Why Are Doctors So Unwilling to Prescribe Antibiotics?
I was recently overseas and was taken aback by a billboard advertisement that I wish I had seen in the United States. While I couldn't read the entire advertisement since it was in a foreign language, it showed a picture of a woman sneezing into a tissue with the premise of the message saying, "we know you’re feeling bad, but you don’t need antibiotics for a virus." This is such an important message, and I wish it were broadcast more in the United States.
I get it, though: You started with a sore throat which was 3 days of misery, and now you have sinus congestion and a horrible cough that has been going on for another 3-4 days. You've been absolutely miserable for the past week, and now you're coughing up green and yellow junk out of your lungs. This is often when us doctors hear things like:
“This is moving into my chest, and I’m concerned that I’ll develop pneumonia.”
“The last time I had this, I was given an antibiotic, and I got so much better.”
“I’m heading out of town, and I want to knock this thing out before I go.”
Below is a symptom chart that I made MANY years ago that sometimes I show patients so they know what they can expect. Keep in mind that every virus is different, and the symptoms can vary to some degree, but as a general rule, they tend to follow this graphic. Ironically, patients usually come to the doctor with their symptoms between day 4 and 7 below. If (inappropriately) given an antibiotic during this time, the soon-resolving symptoms get attributed to the “antibiotic working” when, in fact, the illness is just following the natural course and your immune system is making you feel better not the antibiotic.
While all of these arguments or reasons are certainly valid, they still don’t represent a good reason for antibiotics. While antibiotics are mostly harmless, they can certainly present some concerns. The two main concerns are very real concerns though which are:
Risk of Resistance from repeated antibiotic exposures over the years
Each time you receive an antibiotic, the antibiotic indiscriminately kills off bacteria (while not killing viruses). Our body houses around 38 trillion bacteria (38,000,000,000,000). The antibiotic will kill many of them but not all. Now, we need to ask ourselves what was different about the bacteria that did happen to survive?
The answer: they may have had a mutation that allowed them to survive against the antibiotic.
The problem: Now you’ve killed all of the bacteria without that mutation leaving behind only resistant bacteria. These are the bacteria left to grow and re-culture your body. We have just selected for resistant bacteria by using the antibiotic. When the process gets repeated many times over the years, we end up with a urine culture that looks something like this one:
In this real-life example, the bacteria are literally resistant to almost every antibiotic class. The only options left are a rarely used medication called Amikacin, which is essentially never used due to the serious risks of causing hearing loss and permanent kidney damage. If you’re administered Amikacin, it’s a last resort, and you’re almost dead.
The only other option is an IV-only medication called meropenem. In this particular case, the patient needed a semi-permanent indwelling catheter called a PICC line and frequent trips back to the hospital to administer the very expensive IV-only medication. I can’t stress enough that this is a REAL situation and unfortunately, not that uncommon. I also can’t stress enough that this situation would have been completely avoided by omitting years of unnecessary antibiotics.
2. Risk of Clostridium difficile colitis
Killing off “good” gut bacteria, also known as “normal flora,” runs the risk of allowing abnormal “bad” gut bacteria, called C. diff, to propagate and grow within the colon. Fortunately, this is much rarer than antibiotic resistance mentioned above, but not rare enough that I haven’t seen people succumb (die) to C. diff colitis. Essentially, the abnormal “bad” bacteria causes diarrhea around 30 times per day. Thankfully, this is often curable, but it can lead to a situation where we need to use a stool transplant (yes, you read that correctly—someone else’s business gets put into your business) to cure the condition. Again, I wish I were just being dramatic and you could write off this as a scare tactic, but this really happens and far too frequently.
So what can you do?
ALWAYS consult your doctor, but below are some symptomatic management strategies that can help you feel better while your body clears the infection:
Sudafed for sinus congestion (if you don’t have problems with high BP)
Ibuprofen or similar NSAIDs (if you don’t have stomach ulcer history or kidney issues) to help with fevers, headaches or sore throat.
Hydration: A mixture of low calorie Gatorade (or Pedialyte) and water. Those electrolytes are important. I usually recommend a 50/50 mixture.
Cough suppressants: Mainly at night to help with sleep. Honey works better than most OTC products. Remember that coughing IS GOOD. And coughing up green and yellow junk is EVEN BETTER. This tells me that you’re starting to clear mucous containing white blood cells that have helped to clear the viral infection.
Humidification: Sleeping with a humidifier at your bedside can help loosen up those chest secretions and allow for quicker clearance.
Time: This takes time to go away. Sometimes the symptoms last for 3-4 weeks, especially the coughing.
I’ll end with this viral BINGO card that I recently found on one of the doctor forums that I frequent. It gave me a good chuckle because, without fail, I fill my entire BINGO card every year. But I’m holding out hope that with enough education, someday my BINGO card will remain empty!
