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Frivolous Use of Antibiotics Can Be Dangerous

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November 10, 2000
Frivolous Use of Antibiotics Can Be Dangerous

the letter During the winter season, doctors are inundated with patients demanding antibiotic therapy for their upper respiratory infections. It's no wonder why -- an irritating bronchial cough and sinus pain seem to demand some kind of medical treatment. But that cough and sinus congestion are symptoms of upper respiratory infections that are typically caused by viruses. Antibiotics, which are designed to combat bacteria, are ineffective against viral infections.

Roughly speaking, infections are caused by three different agents: viruses, bacteria, and fungi:

  • Examples of viral infections include the flu (influenza), the common cold (arena viruses), and AIDS; typically, they are difficult to treat and often outsmart antiviral agents by mutating their genetic makeup.
  • Bacterial infections include strep throat, most bladder infections, and ear infections in children. Most bacteria are effectively killed by antibiotics like penicillin and sulfa, but the incidence of resistant bacteria is on the rise.
  • Fungal infections include skin rashes like athlete's foot and a type of meningitis called cryptococcal meningitis; although often difficult to eradicate, most fungal infections can be treated effectively with prolonged use of antifungal agents. Unfortunately, these agents can have negative side effects.

I'll never forget the time I saw a young nurse in the busy urgent care clinic where I worked. She came in with a bad cold and said, "I get it every year, Kevin. All I need is seven days of erythromycin. I went to see Dr. Dickey a week ago and he refused to prescribe antibiotics."

I knew exactly what was going on here. The nurse had a viral syndrome that would run its course (some last weeks and even months), and Dr. Dickey knew that antibiotic therapy would not be effective. I tried to explain to the nurse, who was a bright and educated person, why erythromycin would not work. I was incredulous that she would not listen, especially given her medical background. She argued for the erythromycin. I looked at my watch, considered the 20 or so patients in the waiting room, and wrote the prescription for erythromycin.

Occasionally, a doctor will prescribe antibiotics for a patient with a viral infection, but only when a secondary bacterial infection has taken hold of the patient's lowered immune system and a friendly mucous environment in which to grow. In the case of the young nurse, however, I regretted my hurried prescription because I realized that she would not benefit from the medication. Moreover, the overuse of antibiotics can cause several ill effects in our battle against even everyday bacteria.

Antibiotics are not harmless

Antibiotics are not benign medications. They can be highly toxic and even deadly, and they should be used only when absolutely necessary. Here are some of the potential adverse effects of antibiotic therapy:

  • Allergic reactions. Many people wrongly believe they are allergic to penicillin because it gives them an upset stomach; in fact, a true allergy is totally different. I once saw a patient develop a severe reaction to sulfa. Her entire skin blistered and sloughed off, and her vital organs shut down. She was taking the antibiotic for a simple bladder infection and yet she died within four days.
  • Alteration of normal bacterial flora. Broad-spectrum antibiotics kill bacteria, which normally live in the intestines and in the vagina. Alteration of the flora in the gastrointestinal system during antibiotic administration can cause minor bouts of diarrhea. More-severe alteration of the flora can even lead to life-threatening colitis, a severe inflammation of the colon. I have seen young patients require surgery because of colitis, after which they required a colostomy bag. Along these same lines, antibiotics alter the normal vaginal flora and often bring about vaginal yeast (a type of fungus) infections. When you kill the "good" bacteria with antibiotics, yeast -- which is part of the normal flora -- can take over because antibiotics do not kill it. Many women patients will tell their doctors that they need vaginal yeast medication before they will even take an antibiotic. Antibiotics can also bring about fungal skin infections for the same reasons.
  • Creation of a superior strain of bacteria. Bacteria often become resistant when they are repeatedly exposed to antibiotics -- the genetic makeup of the bacteria changes, making infections extremely difficult to treat. Many doctors consider first-line antibiotics, like penicillin and amoxicillin, to be no less dangerous than candy. But we know better, or at least we should. Most have heard of super-resistant staph infections; well, these infections have been brought about in large part by the repeated unnecessary use of antibiotics. When I prescribed erythromycin to that nurse, I committed an error of judgment.
  • Interference with other medications. Antibiotics often alter the way other drugs are metabolized. I later learned that the nurse to whom I prescribed the erythromycin was also taking birth control pills. It is well documented that erythromycin can make birth control pills less effective. It is possible the nurse could have become pregnant due to the interference of the antibiotic.

I saw that young nurse a week later in the emergency room. "You're a great doctor, Kevin!" she said. "That erythromycin definitely did the trick. Thank you so much." She did not accept that the viral infection had simply run its course and that the antibiotics had nothing to do with it. I knew that she would probably make the same request a year later when flu season rolled around. I also knew that next year, I would refuse.

 J. Kevin Shushtari, M.D., is's Chief Medical Officer and a co-founder of the company. He is also a board-certified internist with a medical degree from Dartmouth College. In Dr. Kevin's Column he will share his own experiences as a physician, a family member, and a patient.