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Dr Duncan

Antibiotics - when might is not always right!

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It’s that time of year again when walking down the street or through a busy supermarket, you hear someone coughing profusely and looking dreadful. Or you yourself are feeling dreadful and have a hacking cough, but you “can’t afford the time off work” so you battle through whilst everyone in the office is giving you dark looks! It’s also a time when literally tens of thousands of people queue up at the doctor’s surgery - along with other fellow hackers and coughers - to get something to “fix it”. In far too many cases they walk away with a prescription in hand for the infamous “strong antibiotic”!

The problem with the whole idea of a “strong” antibiotic is that it suggests that there are “weak” ones out there ... and which poor individuals get that one? Or, over the years I’ve heard patients say to me that their friend in the office got a “really strong” antibiotic and could they have that one please! So at this time of year when the influenza virus  is at its most prevalent, here’s some information:

A recent study in the US (which is not unlike us when it comes to prescribing habits) recently showed that US doctors chose the most powerful broad-spectrum antibiotics in more than 60% of cases and that at least in 25% of cases these antibiotics were “useless” because the infection was viral in origin. I In children even when antibiotics were indicated for a bacterial sore throat, many doctors chose the so called “strong”, broad-spectrum antibiotics instead of the more narrow range ones that were more specific for that particular bacteria.

Now here in Perth in August/September there are lots of viruses in the community - colds as well as influenza - and they take time to run their course. A cold will take 5 to 7 days and mainly affects just the nose and the head, and the more serious influenza that affects the whole system, makes you feel totally dreadful and can take 10 to 14 days to runs its full course.  This will account for at least 60 to 70% of seasonal infections seen at the doctors surgeries and Emergency Departments too: and antibiotics will not have the slightest affect on a virus at all!

With influenza, because it’s a more generalized condition, the inflammation caused by the virus can irritate the tubes inside the lungs leading to viral bronchitis. This will cause the sufferer to cough profusely - it can be a dry hacking cough or a really juicy productive cough - and the temptation is for both doctor and patient to take some action “to be on the safe side”, and give a strong antibiotic for it ... just in case!

WRONG!

My suggestion for everyone - including those who might be at high risk of having a bacterial lung infection and  would include those with chronic bronchitis, cystic fibrosis, asthma and all chronic lung conditions - is, first of all to get an annual flu shot.  If you do get an infection that you think you might require an antibiotic, then go along to the doctor armed with a sample of your sputum so that it can be sent off for testing to see if there are actually any bacteria present in it!

And this is how you get a sputum sample:

1. Send someone to the local pathology collection site or friendly pharmacy, to get a couple of sterile sputum pots (it’s always best to get a few as you might just produce saliva the first time).
2. Try and get a proper sample of sputum from your chest and not your mouth or sinuses by: 
 Clearing your throat first and spit out any excess saliva.
 Rinse your mouth with water and spit out.
 Now take three deep, slow breaths and cough any sputum into the sterile collection pot - this expectorant will more than likely have actually come up from your lungs and is what you really want tested.
3. Take this along with you to the doctor as fresh as you can, as bacteria like living inside your body and not in a plastic jar. Then your doctor can send this off to be properly tested for any bacteria and determine which antibiotic is appropriate to use to kill it off.

This is targeted medicine and not the “blunderbuss” approach of the “strong”, broad-spectrum antibiotic which will always cause collateral damage to friendly bacteria in our bodies and lead to greater chances of resistance too. The sputum results are nearly always back within 24 to 48 hours which is very short in the course of most infections. Those at higher risk should always seek early medical advice and take a sample with them where possible.

If everyone were to follow this plan then the inappropriate usage of antibiotics would be greatly reduced, the dangers caused by antibiotic resistant infections would be blunted and the savings to the community would be in the millions of dollars. And guess what? Your body’s brilliant immune system will be able to deal with the vast majority of those winter viral infections anyway. 
As my beloved mother-in-law used to say “all you need is a little patience”!

Article written by Dr. Duncan Jefferson. More articles here. For more information on health care and private health cover, visit HBF Insurance at www.hbf.com.au.

The content of these articles is not tailored for any particular individual's circumstances. The author does not take into account your physical condition, medical history or any medication you may be taking. Any advice or information provided by the author cannot replace the advice of your health care professional. The views expressed in this article are those of the author and do not represent those of HBF unless clearly indicated.

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