Hylton I Lightman MD DCH(SA) FAAP

My colleagues will concur – Overusing antibiotics must be avoided.  This article was published on November 7, 2019. The November 14th edition of the Wall Street Journal’s article on superbugs echoed some of the points.  I am pleased to share both with you.  

According to the Centers for Disease Control and Prevention (CDC), at least 30% of antibiotics in this country are overprescribed and are unnecessary.  Why?  

Antibiotics are wonderfully important, especially when necessary.  The world should express gratitude posthumously to Sir Alexander Fleming (1881-1955) for his inventing the world’s first antibiotic substance benzylpenicillin (Penicillin G) from the mold called Pencillium notatum in 1928.  Sir Fleming was awarded the Nobel Prize in 1945 which he shared with two colleagues.  

Another posthumous thank you is owed to Dr. Selman Waksman (1888-1973), who emigrated to the United States in 1910 from the Ukraine and received his Ph.D. in biochemistry in 1918 from the University of California.  Dr. Waksman discovered streptomycim, the first antibiotic that was effective against tuberculosis. In 1952, he was awarded the Nobel Prize in physiology.  

These men and many other microbiologists and other health care professionals revolutionized health care for the better through their research and medicine.  

Imagine a world, G-d forbid, where there are no antibiotics.  This would mean, for example, that there would be no treatment for strep throat.  Strep throat, which is more common in children and teenagers (especially ages 5-15) than adults, is an infection in the throat and tonsils caused by bacteria called group A Streptococcus (Group A strep).  Group A strep live in the nose and throat and can spread to other people through coughing and sneezing.  Strep throat does not always present with sick symptoms. Left untreated, it can cause kidney inflammation or rheumatic fever which can weaken the heart.  

And yet, not every sore throat is a strep throat.  Sometimes, a sore throat is…just a sore throat. There is pain, a scratchiness or irritation of the throat that often worsens when you swallow. The most common cause of a sore throat (pharyngitis) is a viral infection, such as a cold or the flu. A sore throat caused by a virus resolves on its own.  You read this correctly – It resolves on its own. This means there is no medicine to make it go away, although Mommy’s chicken soup helps. For real. In addition to the ingredient known as “love” and never to be underestimated, the liquid and vegetables (which are also high in liquids) causes one to urinate.  Staying properly hydrated and flushing out the system is important every day, and especially when feeling unwell.  

Let’s now talk about another malady for which people believe antibiotics are the cure all — ear infections.  Children are more prone than adults to ear infections. Unfortunately, they can be uncomfortable and even painful.  Yet not all ear infections require antibiotics. Seriously. It is important that a physician or experienced health care provider look in the ears to diagnose correctly whether there is an infection and, if there is an infection, whether it requires antibiotics.  

Believe your doctor when he tells you that antibiotics are not at that moment warranted and you should wait it out.  G-d has miraculously created the human body so it can often heal itself. Introducing antibiotics when not needed can disturb the cosmos order of the human body and not allow the body to develop its own antibodies which is a necessary part of life.  Antibodies are produced by white cells that have a memory to the foreign antigen (bacteria or virus). These antibodies attack the bacteria.  

Experienced parents are familiar with this scenario.  Nonetheless, some will beg for antibiotics even when both the rapid strep test and the overnight throat culture are negative or the ear infection is one which should be waited out (with the help of Tylenol and Motrin).  Your child may be getting the strep throat. Notice the verb tense – getting.  Sometimes, it takes time to emerge and I respect a parent, especially a mother who is asking for the antibiotics at this point, because she will know her child best.  But to give antibiotics without proof of infection is not good medicine.  

Plenty of people go to urgent care or PAs in their homes for throat cultures or to have their children’s ears looked at.  Sometimes, I even get a report (which is legally mandated, by the way). So often, the report will state that the tests were negative.  Scroll down a drop further and it will state that Amoxicillin or something similar was prescribed. 

Huh?  If a test is negative, then there should be no antibiotics.  Period.  

You, my dear reader, might be scratching your head right now, wondering why physicians are against gratuitous prescriptions.  The answer is simple – because unwarranted antibiotics can cause more harm than good.  

Let’s say you become sick with a gastroenteritis, a stomach flu.  Antibiotics are not going to get you better. Yet if you take them, you will make your body and germ bacteria (which abound in each of us) drug-resistant to antibiotics.  Antibiotic resistance is a problem in today’s world. When you really need antibiotics, they may not work to eliminate the harmful bacteria.  

If the antibiotics do not work when needed you could be looking at more aggressive intervention.  This will take a toll on the body. There may be more expensive medications, increased health care bills and hospital stays.  There could be multiple office visits to your primary care provider and/or specialists to find the correct antibiotics. Because of the overuse of antibiotics, the field of infectious diseases is challenged to finding appropriate antibiotics.  

There are medicines today for bacterial infections that not so long ago prevented the spread of disease and even reduced serious complications.  Unfortunately, overprescribing them has led to resistant bacteria to pneumococcal infections like pneumonia, meningitis, MRSA or Methicillin-resistant Staphylococcus aureus, and tuberculosis, to cite a few examples.  

It is becomingly increasingly less uncommon that when there has been an over usage or misusage of antibiotics, there are abnormal bacteria that proliferate in the gastrointestinal tract.  The “good” bacteria are killed by antibiotics. C-difficile, which not so long ago was a sickness found in nursing homes and hospital acquired infections, is becoming prevalent in the general population.  

The havoc that it wreaks on a person’s bowels and their frequent trips to the bathroom are far from pleasant.  The antibiotics for this are difficult to administer to a child. Fecal transplants, which are needed to reset healthy gut flora, are becoming growing in number.  

Further, studies from Israel show that the earlier the introduction of antibiotics to an infant or child, the greater the chance of their becoming obese when older.  Why? Because overusing and/or misusing antibiotics changes the gut flora.  

Then there are superbugs.  You read it correctly. Carbapenem-resistant Enterobacteriaceae (CRE) are part of a group of germs that live in the intestines of some people. They’re related to E. coli, which are normal to have in your intestine and stool.  The difference is these germs mutate and become resistant to antibiotics. Some CRE are resistant to so many medications that they are untreatable and, unfortunately, up to half of patients infected may die.  This is troublesome because carbapenems used to be one of the only antibiotics that could successfully treat another Enterobacter “superbugs.” 

Yes, I am scaring you with facts.  

When partnering with your doctor, trust him when he says to wait out something or to return in several days for a recheck.  This might cost you another copay (which is part of your insurance plan, not something “extra” for the doctor) and I respect that costs add up.  But working with your doctor smartly can save you problems down the road and on the other end. Everybody wants the best for you and your family.  

As always, daven.

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