ASK THE DOCTOR: Antibiotics are overused and rarely needed
By DR. JIM MITTERANDO
The Patriot Ledger

Q My doctor would not prescribe an antibiotic recently when I had bronchitis. Antibiotics have helped it clear up in the past. I am angry that he did not listen to me and prescribe an antibiotic. I know my body and when I need an antibiotic.

A This is a common situation. People have been programmed to think antibiotics are necessary to fight colds, bronchitis, ear infections or conjunctivitis. Now, patients hear from their health care provider that antibiotics are not necessary. It can be difficult for a sick person to accept and understand that no treatment may be the best treatment.

Many doctors are under pressure to prescribe fewer antibiotics over concerns of drug-resistant bacteria. New studies show most colds, bronchitis, sore throats, conjunctivitis and ear infections improve without antibiotics. This information is forcing doctors to stop writing prescriptions for antibiotics.

Times are indeed changing. Historically, most patients got a penicillin shot when they were sick and went to see their doctor. This treatment no longer applies because current research shows antibiotics only kill bacterial infections not viral infections, which are cold and flu illnesses. Antibiotics have no affect on viral infections.

With or without antibiotics, most patients get well within a week. Cold symptoms such as cough, runny nose or sore throat often can last up to two weeks. Antibiotics do not help these symptoms.

Patients say they improve quicker when they use an antibiotic. This has been scientifically disproved; studies comparing antibiotics to placebo (sugar pill) showed no difference in length of illness or in symptom relief.

Patients say they feel better once they begin a round of antibiotics. However, they have started the medicine several days into the illness. When they improve quickly, patients naturally conclude that the medicine helped. Rather, the average cold lasts about a week - there is a good statistical chance that you will feel better within several days no matter what you take.

Bronchitis
People with a deep cough/bronchitis often believe they need an antibiotic. ‘‘Bronchitis’’ means inflammation of the large airways called bronchi. A cough is a reflex response to such inflammation or irritation. Viral infections cause most bronchitis.

In the past, doctors treated bronchitis with antibiotics. Today the best treatment of a cough is simply time. If the cough is bothersome, take a cough suppressant with dextromethorphan (i.e. Benylin DM, Robitussin DM). Cough medicines do not speed recovery; they only help the symptoms. Generally, a cough does not require antibiotic treatment unless it persists past two weeks or if shortness of breath develops.

The adage regarding mucus or phlegm: ‘‘if it’s clear, it’s viral and if it’s colorful then it’s bacterial’’ is no longer correct. Yellow or green mucus occurs with a viral infection and does not require an antibiotic. The only color to be concerned about is red, which can mean blood and possibly pneumonia.

Ear infections
Parents no longer need to rush their children to the doctor when they suspect an ear infection. New studies reveal that most ear infections improve in three days without antibiotics. If your child does not improve in three days, follow up with your health care provider.

Antibiotics do not help the ear pain associated with an ear infection. Treat the pain with Tylenol (acetaminophen) or ibuprofen (Motrin or Advil). If pain continues, treat with prescription numbing ear drops such as Auralgan.

Sinus infections
A few days of nasal congestion, sinus pain, colorful mucus are not the signs of a bacterial sinus infection. Actually, bacterial sinus infections do not develop until seven to 10 days into a cold when swelling has prevented drainage of the sinuses.

If you develop sinus pressure or pain, try a decongestant pill such as Sudafed (pseudoephedrine). If pressure or pain persists then add a decongestant nasal spray such as Neosynephrine or Afrin. Use these nasal sprays no more than four days. If you do not get any relief in two days with the nasal spray follow up with your health care provider.

Sore throats
Most sore throats are viral and do not require antibiotics. ‘‘Strep throat’’ is a bacterial infection that does improve with antibiotics. Strep throat symptoms include sore throat with headache, fever and stomach ache. If you have a cough or laryngitis with your sore throat, then you probably do not have ‘‘strep.’’

Conjunctivitis
Most conjunctivitis (pink eye) is viral and often associated with a cold. Conjunctivitis typically will clear in three to seven days without antibiotic eye drops. If it does not improve by five days, follow up with your health care provider for evaluation and possible treatment. Cleaning the eyes with wet washcloths frequently will help it to clear sooner and help relieve symptoms. Antibiotic eye drops do not help it to clear any quicker. Green or yellow discharge does not require antibiotic drops unless it does not clear by five days.

Only a minority of cases of conjunctivitis do not resolve spontaneously and require treatment with antibiotic eye drops or ointment.

Overuse of antibiotics has contributed to the rise in drug-resistant bacterial infections. In addition, antibiotics may also cause side effects such as rashes, diarrhea, yeast infections, nausea and vomiting. Some reactions to antibiotics are serious and potentially fatal.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2002 The Patriot Ledger
Transmitted Tuesday, November 05, 2002