By Ken Cohen, M.D., F.A.C.P
Chief Medical Officer
There are few circumstances in medicine where one type of drug may simultaneously be lifesaving, life threatening, and seriously misused. Most of you are aware that we are in the midst of an antibiotic crisis where bacteria are becoming less and less responsive to our drugs. There are now bacteria that are resistant to all known antibiotics. Antibiotics can cause serious side effects including:
- Altering the bacteria in the intestine can cause problems ranging from mild diarrhea to life-threatening bacterial infections.
- Damage to tendons and nerves, which can sometimes be permanent.
- Allergic drug reactions, ranging from rashes to life-threatening reactions.
Given this challenge, how can we improve our use of antibiotics to maximize their benefits and minimize the toxicities? The good news is that we are learning that there are circumstances where we can now safely avoid antibiotics, or at least significantly shorten the course and lessen the side effects.
Situations where antibiotics are not needed
- Viral respiratory infections (viral sore throats and colds) –antibiotics can only cause harm and never results in a benefit. Sadly, over half of patients seen in urgent care centers for viral infections are still given antibiotics.
- Acute Diverticulitis – This is a serious medical condition that causes inflamed pouches in the lining of your intestine. It has typically been treated with antibiotics, but surprisingly, there is very little evidence to support this approach. New research has shown us that, for mild and moderate diverticulitis, antibiotics do not improve the outcome and can usually be avoided. More severe cases still require antibiotics so this is always a decision you will want to make along with your primary care provider. The other piece of good news is if mild to moderate diverticulitis resolves without antibiotics, diagnostic CAT scans are needed less frequently. This reduces both the cost and radiation exposure from CAT scans.
Shorter courses of treatment – New evidence shows that some common conditions can be treated with fewer doses. Most bladder infections can be cured with a 2 to 3 day course of treatment. Sinus infections, middle ear infections and pneumonia usually need only 5 days of treatment. Using this short course strategy significantly decreases the risk of antibiotic use since most side effects increase with duration of treatment.
Given the gravity and magnitude of the antibiotic overuse problem, it is important for all of us, patients and providers alike, to tackle this problem together. Your primary care provider will stand front and center with you on this journey.