Friday, November 30, 2018

When the best prescription is no prescription

By Philip Robinson, MD
California Physician, Infection Prevention

This article originally appeared on

“Get rest and drink plenty of fluids,” might not sound like adequately aggressive medical advice. If you’ve dragged yourself out of bed to visit an urgent care or your doctor’s office, you will probably feel somewhat cheated by an admonition to head right back to bed and stay there until you feel better.

Most likely, you’ll want a prescription for an antibiotic. You might even demand it.

Nearly half of the antibiotics prescribed in
the U.S. are unnecessary and can lead to a
rise of drug-resistant bacteria.
Don’t. Antibiotics are not the harmless miracle drugs the public and many physicians think they are. Side effects range from a bad rash (amoxicillin) to a ruptured Achilles tendon (Cipro) to a stopped heart (azithromycin, or Z-Pak). And if we keep using them indiscriminately, they might not work when we really need them.

Nearly 50 percent of all antibiotics prescribed in the U.S. are unnecessary and can lead to a rise of drug-resistant bacteria. The most notorious of these “superbugs” are methicillin-resistant Staphylococcus aureus (MRSA), which are resistant to many antibiotics and are associated with 11,000 deaths per year.

Bacteria could evolve into superbugs in our bodies each time we ingest antibiotics. In addition to MRSA, our community now faces drug-resistant forms of tuberculosis, gonorrhea, staph infections and gram-negative bacterial infections, which are not only drug-resistant but can pass along genetic code that allows other bacteria to become drug-resistant as well.

This bacterial evolution hastens us to a post-antibiotic era, a time when a simple bacterial infection can be deadly because antibiotics have stopped being effective.

Antibiotics can also cause infections. In their quest to eradicate “bad” bacteria, antibiotics also indiscriminately destroy the “good” bacteria our bodies need to help us digest food. This can lead to such conditions as Clostridium difficile, or C. diff, which causes severe diarrhea and is associated with more than 29,000 deaths per year.

Across the nation, we are seeing a terrifying rise in cases of C. diff, as physicians, nursing homes and patients continue to think of antibiotics as benign.

Don’t get me wrong, I am a fan of antibiotics. Without them, many simple surgeries and organ transplants would not be possible, bacterial meningitis would be universally fatal, and countless numbers of people would die from wound infections.  But I have seen doctors and patients alike underestimate the power of these prescriptions. The result has been dreadful side effects, the rise of drug-resistant superbugs and preventable deaths and illnesses.

The only way to reverse course is for doctors to limit their prescriptions of antibiotics to the treatment of bacterial infections and for patients to use those antibiotics as directed.

If you have a cold, the flu, bronchitis or some other non-bacterial ailment, don’t demand an antibiotic. An antibiotic won’t help, and in the long run it might cause more harm than good. Instead, might I suggest a less aggressive, but far more effective, approach?

Get rest and drink plenty of fluids.

Philip Robinson is medical director of infection prevention, Hoag Memorial Hospital Presbyterian, Newport Beach, CA.

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