HYANNIS – Life before antibiotics was very different from life today. A simple paper cut could potentially lead to a life-threatening (or life-ending) infection. One of the greatest risks of any surgery was infection. Both mothers and babies were at risk (and commonly died) from infections related to childbirth. War was always hell – but the infections following the injuries incurred could lead to a terrible kind of hell.
Over the millennia, physicians have sought a variety of treatments that would now seem difficult to imagine, but were often the best there was to offer. We now have, across the globe, nearly phased out fever thermometers containing a tiny amount of mercury, yet for centuries mercury was the treatment commonly used for syphilis. Topical iodine or bromine (which was very painful) was used for the treatment of infected wounds and in attempts to stem losses from gangrene. As late as the early part of the last century, bloodletting was accepted as appropriate treatment for many infections, including pneumonia! The red and white stripes on the pole of barber shops have their origins in early advertisements of the bloodletting services provided by the “barber-surgeon” at the location.
The discovery of penicillin by Alexander Fleming in 1928 truly marked a new day for medicine and the treatment of a variety of diseases. But, with the advent of the antibiotic age, came (by 1940) the identification of antibiotic resistance. When bacteria and fungi evolve to be able to survive the antibiotic treatment that had formerly led to their elimination, they have successfully become “resistant.” The antibiotics that were once life-saving tools to defeat an infection no longer work. It is currently estimated that every year in the United States alone at least 2 million people become infected with bacteria that are antibiotic-resistant. At least 23,000 Americans die as a result of this resistance.
The use of antibiotics as a treatment can be lifesaving, but it is not benign. Antibiotics can cause significant side effects and can lead to antibiotic resistance. At a variety of levels, locally and nationally, organized medicine is recognizing the importance of making appropriate use of antibiotics a high priority. It’s currently estimated that of approximately 47 million prescriptions, about 30 percent of antibiotics prescribed, are unnecessary.
The reality is that doctors not only need to be sure we are carefully prescribing only the most appropriate antibiotic for a particular infection (which we do need to focus on), we also need to educate the community not to demand antibiotics for the many common illnesses which they have no ability to treat or cure.
Antibiotics help to treat many infections that are due to bacteria or fungi, and may be appropriate to be used if an infection is related to them. Many causes of illness however (e.g., colds, flu, bronchitis) are caused by viruses. Antibiotics are ineffective in treating viral illness and, in fact, the use of antibiotics in these instances can lead to side effects such as nausea, vomiting or diarrhea, and can lead to infections such as Clostridium Difficile (“c. diff”) which can severely damage the colon and even lead to death!
Viral illnesses are often best treated with supportive measures – fluids, cough suppressants, decongestants, acetaminophen or non-steroidal anti-inflammatories (e.g., ibuprofen) and rest. The CDC has an excellent resource to help quick symptom relief: https://www.cdc.gov/antibiotic-use/community/for-patients/symptom-relief.html
Please help us in our efforts to combat drug resistance by educating friends and neighbors that leaving a PCP office or urgent care without a prescription for antibiotics is perfectly acceptable, and not cause to see someone else.
By DR. DONALD A. GUADAGNOLI, MD
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