Vail Dear Doc column: A tale of bugs and drugs
September 24, 2012
Please tell me why sometimes when I go to see my doctor I get an antibiotic, others I don’t. I know when I’m sick and when I need something so why is it always different?
– Why can’t I just get what I want?
Your question is often the toughest one physicians face and the answer often the most difficult. Patients often come to see a doctor with well-established expectations. At the same time your doctor wants to provide not only the best care, but to satisfy your needs. The difficulty arises when those two do not match. The appropriate use of antibiotics is often at the center of such decisions. The true solution is to become a better-educated patient.
When something invades our bodies that shouldn’t be there, then grows and reproduces causing illness, we have an infection. That infection is either a virus or bacteria (fungal infections are another story!). In simple terms, they are germs. Bacteria are more likely to cause serious complications and serious illness and commonly require antibiotics or anti-bacterial drugs. Viruses are more common and most are treated by our immune systems and resolve completely. Some viruses however cause serious illness, which our bodies struggle to eliminate. The most common of these are Human Immunodeficiency Virus (HIV), Hepatitis B and Hepatitis C. More rare viruses can be very dangerous, such as Ebola virus and SARS (severe acute respiratory syndrome virus). Other viruses can infect us, become dormant and then resurface years later. The best known of these viruses is varicella or chicken pox, which returns as shingles.
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Antibiotics do not work for viruses, although it can seem like they do. If you have a virus and take an antibiotic you will likely feel better in a few days only because your body is fighting off the virus on its own. There are some anti viral drugs for some of these viruses, but they don’t work as effectively as antibiotics do for bacterial infections. Like bacteria, viruses also have the ability to become resistant to anti viral drugs and so it is important to use them only when needed and medically indicated.
The problem for doctors is that viruses and bacteria can cause virtually identical symptoms. There are a few tests that tell them apart, such as a throat culture or a rapid influenza test, but generally the diagnosis is made by the history of the illness and a patient examination in the office. The difficulty for patients is that viruses can take days or (rarely) weeks to recover from and it can be hard to wait that long. What we should all be most concerned about is the very serious problem of increasing antibiotic resistant bacteria.
If you have a bacterial infection, it is a war between the antibiotic (working with your body’s immune system) and the bacteria. Unfortunately the bacteria often win and become resistant to our antibiotics. This rarely happens when we treat a true bacterial infection, and antibiotics are taken as directed for their full duration, but happens much more commonly when we take an antibiotic for a virus. In that case, the harmless bacteria in our system try to fight the antibiotic and become resistant. If those bacteria become invasive or infect someone else, they are now much harder to treat. This is even worse if you are given an antibiotic for a true bacterial infection but either do not take it all or share it with a friend. Then the weak bacteria are killed, leaving not enough antibiotics to kill the stronger bacteria, which become resistant to that antibiotic the next time it is used. While it is not surprising many bacteria can be resistant to our older antibiotics, even newer antibiotics have resistant bacteria.
The next time you see your doctor for an infection, think twice before taking an antibiotic. Remember, it’s the bacteria that are resistant, not you. Finally, if you need an antibiotic, take all of it as prescribed and don’t share with a friend, even if you are feeling better.
A final thought is that the flu is coming and flu shots are available at your doctor’s office, local pharmacies and through Eagle County Public Health.
Dr. Drew Werner is a medical staff leader at Valley View Hospital in Glenwood Springs, a family physician at TotalHealth Care and the Eagle County health officer. He lives in Eagle with his family. Email comments about this column to email@example.com.