Gamble Much?

There has been a lot of medical buzz around antibiotic resistance. Two common questions: When should I take them? When should I watch and wait? It reminds me of some Kenny Rogers lyrics, "You gotta know when to hold 'em, know when to fold 'em, know when to walk away, know when to run..." (you know the rest). Now, you are likely humming that song instead of focusing on what I am about to write.

Most folks, now-a-days, have been educated on why they did not get an antibiotic after waiting in their doc's office for 2 hours coughing and sneezing their heads off. There has been a massive medical push to educate the public on antibiotic resistance and why it's important to only prescribe when truly necessary. Generally speaking, most folks know that antibiotic resistance is on the rise and many are aware there is no need to take antibiotics for everything, yet the CDC reports and estimated 50% of people are still inappropriately prescribed antibiotic therapy in an outpatient setting (this includes unnecessary antibiotic therapy as well as incorrect antibiotic therapy). Wrapped within that stat is the knowledge provided that 1 in every 3 folks are going home with an antibiotic that they may not have needed.

Though providers are highly educated, they are still prescribing. It's not that they want antibiotic resistance to continue to rise. No one is plotting for another super bug to be borne of resistance. Just a quick FYI: approximately 23,000 people die each year from a super bug that is resistant to the common and uncommon antibiotic therapies. The estimated cost of treating super bugs is well over $20 billion a year and on the rise. So, why still prescribe though many know there is no need for an antibiotic? Pressure? Patient satisfaction? That is possible, but I cannot answer for everyone. However, I did find one interesting study released in May 2018 titled "Patients’ and Clinicians’ Perceptions of Antibiotic Prescribing for Upper Respiratory Infections in the Acute Care Setting" This was a smaller study that included both clinicians and patients. They were all given a survey regarding the benefits of prescribed antibiotic therapy vs being sick. Turns out, both providers and patients counted on the gamble that a patient may just feel better after taking the antibiotic without regard to the risk of side effects or resistance. They had the, why not take the risk, mindset.....That sure is a gamble. "You never count your money, when your sittin' at the table, there'll be time enough for countin' when the dealins' done." Well, since Summer is quickly fading into Fall, let's go over some basics that may help you understand why you may not be getting an antibiotic and when to decide it is time to fold your hand and see your healthcare provider.

Many people will visit their providers in the up coming months with complaints of a cough, runny nose, congestion, sinus pressure, sore throat, and an ear ache. These are all the wonders of fall and winter (well, even spring and summer but not as much) because we are trapped indoors with everyone else's goo and we become walking petri dishes...see my blog on germs. Gahhh.

Are antibiotics needed to treat any of these or all of these? Sit down, this may surprise some of you.....the answer is........drum roll pleeeeaaassseee?


For real? Yes. 'Tis true folks. There are numerous studies too numerous to count that back up this blasphemy. The decision to "watch and wait" for most relatively healthy folks, is one that is supported by the the American Academy of Family Physicians for ear infections, sinus infections, and bronchitis. It is a more recent recommendation of the National Institute of Health and Clinical Excellence in the United Kingdom to not treat healthy adults with an antibiotic who present with acute bronchitis. In fact, in a recent Cochrane meta-analysis (nerdy, I know) 17 trials were reviewed where 5100 participants with bronchitis were either treated with an antibiotic or not treated...those treated only showed recovery by a whopping half of a day. I kid you not. What the WHAT?

Most of these nasty infections are self-limiting and just need symptom management without antibiotic therapy. Now, if you have a chronic illness that decreases your immune response, such as diabetes, COPD, heart failure, or you are 65 years or older, then you may need an antibiotic on board because illnesses can quickly turn south. For instance, if you have COPD and come in with acute bronchitis, it is likely you will get an antibiotic to help treat and/or prevent bacterial infection from grabbing hold.

The important thing to keep in mind, if you are a relatively healthy person, is that most of these infections are caused from a virus and antibiotics do not work on viruses. Treating these illnesses with an antibiotic does not help with the symptoms and can cause numerous other issues, like abdominal cramps, diarrhea, vaginal yeast infections, rashes, headaches, and RESISTANCE. So, do the risks seem more pleasant than the current infection?

If you are sick for a few days or more and you feel like a hot turd stuck to a Mack truck tire, then visit your health care provider. Have a candid conversation with him or her about whether you need an antibiotic. Allow them to offer you more education on symptom

management and treatments that may be more beneficial in the long run. They will do a great assessment and also be able to tell you whether you truly need an antibiotic or not. They typically are also good at describing the risks vs the benefits and possible side effects of any antibiotic you may be prescribed. If not, then call me. I love candid conversations.

I hope you feel awesome this coming cold and flu season! More to come on the flu and pneumonia vaccine. I bet you can't wait. For now, "Every gambler knows the secret to survivin' is knowin' what to throw away and knowin' what to keep." Do you need to gamble with that antibiotic?

I love Kenny Rogers.

  1. David A. Broniatowski, Eili Y. Klein, Larissa May, Elena M. Martinez, Chelsea Ware, Valerie F. Reyna. Patients’ and Clinicians’ Perceptions of Antibiotic Prescribing for Upper Respiratory Infections in the Acute Care Setting. Medical Decision Making, 2018; 38 (5): 547 DOI: 10.1177/0272989X18770664




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