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Why Antibiotics Aren't a Cure-All
Overuse and misuse of antibiotics is a public health concern. How can you protect your family?
If your child has strep throat, antibiotics will likely be a part of their treatment. But would antibiotics help with a common cold or seasonal flu? The answer is no, for the simple reason that antibiotics treat bacterial infections not viral ones. Yet many people still think of antibiotics as a magic cure-all.
The over-prescription of antibiotics has become a public health concern. Half of the prescriptions for antibiotics in the United States may actually be unnecessary, according to a recent study; and the Centers for Disease Control and Prevention reports the highest rates of antibiotic use are among children.
What’s the story behind these numbers — and what are the health consequences of so many antibiotics being prescribed?
“Doctors need to do a better job of setting criteria for using antibiotics, and when they are using them to make sure they’re using the right ones,” said Amanda Beach, MD, a pediatrician at St. Vincent Medical Group in Carmel, Ind. “If we keep using antibiotics for illnesses that aren’t bacterial, then they’re not going to be effective.”
Since the 1940s, antibiotics have been extraordinarily beneficial in fighting infectious diseases. But these drugs can target bad bacteria that cause illness as well as good ones. Beneficial bacteria help our digestive system break down food. Scientific evidencesuggests that gastrointestinal or “gut” bacteria may even protect against autoimmune diseases such as rheumatoid arthritis and multiple sclerosis.
"Our findings suggest potential strategies for using normal gut bacteria to block progression of insulin-dependent diabetes in kids who have high genetic risk," said Jayne Danska, PhD, lead researcher in a January study.
The increased use of antibiotics over decades has had the adverse effect of making bacteria stronger and more resistant to drugs. Incidence of infections like MRSA, or methicillin-resistant Staphylococcus aureus, a dangerous staph bacteria, has increased at an alarming rate. The situation is so serious, the CDC lists antibiotic resistance among its top concerns.
So why are many people quick to turn to antibiotics?
“Parents want to be reassured their child is going to be okay, and some parents associate that with getting medicine,” said Ian Paul, MD, a professor of pediatrics at the Penn State College of Medicine.
Paul points out that first-time parents may be more inclined to want immediate treatment for their child, whereas parents with multiple kids may be better informed about their options. “Increased awareness about antibiotic resistance has helped parents realize that they don’t cure everything,” said Paul.
Parental attitudes toward medication can also influence how doctors handle treatment. CDC research suggests that pediatricians prescribe antibiotics 62 percent of the time if they perceive parents expect them to — as opposed to only 7 percent of the time, if parents don’t press for them.
“Doctors need to make sure parents have appropriate expectations,” Beach said. “Parents need to realize their kids aren’t going to be 100 percent better in two days even if they’re on antibiotics.”
Beach thinks doctors can do a better job educating parents about the differences between a bacterial infection and a virus. That can be especially tricky when dealing with a common childhood condition likean ear infection, which can be caused by either bacteria or viruses.
“Most parents just don’t understand that most of the time if a child’s eardrum is just red with no fluid or swelling, it’ll clear up on its own,” Beach said. “You tell parents to watch their child and if the symptoms get worse, then to bring them in again and we’ll see if antibiotics are necessary.”
Paul agrees that “you have to balance many factors when choosing whether or not to prescribe, and sometimes it can be very difficult to tell if it’s a viral or bacterial infection.”
Another consideration is what type of antibiotic to use. Broad-spectrum antibiotics, such as the commonly used azithromycin (“Z-pack”) and erythromycin, attack a wide range of bacteria. But there are also narrow-spectrum drugs available when doctors identify and want to target specific bacteria that are the underlying cause of illness.
“You want to save the broad-spectrum drugs for an emergency, or when you don’t know what the infection is,” said Paul. “If they’re prescribed for everything, they lose their effectiveness over time, as we’re seeing with resistant bacteria strains.”
The good news is that antibiotic prescriptions for children have come down, as awareness of the consequences of overuse grows. “Over-prescribing still exists, but not to the extent that it once did,” Paul said. “Doctors should do the best they can to help parents understand their child’s illness and when antibiotics are necessary.”
Last Updated: 05/06/2013