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Cold and flu season is upon us. And medical professionals want us to know that when the sniffles, congestion, cough and other symptoms arise, patients and doctors must work together to ensure a correct diagnosis and treatment. 

While it’s natural to seek relief, it’s important to understand that antibiotics are not always the route to take. 

In fact, too many antibiotics can lead to chronic, and sometimes fatal, complications.

 

Resistance

As soon as we our born, our bodies begin producing microbiota — bacteria, viruses and fungi, especially found in the skin and intestine, according to Rutul Dalal, medical director for Infectious Disease, and chairman of Infection Prevention and Control for UPMC Susquehanna. Their purpose, he said, is to fight infection and help the human body to recover.

As the years progress, the body is exposed to other antibiotics, such as chemicals, bacteria and fungi, which can also fight infections. 

However, as the microbiota continues to change, the irregular resident bacteria, he said, “can sometimes be harmful.” The bacteria that should be in the body, he explained, starts to diminish, and other microbiota take their place.

If the human body continues to be exposed to antibiotics, it can build up a resistance and not have the ability to fight.

A common clinical condition caused by the overuse of antibiotics, Dalal said, is “Clostridium Difficile diarrhea/colitis, known more commonly as C. Diff. diarrhea.”

“We are beginning to see a rising rate of antibiotic resistance,” said Frederick Lapp, medical director of Urgent Care of Evangelical. 

In particular, this is seen in severe infections such as MRSA (methicillin-resistant Staphylococcus aureus).

This type of bacteria, he said, does not respond to typical drugs. In addition, ESBL (Extended-Spectrum Beta-lactamase) urine infections often require people to be hospitalized for IV antibiotic, because the medical world has lost the ability to treat it with an oral solution.

“The impact is real,” he said, adding that while a young person may not see immediately the effects of antibiotic overuse, “later on in life, they could develop resistance.”

According to James Pagana, M.D., of Family Practice Center in Selinsgrove, short- and long-term consequences of overprescribing antibiotics are possible. C. Diff. remains a common “severe and sometimes life-threatening infection,” he said, while “short-term dangers include side effects like nausea, vomiting, stomach upset and diarrhea.”

In addition, there is always the possibility of allergic reactions, “from mild rashes to life-threatening anaphylactic shock.”

But antibiotic resistance remains “the most concerning long-term/secondary consequence” of this overuse.

“Essentially, we risk causing the development of more ‘superbugs’ that conventional antibiotics do not treat,” Pagana said, adding, “Eventually, if inappropriate antibiotic prescribing remains common, most of our antibiotics will stop working.”

It’s a battle that has been fought, Lapp said, “ever since the dawn of the antibiotics age.”

“We’ve been dealing with bacteria that radically become resistant and reproduce so rapidly.”

Dalal said at least nine different products have been developed in just the last few years to fight this fast-replicating bacteria. But it’s necessary to use them judiciously, he said, and avoid that danger of resistance.

“We’re barely above water in a hunt of new antibodies,” he said. “There are four to five more in the pipeline, but it’s a constant battle. So far we have been fortunate.”

 

Stewardship

While antibiotic overprescribing has been going on for years, Pagana said, “There is more awareness of the issue over the past couple years with programs targeted toward antibiotic stewardship, so we are making progress.”

But to continue that progress, it is necessary for both medical providers and patients to work together.

“Providers are often pressured by patients to prescribe antibiotics inappropriately,” Pagana said. “Generally speaking, our country’s medical system is one that expects immediate results. It is often difficult to accept a prescription for a tincture of time with reassurance that symptoms will resolve on their own.”

The desire for relief is understandable.

“It’s very inconvenient to be sick,” said Ayn Kerber, a physician with Family Medicine of Evangelical, Lewisburg – West Branch Medical Center. What’s important is knowing whether the illness is viral or bacterial.

“A lot of times the body just needs to run its course,” Kerber said. “Part of our job is to help people know how to get better,” and that “antibiotics does not equate to getting better faster.”

It can take 10 to 14 days for a virus to clear out of the body, she explained. Often, the best course of action is treatments such as decongestants, cough suppressants, and inhalers, to minimize the discomfort.

“Usually the body will take care of itself without the need of an antibiotic,” Kerber said. “Helping people to understand that…empowers them to help themselves manage their own expectations of when this will improve. And to know when to come back and say, ‘I’ve tried these things’, and know what are the warning signs of getting worse that would require an antibiotic.”

Lapp said antibiotic stewardship is a “multi-layered approach” that first requires using antibiotics only when it’s actually treating a bacteria illness. If the illness is viral, antibiotics will do nothing to help. In addition, it’s important that the correct form of antibiotic be used when it is necessary. This is based on both the “local resistance patterns” and a focus on using the narrowest spectrum form of antibiotic – “the antibiotic that is more directly targeted at whatever the infection is,” he said.

For example, to treat strep throat, penicillin is adequate, so a broad spectrum antibiotic is not needed.

Some of the most common illnesses treated by antibiotics are upper respiratory tract infections, strep throat, and UTI or ear infections. However, Dalal explains, “Many times, these infections are produced by viruses, which do not require antibiotics.”

Pagana said common cases of sinusitis and bronchitis “are often mistake to be caused by bacteria”, and said that in general, acute upper respiratory infections and GI illnesses do not require antibiotics.

“A general rule of thumb,” he said, “is to try and avoid making an appointment to be evaluated until at least one week into their illness.” However, if there are any severe or concerning symptoms, an evaluation should be done sooner.

When an antibiotic is determined to be necessary, Dalal said, “use them for the correct period of time, and the correct dose.” Never stop taking the antibiotics if you start to feel better, as this can alter the human microbiota in your body. A bacteria can lay dormant and return, causing a major infection – at that point rendering the antibiotic ineffective.

One of the best ways to ensure that we receive the right kind of care is to stay within the same health system when an urgent care visit is necessary. Kerber explains that having a primary care provider gives continuity to treatment, and an urgent care within the same system would have access to the same records. She encourages, however, that patients take effort to advocate for themselves and if traveling, keep with them a thorough record of their medications and diagnoses.

 

Prevention

The best way to avoid the dangers of antibiotic resistance is to protect your body from bacterial infections in the first place.

According to Kerber, a good prevention of the common cold, is to follow the basics: frequent handwashing, use of sanitary wipes at the grocery store, and the use of hand sanitizers. If you do feel yourself coming down with an illness, increase your fluid intake, get plenty of rest, and take vitamin C and zinc supplements.

In regard to handwashing, Dalal said it’s especially important if you are exposed to someone who is sick, to wash with soap and water. Duration of handwashing is also important – he suggests at least 20 seconds. In addition, if someone who is sick comes into your area, be sure to clean with Lysol or mild bleach all the areas that the person may have touched. Bed sheets should also be washed separately.

Dalal also encourages watching what you eat, especially when it comes to meat. He urges buying meat that is fresh, and to “try to go organic if possible.” Avoid meat that has been treated with artificial hormones or antibiotics. Make sure the meat is cooked and heated at the right temperature, and consume perishable items quickly.

According to Pagana, “without question, the most important prevention strategy is to be up-to-date with your immunizations as recommended by the CDC or your doctor for your age and comorbidities.”

He also encourages getting the flu shot each year: “Seasonal influenza remains one of the deadliest epidemics every year, and despite what you may hear from certain sources about the vaccine, it is safe and better than doing nothing.”

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