It is common for people to think that their doctor will prescribe them an antibiotic to “cure” a cold, influenza (flu) or bronchitis, and they are surprised when their doctor does not. The truth is health care providers should not and usually do not prescribe antibiotics. Antibiotics only work against bacterial infections. Almost all colds and bronchitis infections are caused by viruses, not bacteria.
So why not at least give antibiotics a try? For years, health care providers have admittedly over-prescribed antibiotics for colds and bronchitis. Many patients have had experiences where they were prescribed an antibiotic and felt much better in a few days. But studies have consistently shown that people who were prescribed a sugar pill got better at the same speed as those patients on antibiotics – the body simply healed itself, although the patients were giving credit to the antibiotics.
Doctors are becoming much more careful about prescribing antibiotics because they are powerful medicines that can actually cause harm, both to the individual patient and to society. Antibiotics have many potential side effects such as diarrhea (including episodes caused by a potentially life-threatening strand of bacteria, clostridium difficile), vaginal yeast infections, allergic skin rashes and anaphylaxis (swelling of the airways). Any time a medication is prescribed, the physician and patient need to review if the benefits of a certain medication outweighs its risk.
A recent study helped to clarify the risks and benefits of antibiotic use for upper respiratory tract infections. The study found there is about a 1 in 4,000 chance an antibiotic will prevent a serious complication, a 5 to 25 percent chance it will cause diarrhea, and about a 1 in 1,000 chance a person will wind up in an emergency room from a bad reaction to the antibiotic. The risks simply do not justify the benefit.
Resistance is another very important reason for not prescribing an antibiotic for a virus. We all have bacteria that we naturally carry in our bodies (such as in our nose and throat). This bacteria is “good” bacteria that protect us from infection and illness. When you take antibiotics for a virus, the bacteria in your body becomes resistant to the antibiotics. What can this mean? In the future, if you have an actual bacterial infection, the antibiotic may not work. And, you can spread antibiotic-resistant bacteria to the people around you. In fact, there now exist bacteria such as methicillin-resistant staphylococcus aureus (MRSA) that are resistant to antibiotics and pose a concern for communities at large. There are serious concerns that, in the future, we will be unable to treat certain bacterial infections due to resistance that has developed from inappropriate use of antibiotics.
There are times when symptoms of a potential bacterial infection are present and antibiotics are appropriate. Your doctor can guide you through the decision process. If an antibiotic isn’t the right medication for you, talk to your doctor about over-the-counter and home remedies that may help. If your symptoms continue for a week or two, or suddenly get worse, go back to your doctor for help.
Dr. John Holly is a primary care physician with WakeMed Physician Practices – Brier Creek Medical Group.
Dr. Brian Klausner is a primary care physician with WakeMed Physician Practices – City Center Medical Group.