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No Z-Pak for You!*

Don't get me wrong. Antibiotics are great. But our use of antibiotics -- often overuse, misuse or unnecessary use -- has contributed to antibiotic resistance. It is a global public health emergency.
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(*Unless you absolutely need it)

I've had this conversation hundreds, if not thousands, of times. It usually goes like this:

Patient: "I've had congestion for five days now... I have sinusitis, and I need some antibiotics. I have to get better before my trip/important presentation/meeting/wedding/party."

Me: "It is most likely a viral infection. Antibiotics won't help -- we can try other things."

Patient: "I had exactly the same symptoms last year, the doctor gave me a Z-Pak and I was better within three days."

Me: (sighing) "You probably would have gotten better as fast without antibiotics."

Don't get me wrong. Antibiotics are great. Since their discovery, they saved millions of lives around the world fighting infections that were once common killers.

But our use of antibiotics -- often overuse, misuse or unnecessary use -- has contributed to antibiotic resistance. It is a global public health emergency.

According to the Centers for Disease Control and Prevention (CDC), every year -- yes, every year! -- more than 2 million people in the U.S. fall victim to antibiotic-resistant infections. More than 23,000 deaths are attributed to these infections.

This week (November 16-22, 2015) marks the world's first ever antibiotic resistance week -- titled "Get Smart About Antibiotics Week," launched by presidential proclamation, no less!

Perhaps not coincidentally, the World Health Organization (WHO) also designated this week "World Antibiotic Awareness Week."

Antibiotic resistance means that bacteria no longer respond to drugs that were designed to kill them. The result: diseases that become harder to treat, more deadly; the need to use treatments that are more toxic; increased health care costs.

Somehow, we have forgotten that antibiotics are a limited resource: We've been prescribing them inappropriately, using them in food-producing animals, adding them unnecessarily to soaps, clothing, toys and other products, not being vigilant enough about preventing their spread. The organisms themselves, of course, share part of the blame, having developed amazing evolutionary mechanisms to evade and resist drugs of various classes.

While it is true that many of the drug-resistant organisms lurk primarily in hospitals, more and more resistant bacteria (increasingly resistant to multiple drugs) are being detected outside of the walls of hospitals: in nursing homes, emergency rooms, doctors' offices.

In the outpatient settings, where the bulk of my practice is, my colleagues and I increasingly see resistant urinary tract infections (UTIs), skin infections, ear infections, yeast infections. Not enough to scare you? Soon, we may run out of antibiotics to treat gonorrhea, one the most common sexually transmitted infections (STIs). This one is classified as an urgent threat on the CDC's "Biggest Threats" list, responsible for 246,000 infections per year.

Doctors and other health care professionals are certainly part of the problem. Many of us (I have been guilty of this, too, I admit) have prescribed antibiotics when not entirely necessary, or have given the wrong antibiotic (often one that is too "broad" rather than targeted to attack a specific organism). In fact, studies have shown that over 50 percent of antibiotic prescribing in doctors' offices is unnecessary.

Most of the misuse was for treatment acute upper respiratory infections such as bronchitis, sinusitis or pharyngitis (a throat infection).

Consider this:

• Between 90-98 percent of sinusitis infections are viral and won't respond to antibiotics.

• At least 200 viruses can cause the common cold. None will respond to antibiotics.

• Only 5-10 percent of sore throat cases in adults are caused by strep throat.

For those of us who also take care of children, the situation is not that different. We have given antibiotics for conditions "for which antibiotics are not clearly indicated, which accounts for >10 million visits annually."

What about patients and caregivers themselves? There seems to be some confusion out there. A new international survey conducted by the WHO confirmed this, showing that 64 percent of folks surveyed in 12 countries believed antibiotics were effective to treat colds and the flu (they aren't!), 32 percent of respondents believed they could stop taking the drugs as soon as they felt better rather than finish the whole dose (they shouldn't!).

If you are among the confused, or simply the concerned, here's what you should know and what you can do:

• Get vaccinated to prevent infections from happening in the first place

• Most infectious are viral. Antibiotics won't work. Period.

• Remember that coughs and other URI symptoms can take between 7-21 days to resolve. My colleague Dr. Mark Ebell, who studied this issue, found that the average duration of a cough is 18 days. You'll just have to be patient.

• PLEASE do not pressure your doctor to prescribe antibiotics. We may succumb.

• Remember: Many antibiotics have side effects. In fact, antibiotics are responsible for many ER visits for adverse effects and are the most common cause of ER visits for side effects in children. Side effects can range from a potentially deadly anaphylactic reaction to, more commonly, rashes and diarrhea. One of the most common inappropriately prescribed antibiotic -- azithromycin, sold as Z-Pak, or Zithromax -- has been linked to an increased risk of "fatal heart conditions"

• If you are prescribed antibiotics finish the full dose and take it as recommended (dose, frequency, duration). Don't skip doses; don't stop taking it when you feel better.

• Never treat yourself with leftover antibiotics or with somebody else's meds.

• Do not be tempted to buy household products, toys, kitchen counters, clothing "impregnated" with antibiotics. There is no evidence that they enhance health in any way and there is a growing concern that they may contribute to antibiotic resistance and other health problems.

• Ask questions: Do I really need this antibiotic? What are the potential side effects? How long should I take it for? Is there anything else I can do to treat my infection?

• Wash your hands frequently, but know that antibiotic soap is not necessary and may be counter-productive (as I have previously written). Soap and water or alcohol-based cleansers are good enough and offer better protection against viruses.

Speaking of hand washing: Hand washing in health care settings is a major barrier to the spread of resistant infections.

Whether you find yourself in the hospital, the ER, a nursing home, rehabilitation center or community-based practice, watch your health care professional like a hawk: If you don't see some hand-washing action ask not to be touched. We wont be offended. We all need reminders, sometimes. After all, we are part of the problem.

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