Too much can kill; the scourge of antibiotic excess
The discovery of antibiotics in the 20th century represents a pivotal moment in human history. Prior to this, the doctor could only sit at the bedside, with a look of concern, prescribe a malodorous poultice, and dab something on the forehead to “break” the fever. None of this did any good. Now we have the awesome power to kill the invader, with little harm to ourselves. With this new-found power comes responsibility. Shortly after the discovery of Penicillin, Alexander Fleming himself observe the problem of resistance and said, “the thoughtless person playing with penicillin treatment is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism. I hope this evil can be averted.”
Unfortunately, half the time in this country, this wonderful weapon is being squandered on illness where antibiotics are useless, have no effect, and can only cause harm. I have witnessed patients and friends being dispensed antibiotics because they “think they may get a cold.” This is a double act of foolishness. You don’t treat a disease does not exist in the patient, and you don’t prescribe a useless treatment that can only harm. It has been repeatedly shown that antibiotics don’t prevent respiratory infections. One study predicted that over 12,100 patients would have to be given a course of an antibiotic to prevent one case of pneumonia in a patient with a chest cold. Many would suffer side effects, rashes, diarrhea, colitis, and a few would die of the side effects, all to prevent one case of pneumonia that certainly could be cured with a brief course of a properly prescribed antibiotic.
Cases of overuse abound daily. 95% of bronchitis is viral, yet over 72% of patients get an antibiotic. It has been suggested that the term “bronchitis” be abandoned, and it be given a more accurate term, “chest cold.” Only 10% of adult sore throats are bacterial, yet 60% get a script. Only 9% get the right antibiotic for a bacterial sore throat if it were truly bacterial. Green mucus is not a sign of sinus disease, it happens on day 2-3 of a cold and comes from the body’s white cells fighting infection. Generally, we should not consider it bacterial sinusitis unless symptoms are present for at least 10 days.
We pay for this careless overuse. Antibiotic overuse currently kills 50,000 in Europe and the USA. It is predicted by the WHO that this may eclipse cancer as a cause of death by the year 2050. One infection, C. difficle colitis, is caused almost exclusively by antibiotics. It kills 29,000 per year in the USA. It is the only healthcare caused infection that is increasing.
Unfortunately, economics and the desire to please the patient, even when they are wrong, is causing this crisis. Providers are often judged by how well the rate in patient satisfaction surveys and how quickly they can get the patient out the door. The accuracy of the diagnosis and the brilliance of the treatment play no role in determining the worth of the provider to the organization. One physician found that he could increase his satisfaction score and salary by 16% by simply prescribing Zithromax to all patients with a cough. A newly trained practitioner at a local clinic was properly telling patients they had a virus and only needed to rest and take fluids. She was soon ushered into the business managers office and was told firmly to prescribe more antibiotics because the patients expect it. A study last month in the AMA Journal of Internal Medicine reported that 45% of the time, an antibiotic is improperly prescribed for the wrong indication in an Urgent Care Center versus 15% of the time in a physician’s office.
Patients and providers must partner with each other to properly use and preserve this wonderful tool which we have discovered. Patients need to accept that most infections are viral and respect the doctors advise and not demand an antibiotic. Providers must be strong and wisely dispense this weapon. Providers must resist the demands of patients, understandably ill with a viral infection and only dispense when the suffering is due to bacteria. Medical people must stand up to administrators with no medical training who insist we get the patient door-to-door in 45 minutes and fill out a satisfaction survey with all 10’s. We must listen to the sage advise of Mark Twain, ” Always do what is right. It will gratify half of mankind and astound the other.”
This article brought to you by the Forest-Warren Eldercare Council.
Dr. William Sonnenburg, D, FAAFP is Aseracare Hospice Medical Director.