Dr. Jacqueline Gerhart: Make Proper Use Of Antibiotics
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that usually appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: I'm sick of my doctor not giving me antibiotics for a sinus infection over the phone. Can’t they hear that I'm congested and sick? Why do they make me suffer to travel to the office and pay a co-pay?
Dear Reader: I promise we aren't trying to make you suffer. I truly believe physicians want people to feel better. When we ask you to come in for an appointment, our goal is to determine if an antibiotic is needed. We aren't trying to charge you money needlessly - we are trying to assure we get the right diagnosis.
If you are given antibiotics to treat a bacterial infection and you actually have a viral infection, the antibiotics likely will not make a difference in the natural course of your illness. The trouble is that viral infections and bacterial infections often are very difficult to distinguish from each other at the onset of illness.
The common cold, for example, can cause sinus symptoms and congestion, but it doesn't require antibiotics because it is caused by a virus. The common cold is contagious in the first three days, but the symptoms may take five to 10 days to "peak" and start to fall.
The trouble is that five to 10 days is a long time to wait. By that point, you may have called your physician's office or gone to the urgent care requesting antibiotics.
Why do people have the expectation for antibiotics? Well, simply, we hate feeling sick and want to fix it. There are more than one billion colds in the U.S. each year. They are the most common reason that children miss school or stay home from day care. They also cause a significant economic impact due lost productivity and sick days.
And while patients often have strong expectations for antibiotics, we physicians are making the problem worse. In 2012, Time magazine published an article entitled "Why Doctors Uselessly Prescribe Antibiotics for the Common Cold." It described how physicians commonly prescribe antibiotics for illnesses that are more likely caused by viruses.
"So, why do doctors write the prescription?" the article asks. "Most do it out of habit or to make their patients happy. It takes time for the doctor to explain why antibiotics won't do any good." And in our health care system, we don't have much time per patient.
In short, many doctors feel it's easier and faster to give an antibiotic. The result is that about half of the 100 million prescriptions written for antibiotics each year are for respiratory ailments that aren't going to be helped by a drug. And inappropriate antibiotic prescriptions can actually harm patients. More than 140,000 people each year - many of them young children - have a serious reaction to an antibiotic, and 9,000 of those must be hospitalized.
That's why knowing when you do not need an antibiotic is as important as recognizing when you do. And to figure this out, we need a complete history and a physical exam. So, while it may be annoying to visit your physician - and perhaps pay a co-pay - we truly want to diagnose and treat you correctly.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 05/01/2013