More harm than good
GRAND FORKS, N.D. -- As cold and influenza season settles in, public health officials are urging people to avoid unnecessary antibiotics. Dr. Joel Walz, the health officer of Grand Forks Public Health and a family practice physician with Altru He...
GRAND FORKS, N.D. - As cold and influenza season settles in, public health officials are urging people to avoid unnecessary antibiotics.
Dr. Joel Walz, the health officer of Grand Forks Public Health and a family practice physician with Altru Health System, said misuse of antibiotics is a national, possibly global health issue with both individual and societal effects. In that latter category, Walz said health observers are increasingly concerned with antibiotic-resistant bacteria, a resilient group popularly referred to as "superbugs."
Research suggests improper use of antibiotics - such as taking medication when not needed, using incorrect dosages or halting antibiotic treatment regimens before completing a full course of medication as prescribed by a doctor - can give fast-reproducing bacteria a clear window to develop adaptations to ward off future doses.
"As (resistant bacteria) extends and you share organisms with the people you live with, it creates challenges to treat infections as you get them," Walz said. "People are dying from resistant infections more and more."
Unnecessary antibiotic use also can be needlessly taxing on individual body systems. Walz said the drugs can kill off the body's natural bacteria, particularly those that inhabit the human gut and play a role in various health aspects.
Disrupting the tiny ecosystems inside us can create openings for bacterial inhabitants of a more malevolent nature, Walz said. The most common side effect of that is a nasty case of diarrhea.
Bacteria aside, antibiotics can prompt a strong allergic reaction in susceptible individuals. Walz said allergies to the medications aren't common, but he said the reactions are some of the strongest he's seen and represent a substantial portion of emergency room visits related to drug allergies.
"I've seen some really bad ones, and it's no fun to get a serious drug reaction," he said.
Faye Salzer, head of the antibiotics stewardship program for the North Dakota Department of Health's Division of Disease Control, said antibiotics often are misprescribed for viruses such as the common cold, flu and bronchitis. Because antibiotics are intended to kill bacteria, Salzer said the drugs can have no positive effect when used for viral illnesses.
Part of the wider issue of misuse comes from a lack of understanding among patients that antibiotics aren't a cure-all.
"It's human nature," Salzer said, "when we're sick, we go to the doctor and want them to give us medication to make us feel better, faster."
However, she said, with certain illnesses, that's not a realistic expectation. Some kinds of sickness must be allowed to run their course. At the same time, Walz said there's a gray area for doctors considering a prescription, especially for conditions such as sinus infections, which are bacterial in nature but bear similar symptoms to the viral cold.
"It's not as simple as saying, 'You've had a cold for a week, is this now a point where antibiotics might be helpful?'" Walz said.
Even when doctors do make the decision not to prescribe the drugs, he said it can be difficult actually convincing patients they don't need them. As a result, Walz said many might go to walk-in clinics or urgent care facilities to seek antibiotics there.
Moving forward, he said Altru is implementing a system to track the number of prescriptions written for antibiotics by employees in the system's various health care facilities. Though there would be no punitive measures for doctors prescribing above the average level, Walz said it was important to bring physicians into the educational process of how to prescribe appropriately.
"There are good guidelines, but at the end of the day, it's easy to say, 'You can have the prescription,' rather than have that extra conversation," Walz said. "People have gotten so used to this being how it's worked for so many years, so it's on both sides now. It's not going to be easy, but we have to have some other discussions."