Contributing Writer
Sometimes a patient comes in to the clinic and says, “I want a shot so I can get better fast.” Or sometimes the patient just comes in and says, “I want an antibiotic.” I am willing to listen to the patient’s reasoning as long as they are willing to listen to the protocols and rules I am following. First of all, many patients have a history of having bad outcomes whenever they develop a sinus infection or bronchitis. They may have a history of brain involvement with a sinus infection or recurrent pneumonia or bouts of 6 weeks of bronchitis or wheezing whenever they have a new onset of coughing. Usually these people need to be able to get their medication as soon as possible and avoid the repeated complications they suffered in the past.
But to want an antibiotic “shot” just because it works faster is just not accurate reasoning and the risk still has to be balanced with the benefit from the injection. If a person receives an antibiotic injection, it is likely a large dose and may have effects from 24 hours, like Rocephin, or 6 to-7 days, like Bicillin LA. The main purpose for Bicillin LA is as a long-acting penicillin and it is a one time treatment effective for strep throat. Rocephin is a great broad spectrum antibiotic that covers many types of bacterial infections but must be followed by 3 to 10 days of antibiotics by mouth.
I am always conscious of the fact that once an injection is given, it can’t be taken back. If there is a reaction, you are stuck with it for the duration and I should have a good reason for giving the injectable drug; certainly better than just for the sake of convenience.
But what other considerations are there when deciding to order an antibiotic for someone who is feeling just rotten?
I am reading more and more frequently that prescribers are holding off or just not ordering antibiotics for many patients with upper respiratory or ear infections. In ear infections most cases get better without antibiotics if the child is at least 2 years old. Often they will get better without anything other than over-the-counter medications. Sometimes I will give the parent a prescription to hold onto in case the pain, fever, or other symptoms don’t improve in 2 to 3 days to save them an extra office visit. However if we are dealing with a baby especially in the first 6 months, or with a child with 102 fever and ear pain or with other serious pain, antibiotics definitely are called for. For mild pain in the older child, acetaminophen (Tylenol), ibuprophen (Children’s Motrin) or analgesic ear drops might be all that is needed, along with the body’s own disease fighting mechanisms.(Recommendation by the American Academy of Pediatrics and American Academy of Family Physicians.)
According to Prescriber’s Letter, nearly all cases of acute sinusitis improve with just symptomatic treatment, such as acetaminophen, ibuprophen, and decongestants. Antibiotics are really indicated only after 7 to 10 days unless there is a fever and the over-the-counter (otc) medications fail to provide relief. The problem with the otc medications often is due to the patient’s inability to take them due to high blood pressure, thyroid disease, or glaucoma. he choices are narrower and often need to be prescribed then, but not necessarily to include antibiotics.
Sore throats rarely need antibiotics. Only 10% of adults and 30% of children have a streptococcal infection, which requires a form of penicillin or erythromycin. The rest are caused by viruses and are not helped at all by antibiotics.
Bronchitis is caused by a virus 90% of the time, and there are inhalers and medications that can help control the symptoms. However if you have a chronic lung condition or suffer from chronic bronchitis yearly, you will most likely need antibiotics. Sometimes a cough can linger for several weeks after a strong respiratory infection. If you can relate it to a previous infection and see gradual improvement, you do not need antibiotics. However if there is a continual relapse in the condition or you develop a new cough that lasts longer than 10 days, an examination is needed with appropriate tests and treatment. (For a list of common symptoms and viral illnesses that are not responsive to antibiotics, see the article on the Center for Disease Control and Prevention cited at the end of this article.)
Of the 160 million antibiotic prescriptions written each year, 20 to 50% are estimated to be unnecessary. As a result we see a growing number of bacteria resistant to standard antibiotics, leaving us no choice but to order the more expensive, powerful antibiotics for uncomplicated bacterial infections. Moreover, some people develop sensitivities to the older, generic antibiotics resulting in their having to pay for the more expensive antibiotics that are really much stronger than they actually need to be for a minor infection. Even with insurance, the newer, designer antibiotics often have a whopping co-pay.
Antibiotics are not without some serious side effects, which may be rare or fairly common. Beside rashes, yeast infections, diarrhea and itching, there may be a change in the heart’s electrical activity (rare but serious), nausea and vomiting, swelling of the throat with suffocation (life threatening), sloughing of large areas of skin (extremely serious), etc. Of course the onset of any unusual or uncomfortable symptom is a sign to immediately stop the medication and call your prescriber. In some cases as noted above, a quick trip to the emergency room may be best – and take the medications with you for immediate identification.
It’s a good idea to discuss with your healthcare provider the concern you have about not taking an antibiotic if the illness seems to be viral, or due to non-bacterial causes such as allergies or acid reflux (can cause coughing and wheezing in some people). It helps the health professional if you give other pertinent information such as whether others in the family have had the same illness and it seems to run its course in about 3 days. Such discussions help in the decision to medicate for symptoms or for a possible bacterial cause. If you have had a bad experience with a particular medication before, even if you do not think it was an allergic reaction, please let us know. The more information you share with your health care professional, the better and safer your outcome will be.
And remember: frequent handwashing works! It reduces the spread of viral and bacterial infections.
Resources:
Tom, W.C. “Delaying Antibiotics in Uncomplicated Respiratory Tract Infections.” Prescriber’s Letter. November 2006.
Weber, T. “Snort, Sniffle, Sneeze. No Antibiotics Please!” Centers
for Disease Control and Prevention. Web article at:
www.cdc.gov/drug_resistance/community/know-and-do.htm.
JoAnn Lister
is a Family Nurse Practitioner Certified, at both the Marathon Health
Center and Alpine Family Health Care Services. The Marathon Health
Center is open Mondays & Thursdays, 8:30 a.m. - noon, 1:00 - 5:30
p.m. Located at South First at Post Road in Marathon. Phone:
432/386.4316. The clinic accepts appointments and walk-ins. Dr. James
Lueke is the Medical Director. Alpine Family Healthcare Services is
located at 910 East Lockhart Street in Alpine. Phone: 432/837.1541.
