 20 percent of ER visits related to adverse reactions from a medication. Common complications include drug resistant infections, allergic reactions, rashes and C. diff — bacteria that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. “It’s not just a matter of having more people here, but the overall percentage is going up,” he explained. “I’m passionate about antibiotic awareness because I see these complications in my practice.”
Bacterial vs. viral
Distinguishing between a bacterial infection and a viral illness such as a cold, flu or bronchitis can be tricky, even for a provider. Knowing what to look for, and when symptoms start, can help steer patients toward the safest treatment.
“Viral infections are a lot more contagious, and if you have something going around the household there’s almost a guarantee it’s an upper respiratory virus,” Spires said. While viral illnesses aren’t completely avoidable, patients should take a proactive role in minimizing health risks. With influenza expected to hit 30 to 60 percent of Americans in 2018-19, providers are encouraging patients to receive the flu shot, still considered the best defense for staying healthy this winter.
Duration of symptoms also matter. For example, a sinus infection that lasts more than two weeks or that gets progressively worse may be bacterial, and warrant antibiotics. Patients with worsening symptoms including increased weakness, prolonged fever or inability to keep fluids down should also follow up with their doctor.
Recent data shows outpatient antibiotic prescription rates decreased 11 percent from 2011-2014, although numbers spike again each winter during respiratory virus season. Spires said diagnosis rates for conditions like bacterial pneumonia simply don’t justify the number of prescriptions being written during virus season. “We can only presume that most people are getting antibiotics that aren’t appropriate for them,” he said, noting that many patients still don’t understand risks associated with them.
“Sometimes patients will say, ‘If there’s even a chance it’s a bacterial infection don’t you think I need it?’ In reality, there’s a very small risk of your illness being a bacterial infection, so that’s a myth I want to get rid of.”
About Dr. Spires
S. Shaefer Spires, M.D., is a physician at Vanderbilt Infectious Diseases at Williamson Medical Tower, located at 4323 Carothers Parkway, Suite 400, in Franklin. To schedule an appointment, call (615) 936-1174.
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